In this article we will cover what a Ketogenic diet is and if you can manage your diabetes while on this diet.
Ketogenic diet for diabetics is a highly controversial topic, but we will break down everything here for you! As a Certified Diabetes Educator (CDE), I have to tell you from the start I will have a biased view here. Sorry, but I feel that I need to be completely honest right up front! I will however, present all the evidence that is available currently on the subject.
As a CDE, I have been taught to follow the American Diabetes Association Dietary Guidelines for Americans which is low in carbohydrates, high in fiber, with fresh vegetables, fruits and whole grains.
The Ketogenic Diet this article will be discussing is much lower in carbohydrates, in order to promote the state of nutritional ketosis, or the fat burning state for weight loss.
What is a Ketogenic Diet?
The Ketogenic Diet is a low carbohydrate diet, consisting initially of less than 20 carbohydrates per day. Not per meal, yes, you heard me correctly, per day. It is not for the faint of heart and yes I am writing from experience. Of course I have tried it! Hasn’t everybody in America at some point who has wanted to lose weight? Does it work you ask? Of course it does! The problem is how long can you keep it up?
Your body uses the carbohydrates you eat for energy, so if we restrict how many carbohydrates we eat, the body has to get its fuel source from fat. A byproduct of this fat burning state are ketones which are produced; this is called nutritional ketosis. You can determine if you are in this fat burning state by purchasing urine ketone testing strips from your local pharmacy.
The Ketogenic Diet with Diabetes
Some precautions must be made clear;
- this diet is not appropriate for people with any stage of kidney disease.
- this diet is not for people who are pregnant, nursing or who have Gestational Diabetes.
There are also other considerations such as the possibility that you may need to rapidly change your medications while on this diet. If you are considering the Ketogenic Diet, I urge you to first speak with your physician or endocrinologist to develop a plan.
Since you will be drastically reducing the amount of carbohydrates you are consuming, that may require a medication adjustment. Then, once you begin to lose weight, you may require medication adjustments.
What to eat and what not to eat in a ketogenic diet
For starters, forget about eating anything white essentially on the Ketogenic Diet. No more potatoes, bread, rice, pasta, cake, pies or sweets.
You can eat any meat (without coating on it like fried chicken), fish or poultry, soft, full fat cheese, eggs, salad and no starch vegetables, olives, half of an avocado, butter, oils, and certain sugar free foods and drinks.
When Steve contacted TheDiabetesCouncil, he wanted to know where to find information on meal plans for the Ketogenic Diet. There are many resources online where you can search for meal plans for the Ketogenic Diet. There are also many books you can purchase at your local bookstore. The Atkins Diet is the most well- known Ketogenic Diet in its Induction Phase which is the first 2 weeks in this diet.
I must tell you when looking at this link they say the American Diabetes Association Guidelines call for 60-75 carbohydrates per meal and that is simply not true. The ADA has recommended since 2013 we use our best clinical judgement in recommending a low carbohydrate diet for people with diabetes, recognizing it needs to be individualized. 60-75 grams is the carbohydrate amount I would give to a very tall, large boned man or perhaps an active teen or young adult. I would never recommend that many carbohydrates for an average size man who was trying to lose weight; he would get 45-60 grams of carbohydrates per meal and 15-30 grams for snacks. A women trying to lose weight would get 30-45 grams of carbohydrates per meal and 15 grams for snacks.
Can a Ketogenic Meal Plan Be Used to Prevent Diabetes?
Obviously, if you could keep the weight off, it may help in preventing diabetes. There are many risk factors for diabetes, but the Diabetes Prevention Program in 2002 followed 1,079 people with prediabetes. This groundbreaking study showed that 58% were able to prevent the progression of developing diabetes through diet and exercise. Want to know what the great news is? They didn’t have to eat 20 carbohydrates per day to achieve this!
For more diabetes dietary advice read the following:
Can a ketogenic diet reverse diabetes?
I can’t tell you how often through the years I have been asked the question, “If I lose 20 pounds, will I no longer have diabetes?” Let me answer this very clearly, there is currently no cure for diabetes. Once you have been diagnosed, you have it for life. Every day, our most brilliant researchers are busy searching for a cure though. There is good news however; you can manage your diabetes, get it under control, prevent all the complications of diabetes and live a normal, healthy life.
Is the Ketogenic Diet Safe For Women With Gestational Diabetes?
If you are pregnant or are nursing, you should not follow a Ketogenic diet. You will not receive enough of the recommended carbohydrates, vitamins and nutrients necessary for yourself and your growing baby on this diet. Your obstetrician will recommend how many carbohydrates you should consume per meal and for snacks during each phase of your pregnancy. They will likely refer you to a Certified Diabetes Educator for nutritional counseling as well. Please check out The Diabetes Council’s FAQ’ About Gestational Diabetes for all your gestational diabetes related questions.
Whether you have gestational diabetes, or pre-existing Type 1 or Type 2 Diabetes and have now become pregnant, all the same rules still apply when it comes to dietary guidelines. Carbohydrate intake will be moderated, and you will need to consult your obstetrician to determine your individual recommendations.
When you are pregnant and/or nursing, you need a well-rounded diet with foods from all of the food groups; fruits, vegetables, proteins, breads, grains, and especially milk and other forms dairy for your daily intake of vitamins C and D. Vitamins C and D are essential to proper bone growth for your developing baby.
As a Certified Diabetes Educator, I was taught to educate my gestational diabetes and pregnant patients with diabetes to avoid fruits and dairy before noon. I know this is hard! That’s when you all are craving that glass of orange juice, but that’s the whole point here. We need you to give up that orange juice for the next six or so months for the sake of your baby. Instead, you can have a real orange with lunch; try it with a spinach salad with tuna salad and whole wheat pita. The nutritional value is pumped up by all those vitamins and the spike on your blood glucose will be reduced dramatically by the fiber in the real fruit combined with the protein you had in your lunch. You can even have a glass of milk; you’ve included all of your necessary food groups, and you are still only at 45 carbohydrates for the whole meal!
Can A Ketogenic Diet Cause Diabetes?
The good news here is no! All the evidence points to the fact that a low carbohydrate diet actually does lower blood glucose and A1c levels and does contribute to weight loss. The problem is we do not yet have enough large studies, over enough sustained years to support evidence that people with diabetes can remain on a highly restrictive Ketogenic Diet for the rest of their life and also not have other consequences to their health.
Firstly, I am highly skeptical that anyone can sustain such a restrictive diet long term without it having a negative impact somewhere else in their life. At some point, they will start stressing about what or what they are not eating. That stress is going to lead to many other harmful consequences to their bodies.
Secondly, I for one could not be happy knowing that I had to limit my diet so drastically from for the rest of my life. Let’s face it, our lives our built around our meals. My husband is texting me before noon each day asking what our dinner plans are each day.
One study from 2003 followed 132 participants; half on a low carbohydrate diet restricting them to less than 30 carbohydrates per day, the other half on a low fat diet. These participants were then followed up with after one year. It was found that 34% had dropped out, not being able to sustain such restrictive diets even for one year.
Now, I know what you are going to say, “I can take a break from the diet anytime.” What do you think happens when you take that “break”? As soon as you start consuming a normal amount of carbohydrates again, you immediately go out of ketosis or the fat burning state, and your body starts storing fat again immediately. In other words, you immediately start gaining weight. So whatever weight you lost on the diet, you gain back right away. How healthy do you think it is for your body to be in a starvation mode, then in a feeding frenzy, making up for lost time?
Thirdly, you cannot get all the nutrition you need from this diet. You need foods from all of the food groups for a healthy body. Now, I can already hear some of you arguing with me…the cavemen didn’t have access to fresh fruit. Nope, they sure didn’t and look how long they lived. What was their average lifespan?
Herein lies the problem. I believe the solution is moderation. Moderation in the number of carbohydrates you consume every day and in when you consume them.
Is it good or bad for people with Diabetes?
The short answer here is it definitely depends on the type of diabetes that you have, but the ketogenic diet does seem to have health benefits and consequences for all types of diabetes.
As I stated earlier, and forgive me if I am blunt, forget it if you are pregnant. Momma, you need your nutrition!
For people with Type 1 Diabetes, you probably have heard of their diabetic emergency, diabetic ketoacidosis, also referred to as DKA. This can be life threatening condition for people with Type 1 diabetes and Certified Diabetes Educators spend many hours teaching preventive care for DKA. This condition should not be confused with nutritional ketosis, the fat burning state reached when following the Ketogenic diet. The two conditions are quite different.
So, is the Ketogenic Diet safe for people with Type 1 Diabetes?
One study from 2005 followed 22 people with Type 1 Diabetes for 12 months. The difference here however is they consumed 70-90 grams of carbohydrates per day versus the restrictive less than 20 grams per day on the Ketogenic Diet. Remember my motto? Moderation is the key! The results were positive; less hypoglycemia, insulin requirements were reduced and their A1c dropped from 7.5% to 6.4%.
Does the Ketogenic Diet Benefit People With Diabetes?
The jury is still out on this important question! In my humble opinion, the limited research we have so far simply does not support that it does.
There have not been very many studies done and of these studies, the data is very limited or they have serious flaws.
Either there are very few participants in the studies, they don’t have an even number of males vs. females, or they don’t last but a few months. One study only looked at 28 people; only 21 completed the study and 20 of these participants were men. On top of this, they were only followed for 16 weeks. Okay, so we see that 20 men can limit their carbohydrates severely for 4 months and lose weight which automatically makes their A1c come down. Great! So, the real question is, how long can these 20 men stay on this diet for the rest of their lives? How long would you like to go without eating any fresh fruit? I’m craving some now, so I’m taking a break to go grab a snack now!
Ok, I feel better! Let’s finish this up!
In a study that was sponsored in part by the Atkins Foundation in 2004; 105 participants with Type 2 diabetes were followed for one year. Half followed a low carb diet (Atkins), the other half a low fat diet.
Ok, let’s break this down. So with this study you have a decent number of participants…I would love to see 1000, but 105 is certainly better than 20. Many ages, races and socioeconomic backgrounds were represented. There were a closer number of males versus females included in the study. Lastly, they were followed for a longer period of time, a full year.
The suspense is killing you isn’t it? No real differences in either A1c or weight loss in the two groups; in other words, they lost about the same amount of weight (3.4%) and no change in their A1c levels.
19% of the people had dropped out by the one year mark however, which again, supports my theory that over the lifespan, severely limiting your diet is unsustainable. And come on people, why would you even want to risk your health or mental well-being on something that science hasn’t even proven as beneficial?
Case in point, Steve Richert has Type 1 Diabetes and his September 1, 2015 blog The Ketogenic Diet and Type 1 Diabetes: What I Eat. He gave it the good old college try and has fearlessly came back and showed us all his results. His cholesterol increased, which just like mine, was due genetic factors, but was exacerbated by the Ketogenic Diet. So, what’s the best part of Steve’s story? He’s coming close to being right in line with what I would recommend for him! Moderation and the mediterranean diet; he’s currently trying a modified ketogenic diet or really a modified mediterranean diet. Brilliant and exactly what we all should be doing!
Some interesting stats
Insulin concentration before and after diets:
I’ve been there and have tried the Ketogenic Diet. It’s very difficult even though I am a very determined and goal oriented person. When I set my mind up to do something, I will normally achieve it because I am just so stubborn about personal goals that I don’t give up until I do! Yes, you will lose a lot of weight quickly, but I am not interested in giving up bread, pasta and birthday cake for the rest of my life.
The fact is, the stress that you will bring on yourself from constantly restricting every single thing you put in your mouth is far more detrimental to your health. Remember, moderation is the key! You can count your carbohydrates and follow a sensible low carbohydrate diet to control your blood glucose and your weight. Exercise will always be the key component to add that contributes to added weight loss.
My pick for the healthiest meal plan for diabetes? My favorite is the Mediterranean Diet. It’s high in fiber, low in saturated fats and includes no processed foods which is the challenge for all of us at this point in history. If we could all eat like they do in Italy and Greece! Think of Sicily and the coasts of Greece where their diet consists of fresh fish, fresh fruits and vegetables, nuts, beans, seeds, olives and olive oil, lean meats such as chicken and pork, some eggs and little red meat. The American Heart Association recommends it as well as the American Diabetes Association as being one healthy diet choice for people with diabetes.
Further reading:
My best advice, always consult your physician first regarding what type of diet you should be on! Then, team up with a Registered Dietician and/or a Certified Diabetes Educator to develop a meal plan with an individualized carbohydrate count for you.
Make sure to read what experts think about diabetes type 2 and ketogenic diet.
References
- http://www.diabetes.org/newsroom/press-releases/2016/2015-202-dietary-guidelines-to-promote-healthier-living.html
- http://care.diabetesjournals.org/content/36/11/3821.full
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1282458/
- https://www.ncbi.nlm.nih.gov/pubmed/15148064
- http://eatingacademy.com/nutrition/is-ketosis-dangerous
- https://www.ncbi.nlm.nih.gov/pubmed/16454166?access_num=16454166&link_type=MED&dopt=Abstract
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
- http://care.diabetesjournals.org/content/32/7/1147
- http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Mediterranean-Diet_UCM_306004_Article.jsp#
I have diabetes 2, and IBS lrrable bowl systrem. ..it bounces with the other. Helpn.addington
Having both Type 2 diabetes and IBS is very challenging when it comes to meal planning. Following a diet for diabetes, while trying to identify foods that may trigger your IBS will be your first course of action. Here’s a link that will help identify some of these trigger foods: https://www.verywell.com/ibs-and-diabetes-1945195
My best advice is if you haven’t started working with a Registered Dietitian (RD) yet, ask your physician for a referral. They will be a wealth of knowledge regarding meal planning for both of these disorders, especially if you see a RD, Certified Diabetes Educator.
Best of luck to you!
Well, lets see, here is my thought on the ketogenic diet…
1. No, you do not need to eat that much fat. The fat is only consumed to help you feel full. You do not NEED to literally eat 75% of your calories from fat.
2. No, the keto diet does not have to be tough on the kidneys. This is a MODERATE protein diet. My plate is mostly vegetables with some fatty meat.
3. I WAS on insulin when I started keto. I had just started long-acting insulin 2 months before keto. One month after keto I was off insulin.
4. Due to the whole food nature of the diet AND eating enough fat so I do not feel hungry I have FINALLY found a diet I can follow where I am NOT HUNGRY! My blood sugars are stable. I went from an average of 220 to 95.
5. With the keto diet I have lost 65 pounds in 8 months with no crazy exercise routine. I am staying with the diet because I no longer suffer from high blood sugar, dry mouth, and just feeling like crap!
6. I do miss some foods like milk, popcorn, and chocolate; HOWEVER NOTHING TASTES AS GOOD AS MY HEALTH!!!
7. I should mention ALL my health markers have DRASTICALLY improved including cholesterol and inflammation markers? My fatty liver is resolving and my cardio markers are perfect! The study where you cited there were not significant changed in diabetes markers in two months, well it takes longer! Check it out at 6 and 8 months. Most people will show a VERY different story than what you are reporting!
8. I tried for YEARS (20+) to lose weight as recommended by the FDA, doctors, and the ADA, BUT guess what? It NEVER worked! I ALWAYS got hungry again and could not stay on the diet. Keto has literally saved my life!
You and my daughter may be registered dietitians but I will tell you that you are killing people with your advice. Truly, you are!
Here are some other studies you might want to read:
http://obesity.imedpub.com/benefits-of-ketogenic-diet-for-management-of-type-two-diabetes-a-review.php?aid=14629
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329646/
http://www.fasebj.org/content/30/1_Supplement/1161.7.short
http://www.mdpi.com/2072-6643/8/8/486/htm
http://drc.bmj.com/content/5/1/e000354
I, too, am finding the keto diet to be beneficial. My weight is moving down. My recent A1c was 5.7. I am consistently below 90 each morning when I check my blood. I am learning to adapt my cooking to the needs of maintaining this way of eating. I have incorporated walking because now I FEEL like it. I don’t feel deprived. I feel empowered. No medications for diabetes!
I started on the Keto diet as a last resort. Almost 2 years later, I’m down 80+ pounds and my levels are perfect! No more uncomfortable hunger and cravings, and no more brain fog. I haven’t used my inhaler in almost 2 years. I don’t catch colds or even suffer from seasonal allergies. This is amazing.
You are absolutely right, if your colesterol or triglycerides climb up you have to watch out what fats are you eating, prefer coconut oil of good quality, avocados, olives, good quality butter, all sources of good omega 3 and try to low the omega 6 fatty acids sources that increase your bad colesterol.
also try to avoid stress that increase the cortisol that increase bad colesterol and triglycerides
And what benefit you will have with “moderate” diets that let you eat bread and others carbohydrates but high insulin ? remember that it is critical to not only look after glucose levels on blood, it is very very important to reduce your intake of insulin to avoid a lot of diseases including metabolic syndrome for high insulin and insulin resistance.
moderation sometimes can kill you
If Doctor’s recommend Keto to their patients that less drugs and no kick back from pharmaceutical companies, they need to keep people medicated because pharmaceuticals run this entire country. I followed a strict diabetic diet when my husband was diagnosed with Type 2 NEVER could keep his blood sugars under control still would be 220 after a meal.. Keto has brought that down to 95-98 AFTER a meal.
Bingo!! It’s all about the $. The info graphic at the very beginning is labeled Keto-Paleo. And is misleading. Contrary to popular belief the Paleo diet is plant based. It restricts carbohydrate and dairy consumption based on foods that cause an inflammatory response in the body. Keto restricts foods that cause a blood sugar spike two very different purposes. American nutrition is very obviously broken and any recommendation tied to a money making association should be taken with a grain of salt because you can bet there are $$ strings attached. Usually big Pharma funding.
I have patients that have lost tons of weight on keto. They do go off some meds. I also have people who eat a moderate amount of good carbohydrates, and they have lost tons of weight, and been taken off meds, had improved markers, even reversal. I think both approaches work, as I have seen in practice. Many people cannot stay on a keto diet forever. I for one, prefer to have some carbohydrates. I try to pick the right ones. If this works for you, then just be sure to have some medical supervision, which it sounds as though you are doing.
Where is the science? And if insolin intolerance is a diabetic problem why keep trying to regulate insolin? The stuff isn’t working because your patients are not getting better just deteriorating slower while you make more money keeping them on drugs!!!!! Your hole point is ketosis is bad cause they don’t have to see you after they adjust off the medication that keeps them having to see people like you!!! I have been eating keto for 6 months and feel amazing!!! These people are twisting the truth to keep you sick for there own pockets!!!!!!
Two years in and I am this exact same story. I do agree that if one is not insulin resistant or diabetic and has normal insulin response there are other less restrictive diets that will work. I would also add that people fail and drop out of almost EVERY diet program for one reason or another so that argument is null and void. I am under a doctor’s care and am healthier than I have been in years. My only dietary “sin” is artificial sweeteners and I am not looking back! I have not cheated at all on high carb foods and am rarely even tempted. It is doable if your motivation is there and you have support which is true for any kind of life altering decision.
Michelle, you are a goddess! What the hell is wrong with these people? I can only hope that the people who read this crap article read the comments below, where people with actual experience as patients of diabetes who have healed themselves with keto, speak some actual truth.
You would be surprised how many people do read the comments. I wouldn’t say the article is crap. You are excited about keto because you have heard about it yesterday, or last week, or last month or last year or 2 years ago or 5 years ago or may be you were born in 20’s-30’s when it all started but I doubt you were born in 20’s-30’s because your language would differ a lot.
I can delete this article with a click of a button but I shall not do that, what Tammy has written is based on her experience of years and years of work with patients and in the field. It doesn’t mean she is right or wrong.
I believe keto is good, but I wouldn’t sell my house for keto or any diet for that matter
I wouldn’t sell my house for ADA guidelines either.
The issue is that common sense is not so very common these days. It used to be a part of growing human neocortex in the past but for past 17 years since the exposure of internet our neocortex has taken a left turn in regards with common sense.
I think that the experts don’t want to admit that they have been wrong all this time, They all screamed low fat/high carb which is a miserable, unsatisfying way to eat. Who wants to eat a potato with plain yogurt? Gross! She mentions that you are missing out on vital nutrients, but where is the mention that you are giving up things your body needs when you limit fats too? Keto is the only way to eat where you feel satisfied. I would eat cereal and be starving an hour later. How is that helpful? I can eat bacon and eggs (no toast), and be perfectly content for hours. It takes more food preparation, but I truly believe now that bread (whole grain or not) is the enemy of man.
You are so biased against Keto, this can be noticed very quickly because almost every positive thing you say about Keto, you immediately follow with a “but…” negative statement. And most of your negatives are simply saying it’s hard to maintain. You completely exaggerate the negatives “If you have one bad day and your body is kicked out of Ketosis, you immediately gain all of your weight back”. That is simply not true; if someone is on a Keto diet for 3 months, they will not gain that weight back in a day. Also, their body will be back into Ketosis the next morning. You say that the ADA doesn’t recommend 60-70 grams per meal, but it does (coincidentally I just left their website before coming here). I don’t claim to be a Diabetes expert; I admit that. But your bias is leaning heavily against Keto. “Moderation” is not your goal if you have diabetes. When you compare HbA1C levels, for example, you compare them with someone in Keto at less than 20 g of Carbs per day as compared to someone at a 70-90 gram of carbs per day diet. You should be fair and compare them with someone on a 200 g of Carbs diet. If you want to get rid of the effects of Diabetes, get on a Keto Diet, period. It MAY get rid of the effects completely, but in the very least it WILL reduce your Insulin needs to very low and you’ll have little-to-no side effects other than a relatively restrictive diet (most diets are WAY more restrictive than Keto). You back up everything with “science” and misleading numbers/arguments without providing any real evidence.
Hi Edward,
As a Certified Diabetes Educator, we have been recommending the same amount of carbohydrates for our patients with diabetes for years with tremendous results. This part of my article explains the ADA recommendation regarding their nutrition guidelines and what every Certified Diabetes Educator I’ve ever met recommend to their patients:
I must tell you when looking at this link they say the American Diabetes Association Guidelines call for 60-75 carbohydrates per meal and that is simply not true. The ADA has recommended since 2013 we use our best clinical judgement in recommending a low carbohydrate diet for people with diabetes, recognizing it needs to be individualized. 60-75 grams is the carbohydrate amount I would give to a very tall, large boned man or perhaps an active teen or young adult. I would never recommend that many carbohydrates for an average size man who was trying to lose weight; he would get 45-60 grams of carbohydrates per meal and 15-30 grams for snacks. A women trying to lose weight would get 30-45 grams of carbohydrates per meal and 15 grams for snacks.
As CDE’s, we individualize our recommendations for each of our patients. One person’s diet may not be appropriate for another person. For example, a six foot 6 inch tall man weighing 220 lbs of mainly muscle, who exercises 2 hours per day at the gym cannot have the same number of carbs per meal as a petite 5 foot 1 inch 75 year old lady who does not exercise.
We do recommend everyone eat something every 4-5 hours to maintain a healthy metabolism. If your meals are more than 4-5 hours apart, a snack consisting of a protein and a carbohydrate is a great choice. The protein will help fill you up quicker and keep you feeling satisfied between meals. The protein also has a slower effect on your blood glucose than most carbohydrates, so when paired with carbohydrates, your blood sugar will not spike nearly as high. We recommend eating a protein with every meal and snack.
I hope this information helps Edward!
Why ADA has such a strong stance against keto diet? When will ADA update their information and be in sync with the latest information.
I am in no way suggesting ADA is spreading incorrect information but there are things that needs to be updated.
For instance the recommended carbs per day on health.gov is not correct and it’s one of the reasons we have epidemic of diabetes.
The current recommendations for carbohydrate consumption is 130g/day. This is absolutely correct! This equates to the equivalent of about 30-40g per meal and one or two snacks with no more than 15g per snack. This is LOWER than previous ADA recommendations for people with T2DM!
“We do recommend everyone eat something every 4-5 hours to maintain a healthy metabolism.”
What!? It’s no wonder why diabetics are getting worse with these dated recommendations. Eating every 4 to 5 hours will spike insulin and therefore constantly raise blood sugars.
Question: How many diabetic patients has the ADA truly helped? You claim to have helped many with great success following these ridiculous guidelines. Yet, year after year diabetics get worse and diabetes is increasing. Your track record speaks for itself.
I teach ADA. I saw 49 people in 8 months. All except 1 lost weight and had A1C reduction. 16 reversed their condition. All this on ADA diet. ADA works, you just have to follow it. Keto will work also, I just do not believe that it is healthy in the long term. We need more study results, and evidence that it works before we recommend that everyone should go on a keto diet. I would recommend that any of you who are on keto diet, and who are adamant that it works, and that ADA does not, should look for clinical trials and become subjects. We will need to know scientifically that it works, not just by word of mouth. And we will need to see medical evidence that it helps. If there is science behind it, I am sure that ADA will get behind it. Their are medical programs where you can be followed on a keto diet. Look for those.
The Science is already behind it, and it has been behind it for a very long time. What are you talking about?
There’s LITERALLY an ENTIRE TED talk about a doctor talking about how slow the ADA has been to act on the Science on this from 2015.
https://www.youtube.com/watch?v=da1vvigy5tQ
Pick up Gary Taubes book, “The Case Against Sugar” where he lays all of the studies out involving ketogenic diets and diabetes, and instances where the sugar industry paid off scientists and ultimately contributed to the diabetes epidemic.
Here’s studies, most will be for diabetes, others will look at cholesterol and weight loss, important factors to consider in diabetes patients:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/
https://www.ncbi.nlm.nih.gov/pubmed/25828624
https://nutritionandmetabolism.biomedcentral.com/articles/10.1186/1743-7075-2-34
http://www.nejm.org/doi/full/10.1056/NEJMoa0708681
https://jamanetwork.com/journals/jama/fullarticle/205916
https://www.ncbi.nlm.nih.gov/pubmed/28750216
https://www.ncbi.nlm.nih.gov/pubmed/28053201
https://www.ncbi.nlm.nih.gov/pubmed/21234818
I would love to join a study! Could you recommend where to go to find one? I have done 30 or less total carbs a day for almost 2 years and feel great. I have NEVER EVEN ONCE gone over 40 total so I do follow it and I do not cheat on high carb foods, although I do occasionally over-eat on low carb foods resulting in a bit over 30 maybe 1 -2 times a month. I do feel that time will provide more support and think that the medical community should educate on this as another alternative. It isn’t for everyone because it is a bit more problematic if a person does fall of the straight and narrow too often but it can be done!
Edward, can you share your experience with Keto? Would love to hear from more people like you.
I’m not Edward, but I’ve been on a keto diet for 3 weeks. I don’t find it difficult at all. I’ve attended 2 birthday parties, and it’s easy to say “No thank you” when I’m offered cake because my health is my top priority. Drinking a lot of water to support the kidneys is an absolute must. Also, supplementing sodium, potassium and magnesium keeps electrolytes in balance. A Naturopathic doctor is a great source of information on true lifestyle modifications.
I’d gladly share my experience and help correct your misunderstanding of the science. I’m on 15 months and am no longer pre-diabetic or morbidly obese.
Find me on Facebook (and check out my “Body by Bacon” pic in my featured pics, or email me, if you want to have a real discussion and want to take a look at the real and recent science.
Hello Robert,
Could you share the science in our discussion here? Thanks.
Thanks for posting this Edward. While I agree that the thought of a lifetime without any sweets or any grains sounds miserable, it’s even more miserable every time I see a number above 120 on my meter, which is guaranteed to happen every time I eat even a few bites of one of those foods. Yeah, it’s stressful (and cortisol is just as much of a pain as T2D), but I want a better life and a life off of drugs. I was on three orals and two shots of insulin daily.
What the doctors never tell you is that you could also just eat completely different and take none of this crap. So that’s what I did. I stopped all of them all at once. Sure I don’t recommend that, but this damn disease and my disgusting visceral fat filled stomach ruined every aspect of my life-professional, relationships, sexual, mental. I am now 41 living back at home having to start from the bottom. I don’t want what the book recommends. I want every disgusting piece of fat off this body so I can excel again. If staying in ketosis every moment for the rest of my life will get me there then that’s what I’m going to do.
I lived the last 10 years with this disease and a mentality of “Well all those other people around me are eating and drinking this stuff, so I want to be normal like them” I’m lucky that mentality didnt kill me. I’ve had A1C of 12, bad cholestoral in the high 600s and triglycerides of almost 2000. And yes, the author is right, our lives are ridiculously built around food. That’s why we have an obesity epidemic in this country. I am the only person I know that eats healthy. Everywhere I went for the last 10 years I was surrounded by food and drink. Oh well. Moderation is only the key for people with good genes. For people like me, sacrifice is the key. I don’t want a normal life anymore. Excuse my vulgarity, but I want energy, six pack abs, and a hard dick again. This disease wrecked my life and I’m never going back there again.
Oh Mike, I just cried when I read this. Jesus…you are right on so many different levels. For you, this sacrifice is a total game changer. It’s changing every aspect of your life and yes I am very happy you were brave enough to divulge the erectile dysfunction (ED) issue also. It’s one of the biggest (no pun intended lol) issues for teens and men and the reason they get on board quickly with getting back on track! Once they learn their high blood sugars are the actual cause of the ED, they are extremely relieved and happy to learn any way to lower their blood glucose levels!
As far as the Ketogenic Diet is concerned, I think I am going to have to make a full about-face. As you said, for some people like yourself, you were unable to eat in moderation and feel it is due to your genetic makeup. This is probably true…to add insult to injury, in addition to genetics, it could also be an inflammatory process going on due to the sugary drinks and processed foods we are eating causing obesity and a host of other issues.
I have to also face the fact that some people are also addicted to sugary drinks and food and this is the way they get off of their addiction. Just like an alcoholic cannot drink alcohol, a person addicted to carbs probably shouldn’t be eating sweets.
So, on the Ketogenic Diet, you are successfully working towards losing the weight and getting your blood glucose levels under control. Please let me know how you are doing…if you want to share how long you’ve been on the diet and any details, I would love to keep up with you!
The main thing is you’re preventing the complications any type of uncontrolled diabetes can cause. That’s all we want. To see everyone happy and healthy and enjoying their lives! Thank you so much for sharing Mike, you are the best!
Mike, that’s exactly right! With T2, we no longer have the option of eating carbs, sugar and all the good stuff. Why can’t dieticians and the ADA recognize that and quit trying to shove all those carbs down our throats? I don’t get it… I seriously don’t. And I think the author of this article would do an about face is she actually had diabetes. It’s amazing the amount of people who claim to be experts that seriously don’t get it!! It I had Celiac Disease, I couldn’t eat gluten… at all. Why is the same not recognized for diabetics? Our meters show us when we are eating too many carbs. Its VERY clear as the number goes very high. What do the professionals not get about that? It’s been the most amazing thing about this whole process for me and I just can’t believe how biased people are against a very low carb diet for managing diabetes. You think that because people can’t maintain that kind of diet for long term makes it OK to go ahead and be against it? Did it ever occur to any of the professionals that by recommending a low carb diet it might actually encourage people to maintain it? Instead, you are giving them excuses and reasons to eat way too many carbs!! Last August 2016 I was diagnosed with T2, with an A1C of 12.7. My last blood test showed an A1C of 6.2 (July 2017) and I had reduced some of the meds I was originally on. I am still working on lowering my numbers. The whole process has been a slow progression to keto and I had to stumble on the whole thing myself through my own research. I tried vegan at first and quickly realized that I was eating too many carbs. Then I went low carb but knew I could do better. When I tried the Keto diet, my numbers went much lower. You get over the sweet addictions. You get over the bread addictions and you find suitable substitutions. You do what you have to do. But by not recommending an ultra low carb diet simply because you don’t think people can do it is ridiculous! It is basically telling people that they can’t possibly manage their own lives… they can’t possibly make their own, good choices. And then, because you are the authority, you are giving them reasons to not even try. You defeat them before they even begin. It just amazes me!
Mike,
You’re brave and you’re going to be fine. I know if you get through one month you aren’t going to believe how much better you’ll feel. It will take you to a year and another year.
You’ll be surprised how easy this is to do when all the sugar and chemicals are out of your body and you no longer have insane cravings. You’ll feel clean and when you look at a cookie or a piece of cake, you’ll know that to eat it will pollute your body again.
Good luck. You can totally do this.
Bravo, Edward!
Yes!! Edward!! I am pre-diabetic myself and have IBS which many doctors have no explanation for many of my questions because IBS triggers everyone differently and with different foods. I have been keto for 6 weeks and have lost 14lbs and have not noticed any symptoms of IBS even when I eat trigger foods (onion/garlic) I am no means 100% keto yet because I have had slip ups here and there but I jump right back in. I can’t imagine not following this way of life moving forward. I immediately feel the difference if I indulge in anything more then I should. Im learning to listen to my body and now see carbs/sugar is what has been causing madness on my body. Keto-on Edward!
Also, to the author I do appreciate you stating you are bias up front, but I do get to indulge with some fruit/berries when I want. You dont give up everything forever but you learn to fit them into your macros. I have learned to make Keto ice cream and fat bombs if the urge comes along. I have learned to take keto friendly foods along to potlucks that everyone loves. Keto can be a way to follow forever but everyone has their own needs for their bodies. I am new to this but finding it easier and easier to remain keto
@ A Mooney on pinterest they seem to have lots and lots of keto ,sugar free and low carb desserts. But since i’m diabetic and barely taking really seriously a keto diet I don’t know at what point most of those recipes I should follow. Should I wait until my sugar levels are at a safe point ?
Bravo Edward!!!! Well said! You highlight the author’s bias or at the very least, her poor research.
“As soon as you start consuming a normal amount of carbohydrates again, you immediately go out of ketoacidosis or the fat burning state”. I am sure you know the difference between nutritional ketosis and ketoacidosis yes? One is the natural fat burning state, and the other is toxic. Right now i am in ketosis but not ketoacidosis. One has a natural balance of Ph level, the other not. Once you make that statement, i have a sick feeling i am not getting the right information here.
Hi Edward,
Yes, it was a typo and thank you so much for pointing it out; we have corrected it. I do address the differences between Nutritional Ketosis and Diabetic Ketoacidosis (DKA) in the beginning and later near the end of the article:
Your body uses the carbohydrates you eat for energy, so if we restrict how many carbohydrates we eat, the body has to get its fuel source from fat. A byproduct of this fat burning state are ketones which are produced; this is called nutritional ketosis. You can determine if you are in this fat burning state by purchasing urine ketone testing strips from your local pharmacy.
For people with Type 1 Diabetes, you probably have heard of their diabetic emergency, diabetic ketoacidosis, also referred to as DKA. This can be life threatening condition for people with Type 1 diabetes and Certified Diabetes Educators spend many hours teaching preventive care for DKA. This condition should not be confused with nutritional ketosis, the fat burning state reached when following the Ketogenic diet. The two conditions are quite different.
I have cared for many patients in DKA in the hospital setting throughout the years, both as a RN in a Medical ICU and as a Certified Diabetes Educator. I really love teaching preventive care to my Type 1 patients in the outpatient setting to ensure they have all the skills they need at home to never get to the point of DKA.
As far as the the Ketogenic Diet goes, it is a very personal decision between you and hopefully your physician. I would just recommend working closely with your physician for all the recommended lab tests to make sure you remain healthy while on the diet. That’s really the goal of any “diet” anyway, right? To get healthy? This is why we normally always recommend moderation with everything…moderation in the foods you eat along with moderate amounts of exercise equals a healthy lifestyle that will prevent diabetes or help you control your diabetes if you already have it.
Happy eating Edward and good luck!
This article is a perfect example of the misinformation regarding diabetes and insulin resistance. The authors stance against the ketogenic diet is a simple, “its just too hard, I cant live without fruit.” She projects her lack of willpower to her audience. Ketogenic diets are a great way to reduce insulin levels and get to the root of the problem.
The most frustrating part is her insistence on “moderation.” What does that even mean? Moderate amounts of ice cream or sugar that can trigger insulin spikes for days. This article is ignorance at its finest!
I suffered through a year on 20 grams of carbs per day and it was the worst year of my life. Yep, I lost weight, but at my current weight of 130 lbs and eating 30 carbs per meal and remaining in a prediabetes state for 15 years, I am healthy AND happy now. None of us know the long term effects of most of what is offered to us…medications, diet drinks, processed foods, restrictive diets. The point I was trying to make was eating healthier, more natural foods will be better in the long run, I believe we all have the common sense to agree on that, even if we can’t agree on how many carbs we will eat!
Fat has the longest effect on blood glucose levels. Pizza may be one of the worst, but would never effect your BG longer than 4 hours more than likely. No food has the ability to effect your BG for days! Please check your facts before scaring people from ever eating ice cream again!
So, you like sweets too much to take care of yourself and are happy being a pre-diabetic for so long?
THAT is what you want for others? No thanks. I’ll take my A1c of 5.1 over your pre-diabetes any day. Keep eating your carbs if you want, but stop giving people bad information that will also leave them continuously sick.
You choose to be a pre-diabetic, and likely diabetic as you get older. Don’t misuse science to push others down your path.
I know a few people who struggle with keeping on the low carb diet and staying in ketosis. They introduced me to a exogenous drink called keto/os that is a natural energy drink that contains ketones. It gets you into ketosis within an hour!!! This can be tested in the blood and they showed me the results and it works!!! Not only that but it dropped their blood sugars as well. I am now on the product myself for other reasons but just thought I would share it. Let me know if you want more info.
Yes i would like more info on this drink
Can you share this recipe please…
This is a helpful article. But there are some inaccurate things too. I have type two diabetes and use a keto genie diet to lose weight (45# so far). I was able to get my cholesterol down, Triggs down, and my A1C to 6! I went off and followed a Mediterranean diet for a year. I gained back 15# and my diabetes got worse. So I am back on keto. I am using a closer to Mediterranean keto both then and now.
I read in Authority Nutrition a review many studies that show LCHF diets are more effective. Studies not mentioned in your article. As for gaining weight back, The truth is anyone who stops a Healthy diet and returns to a crappy one will gain weight back.
Also your keto food pyramid is off; protein is not the base! Duke University has done a lot of clinical work and research with positive results. In addition before insulin Dr’s actually used keto to treat type two diabetes.
I appreciate that you are at least willing to look at keto. Thank you!
Hi Kate!
Thank you for your feedback! First of all, I want to congratulate you striving so hard to find a diet that works for you. That’s the difficult part for sure…finding a way to eat healthy while getting your weight in the normal range and your blood glucose under control.
It is true that before we had insulin, people with Type 1 Diabetes in particular were treated by severely restricting carbohydrates…so restrictive however, it was semi-starvation. Some patients actually died of starvation.
Luckily today, we do not have to treat any type of diabetes with this barbaric method. There are so many healthy food options for most people today in modern society. In America, most of us are blessed to have access to healthy food options. I did see the research that Dr. Westman has completed at Duke University and did reference one of his articles above (reference #7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1325029/). I have no doubt the diet works, I’ve done it and lost weight really fast, so I know from firsthand experience that it works. You will lose weight which will have wonderful effects on every aspect of your health. The problem I have is, can anyone go the rest of their life without consuming anything white EVER? Do you think every author of all those books actually does that? I would offer to put them all on a lie detector to prove that they haven’t lived 40 years without consuming one white thing or one fruit or anything with sugar in it. My question is, what quality of life do they really have if they have? I for one will NOT be giving up my or my family’s birthday cake!
After seeing thousands of patients now for years and from personal experience, I still believe it comes down to staying away from processed foods and cooking at home whenever possible. Eating a variety of fresh fruits, vegetables, proteins, and fiber. Also, cutting out any sugary liquid calories; staying away from sodas, juices and the infamous sweet tea! Keeping stress levels under control and incorporating exercise into your routine will also be key to breaking through challenging times when you are having trouble with continued weight loss.
Also recognizing what worked 6 months to 1 year ago may not work today. Our bodies change over time and we have to adapt to those changes. So many factors affect your blood glucose levels; you will face hormonal changes, stress related changes, and your pancreas may not be working as well today as it did a year ago and we wouldn’t expect it to. Just as the heart of an 18 year old person is much stronger than it will be at the age of 50 years of age, your pancreas’ function will decline with age with the normal aging process. Many of my patients throughout the years have came to me feeling so defeated because now they have to go on medication or insulin. They are so relieved to hear this may not be due to anything they have caused by overeating or weight gain, it may be just the unfortunate natural progression of diabetes. Until we discover cures for the different types of diabetes, this is what we face.
I love your idea of a low carb/Mediterranean diet…it’s exactly what I would recommend! I hope this has helped some and good luck to you Kate!
You’re a diabetic counselor and are talking about being worried about not being able to eat birthday cake? Hell I’ve been on keto since July 2016 and haven’t felt any urge to go back, simply because I feel so much better. Also the diet is really not all that restrictive, you can make desserts using stevia/erythritrol, coconut/almond flour, etc. I had ketogenic pizza the other night and it turned out great. Lots of great resources out there for food options. I’m not diabetic myself, but I used to be prone to hypoglycemia and keto has eliminated the issue since I’m not dependent on glucose. There are a lot of wrong ways to do keto though, and doing the diet correctly has a moderate learning curve.
We all have different meanings for “quality of life” for me it means feeling good, with energy, no bloating, no heartburn, on my weight, normal glucose levels… for you it means having “white stuff” to eat, enjoy it while you eat it and then feeling bad about it, ’cause if you’re a diabetes educator you know (or at least you should) the harm it does to your body! I’m glad no one believed this biased article! It means everyone out there know what is real and what is not…
I’m sorry, this comment was for the author, I agree 100% with what you’ve said!
You keep saying how can you stay on keto for life. Well if I were an achoholic I better not drink alchol ever again. It is choices you make. Do I want to feel good and live longer or do I eat anything and die early or worse yet go blind, have a limb amputated ect. I choose to live longer
“The problem I have is, can anyone go the rest of their life without consuming anything white EVER? ”
I am confused by this statement, as there are many wonderful “white” substitutions that taste great, and don’t make me feel like i am missing out. One of the things I thought I was just going to die if I couldn’t ever have it again, was waffles with peanut butter & maple syrup. Guess what….there is a sub for that! I am T2D, and my doctor, who specializes in diabetes, told me to stop eating sugar, carbs and she said that in a perfect world, I would stop eating fruit, as it contains sugar. That’s when I found Keto, on my own. I’ve been on it for a little over a month or so, and have lost 12lbs, but more importantly, BS levels that were averaging in the 200’s are now lower than the 90’s, consistently… The highest number I’ve tested was 97, after I ate dinner & had a satisfying bowl of Keto ice cream. I’ve been diagnosed Diabetic for approx 4yrs, but am certain I was diabetic for probably 3 yrs prior to that. I’m not over weight, and did not have the hope of “losing weight and getting off meds”. This has been my answer, and I truly think that if we did live in a perfect world, more things like this would be taught to those of us who need better choices than medications. There are so many other things in the world that are suppressed due to greed of Big Pharma & Government. Let’s start helping our fellow man be healthy & heal….
Kate can you share your keto experience?
Your pyramid is wrong. Fats should be on the bottom and protein above it. Its High Fat, Moderate Protein and Low Carb. Protein as your largest Macro would be something like an Atkins diet. High protein can convert to glucose and would not be effective.
I am not a fan of atkins diet.
Have you been following a keto diet to manage your diabetes Tami?
I see several inconsistencies, one being a strict 20 grams or less of carbs, most Keto followers I see aim for closer to 30, and even as high as 40 per day. I also see several times in this article her opinion that you cannot get all of your essential vitamins and minerals without eating fruits, and I’m no nutritionist, but this is far from the truth. The writers hatred for this w.o.e. Presents itself early and often in this article, and because they weren’t able to successfully stay away from sweets, and other carbs, they’re attempting to scare others away as well, especially pregnant women. She admits that she’s been taught to follow the ADA’s dietary guidelines which has been proven to fail. It sadly isn’t working. She recommends consulting your physician before attempting this w.o.e., I tried that and was instructed to follow the clean eating that I had followed for the first 15 years with type 1. The 60 grams of complex carbs in meals, and 20 or so with snacks. That way allowed me to ride a dangerous daily rollercoaster, with damaging highs, and very dangerous lows. Yet my Endo was pleased with my sub 7 a1c, even though I was always tired. I’ve practiced a very healthy way of eating long before being dxd with type 1, which probably makes it easier for me to continue living this way. Ultimately, the info is out there, and those able to avoid certain foods will be rewarded with non diabetic numbers… some say big food/pharmaceutical are doing all they can to end this “fad” I’m not sure if it’s true or not, but the simple fact that there will always be those that lack enough discipline to remain in ketosis should still present them with enough clientele.
Avoiding ‘sweets’ isn’t entirely true. While most people when they think of ‘sugary’ foods aka loads of carbs, however, sweet is more of a ‘taste’ and there are still many ketogenic recipes for desserts that taste sweet but still are low in carb. Clumping it into one word of sweets isn’t entirely true.
The ketogenic diet does take discipline and dedication to sticking to, but stating that it isn’t sustainable in the long-term isn’t necessarily true. There are many people who have the discipline to stick with this type of diet and to them it isn’t a “diet” at all, but a lifestyle.
Comparing cavemen to us right now in terms of lifespan isn’t a good comparison. Did they die strictly from lack of nutrition? Or did they die from diseases that we have eradicated? There wasn’t a coroner available then so we can’t say for 100% certainty that is was due to their diet.
“How healthy do you think it is for your body to be in a starvation mode, then in a feeding frenzy, making up for lost time?”
this is exactly how we evolved.
Tammi,
You say keto is a highly controversial topic. For those of us following a keto diet, there is no controversy whatsoever because the diet proves itself efficacious very quickly. I think the real controversy comes in because the ADA has been recommending dangerous levels of carbs for decades now, and they would lose face if they had to change their recommendation and admit they’ve been wrong for so long. You say there are not many studies on the keto diet, and I disagree with you. You’ll find the evidence if you look for it. Eric Westman, Steve Phinney, Jeff Volek and many other researchers have written volumes about this.
One aspect that is not often mentioned is carb cravings. Before I started a keto diet, every day I would have serious starchy- or sweet- carb cravings that were uncontrollable and HAD TO BE satisfied. The high-fat keto diet has pretty much eliminated those carb cravings. It is wonderful to not be under the control of those cravings anymore. I think the high success rate of keto diets is that you are not hungry and have no cravings.
We have all heard of essential fatty acids (EFAs) and essential amino acids (EAAs), but have you ever heard of essential carbohydrates? No. The human body is capable of burning fat for fuel. If the body can burn fat for fuel, why would you ingest a substance (carbohydrate) that raises your blood sugar, raises your insulin levels, and makes you sick? Why would the ADA advocate the very diet that made us sick in the first place? When are they going to admit they’ve been wrong and start doing what is in the best interest of diabetics?
Tammy, just because someone follows a keto diet doesn’t mean they can’t have their sweet treats. There are dozens of websites with hundreds of keto sweet treats and “fat bombs” made with stevia or other natural non-caloric sweeteners which will not raise blood sugars. One of my favorites is Keto Mocha Mousse https://www.ruled.me/keto-mocha-mousse/ which has 5 g net carbs per servings. We don’t have to be deprived on keto.
One of the keto researches commented, (I think it was Steve Phinney) that change will come about only because enough of the the public will be become educated about this and will demand that the ADA change their recommendations because those recommendations are just wrong. What is the proof they are wrong? If you eat 45-60 g of carb daily, you will continue to have diabetes, and the epidemic will continue as it has for the last 25 years.
I know you have to earn a living, Tammi, and there is nothing wrong with that. However, would you consider that what you are advocating, which was taught to you by mainstream medicine, might actually be harmful? And if it is, what will you do about it? That is the real controversy.
Hi Elizabeth,
I can tell how passionate you are about this subject. As you can see on one of my reply’s above, CDE’s do not recommend the same number of carbs for every person we see; we use an individualized approach. It varies depending on the person’s height, bone structure/muscle mass, amount of weight they may need to lose (or gain) and the amount of exercise they may or may not do per day/week.
As I told Edward:
The ADA has recommended since 2013 we use our best clinical judgement in recommending a low carbohydrate diet for people with diabetes, recognizing it needs to be individualized. 60-75 grams is the carbohydrate amount I would give to a very tall, large boned man or perhaps an active teen or young adult. I would never recommend that many carbohydrates for an average size man who was trying to lose weight; he would get 45-60 grams of carbohydrates per meal and 15-30 grams for snacks. A women trying to lose weight would get 30-45 grams of carbohydrates per meal and 15 grams for snacks.
As CDE’s, we individualize our recommendations for each of our patients. One person’s diet may not be appropriate for another person. For example, a six foot 6 inch tall man weighing 220 lbs of mainly muscle, who exercises 2 hours per day at the gym cannot have the same number of carbs per meal as a petite 5 foot 1 inch 75 year old lady who does not exercise.
These carbohydrate recommendations are not PER DAY, they are per meal. This is the major difference between Ketogenic diets and a consistent, low carbohydrate diet CDEs advocate for. 30-45 carbs per meal is considered a low carb diet. Eating this in the form of a Mediterranean diet is what I recommend and what my article outlined. In a perfect world, we try to have people steer clear of anything artificial or processed when possible. Just eat fresh foods, like our grandparents did, who never had these types of health problems.
There are many physiological reasons for eating enough carbohydrates throughout the waking hours to maintain a steady blood glucose level…a couple of important reasons are to minimize the hepatic release of glucose (from the liver) and to help prevent hypoglycemia which can be very dangerous and lead to hypoglycemic unawareness over a short period of time. Each person is different of course..if you aren’t taking insulin, or pills that lower your blood glucose levels, you may not have to worry about low blood sugars. The reality is, most people with diabetes do; it can be very dangerous for some to not get enough carbohydrates at each meal.
We are all supposed to be eating 5 servings of fresh fruit and vegetables per day. That provides you with all the essential vitamins and nutrients needed to run a healthy body along with the protein you choose to consume alone with them. I guess if you can fit those into a Ketogenic diet and make that work for you for a lifetime, I would have to say that is absolutely wonderful! I just know, I have a lot of willpower and I only made it 1 year back when I tried. It was just too restrictive. I see too many stories like that. The blogger I wrote about, all the studies, most participants had dropped out at 6 months. No study I have seen has shown anyone who has stayed on it for 10 years, 15, 20, 30, 40 years. If you know one, please let me know!
It’s your body, your health and together with your physician, I wish you luck on your journey! Let us know how long you’ve maintained it and please keep us updated!
Good luck Elizabeth!
Hi Tammy,
I have been eating a ketogenic diet for almost exactly one year, and I can’t ever imagine going back. Elizabeth lays it all out quite nicely — my favorite part is having almost no cravings whatsoever – talk about freedom! I won’t repeat her thoughtful message.
I’d like to add to her message and respond to yours a little.
It’s only dangerous to not get enough carbs at each meal if one is taking too much meds or insulin for the amount of carbs they are eating! Restricting carbohydrates doesn’t lead to hypoglycemia unawareness, but having lots of lows and lots of highs will (and decreasing insulin and carbs leads to way fewer highs and fewer lows, or at least it can). On the other hand, being in ketosis does make low blood sugars less negative as an experience. I still feel my lows just fine, but they are less of an emergency because my brain still works (feeding on ketones) and by body doesn’t freak out and release tons of adrenaline that then makes me want to eat a house. Mind you, I still wake up and know immediately if I’m low, I know from experience and how it feels in my head and body but without the crazy shakes. This is not unawareness but it is less reactive.
There are definitely people who have been eating this way for decades — there’s a facebook group of people who follow Dr. Bernstein (all are low carb, some are also keto) = TYPEONEGRIT and there are many on there who have been doing this for many years.
The crazy thing is it is not hard, if it matters. Sure I can see it being hard for someone who does it to lose weight, then when they get closer to their ideal, they want to have treats, etc. Well, for a type one diabetic there’s no end in sight, this is it, and it’s a relatively complication free life (many people reverse their complications when they bring their A1C down to normal) vs. one with inevitable complications. So, perhaps it was too hard for you after a year (you didn’t say, but I assume you are not a type one diabetic), but that is a choice you can make. Not I.
Thanks so much for starting this conversation and continuing to explore and learn along with the rest of us.
The comments defending the keto diet suggest that the individuals are successfully using the keto diet to help them maintain a healthy weight and a healthier A1C level. The individuals also suggest that they view it as a way of life rather than a diet. This is good news for many of us who are facing the question of whether it will be helpful and necessary to reduce carbohydrate intake to keto producing levels in order to halt or reverse the onset of type II diabetes. I think like those individuals, Tami is speaking from her own personal experience where she had success losing weight, but had difficulty maintaining the keto diet long-term. I am sure that though you have been successful, you can understand that there are many who might find it difficult to maintain. I too have been given very bad guidance by Medical Doctors who lean on old Med School information to practice medicine rather than continuing to broaden their knowledge base and learn more about nutrition. I cannot get back the 20+ years of suffering with a debilitating disease that could have been cured because my doctors were not well informed or willing to listen to information that disagreed with their limited knowledge base. Those years are gone and the destruction to my body is not reversible. So I understand the anger you feel toward a system that isn’t working in the best interest of the patient. But I think that expressing anger toward those who disagree with our personal experience, is not solving the problem. Hopefully we can change the ADA guidelines by respectfully urging them to reconsider their position based on the sheer volume of the comments they receive from successful people like you, who are living the keto diet lifestyle and living better. I commend you for becoming your own best health advocates. Thanks for your encouragement and your passion. And thanks to Tami as well for sharing her personal experience and the information she had collected. We all have to be true to what we believe and we all have a right to come to our own conclusions. It is good to know that there are success stories out there. I wish you all good health and continued success. I also hope that one day medical training will do a much better job of preparing doctors to become their patient’s best advocates, actively learning and searching for cures rather than treating symptoms in ways that cause even more disease to develop. The system is failing so many of us.
Tammy, responded to your message!
I’m sick of non-diabetic educators who pretend to know everything… sorry, but you should feel it by yourselves. I will only believe diabetic advice from diabetics
Thank you for your wonderful comments Marcia. To share more about me personally with you all…I am not a completely non-diabetic Certified Diabetes Educator. I found out I had Prediabetes 15 years ago when I became a Diabetes Educator. I tested my own A1c and found it was 5.8%. The incredible news? There have been years when my A1c dropped to a normal level of 5.4%…out of the prediabetes range. My last A1c in May was 5.8%, so I still have Prediabetes 15 years later, but not diabetes, and without any medication, just the sensible diet I’ve discussed and exercise, so I really am living with this. I feel it everyday, I wonder what my A1c is going to be just like you every 6 months when I go to have it drawn.
My A1c did jump to 6.0% 2 years ago when I injured both of my rotator cuffs through too much exercise. The constant pain and inflammation for 6 months caused the increase. Once I had the manipulation done, completed physical therapy and the pain was gone, my A1c dropped back to 5.8% again where it has stayed since.
Many CDEs actually have diabetes…it’s what draws them to choose this career…to help others with diabetes, to share their knowledge. Most already wear an insulin pump and continuous glucose sensors (CGMs) also. When I first became certified on each new pump and CGM, I would wear them (and check my BG 4-6 times per day) for 2-3 weeks, not only to learn the technology really well, but to gain a sense of how my patients must feel having to wear them 24 hours per day. Since, I’ve started a 6 month old baby on a insulin pump and CGM all the way up to a 89 year old…there are no boundaries for people with diabetes!
For me, I chose to become a CDE because I had worked as a Registered Nurse first on a medical unit, then in a Medical ICU. These are the units where most of the people with diabetes are, so I had seen every horrific complication that diabetes can cause. When I had a chance to become a Diabetes Educator…to actually help PREVENT some of those horrible complications…I jumped at the chance!
We really do only want to try and share the knowledge we have through seeing thousands of different patients with complex issues over decades with all of you. Physicians jump at the chance to have a CDE see their patients in their practice or in the hospital because they know our value. They know how thorough we are when assessing their patients and often find issues that may have been overlooked for years. It’s all we do all day, so it’s our specialty…diabetes. We live and breathe it and are very passionate about helping people overcome their hurdles. I do hope sharing some of my personal experience with all of you will help, but I am here if you all have more questions anytime!
I have type 1 diabetes, diagnosed in 2001 when I was 24 years old. I’m currently using an insulin pump. Managing my diabetes has always been incredibly difficult and taxing for me, but thankfully, I don’t have any major complications from it (other than being 40 lbs overweight due to serious insulin resistance).
I have to say that following a keto diet has made managing my diabetes A LOT easier. Trying to manage by covering 45g of carbs per meal, then watching my BG spike, then plummeting soon after, was a daily norm for me. I hated it and no matter how many ways my doctors adjusted my pump settings, it just wasn’t working for me.
On keto, I’ve adjusted my basal rates and I barely need to bolus at all. My blood glucose numbers have definitely improved and what I find really extraordinary is that I’m needing about 60% less total daily insulin, than I did before starting keto. What’s even more fascinating to me is seeing a steady straight line across my pump for 6, 12, and even 24 hours – no crazy spikes or dips in my blood sugar.
AND i’m losing weight! I’m losing about 1 lb per week and actually have the energy again to workout regularly. If you have diabetes, you know how fatiguing of a disease it can be. I feel less sluggish, more “awake”, just better in general, while restricting my carb intake. Yeah, I miss some fruits, but I sure as heck don’t miss what I felt like after eating them. Besides, berries are allowed on keto 🙂
That alone tells me that keto is working for me. I hope my story has helped someone in some way.
Congratulations to you!! Keep up the good work. And, I have to say again, choosing the keto way of life as a type one diabetic is a lot easier than one would think, right?!. It is so rewarding, as you point out, and actually quite easy (lose the carb cravings and enjoy eating everything that you can!). I honestly feel more FREEDOM eating this way than I did eating the other way for 20 years and I love the normal sugars and better energy. Also the decrease in inflammation is awesome.
Of course I’m going to miss eating lots of fresh fruit – sugar is after all an addictive drug to the brain! But in reality I don’t miss it at all – though I do love my berries when I remember to have them.
Fruit is tasty and enjoyable, but it is not a necessity. As Elizabeth pointed out earlier, there are essential fatty acids and essential amino acids, there are no essential sugars/carbs. Also, there are plenty of vitamins and minerals in vegetables and nuts and seeds and eggs, etc. Fruit is mostly sugar, not mostly nutrition.
I love keto and I wish someone could have made me see the light many years earlier than I did.
I was diagnosed in 2004 with Brittle Type 1 diabetes, peripheral and autonomic neuropathy, and Hypothyroidism. A short time later with Gastroparesis due to the nerve damage from diabetes. Since then, I had followed every guideline and rule that the Endocrinologist and Primary Care Doctors had told me to follow. NOTHING WAS GETTING BETTER. In fact, I was gradually getting worse. So many ups and downs. Extreme highs (250-500 bgl ) to seizures from crashes (drop from 300 to 13 in no time). It was a constant battle with adjustments in insulin intake (and different insulins NPH, R, Novolog, Humalog, Lantus), carb intake, exercise and one contributing factor was the Gastroparesis. Meds were taken for the Gastroparesis but I always had side effects from meds. To my point. I was kicking a dead horse and I told them this. My sister and mom had come across the ketogenic way of eating and it dramatically improved thier lives. Mom was diagnosed way back with Type 2 and within a week or two she was off of her meds completely. I was totally interested. So, I decided to go for it on April 17, 2017. I did go through some rough patches of what they call Keto Flu. It did pass after a couple weeks. I was gaining so much energy like never before as well as mental focus. The even greater aspect of this all was, I had DRAMATICALLY LOWERED MY INSULIN INTAKE TO ALMOST NONE! My Lantus was always being adjusted from 30-40 units daily (and changed from AM to PM to splitting it to half AM, other half PM). I was on a sliding scale of Humalog or Novolog. From 4-6 units per meal and then there were the corrections throughout my day (some daily totals could be up to 40 UNITS)! Very exciting for me to only take 2 units of Lantus in the AM and daily totals of Humalog/Novolog….1.5-3 units! Other great things I began to notice, neuropathy pains were fading and finally GONE. No more nights up stinging, burning and RLS (restless leg syndrome). So, in my life, there are no questions or hardships on whether I can get off of this way of eating. It’s either do or die. If someone truly wants to have a better life, they can. The sad thing is, doctors and nutritionists aren’t being educated in the real facts. My primary care doctor isn’t willing to help me with all the labs I need nor listen. Always telling me “You need carbohydrates and insulin to live.” All that know me see the dramatic change for the better. I’m doing the Ketogenic way of eating with intermittent fasting for the rest of my life. The alternative IS NOT WORTH a lifetime of illnesses and suffering.
I am in the uk and a diagnosed t2d. I am also a nurse, although I am in end of life care. Up until my diagnosis I am ashamed to say the I believed in exactly th.e same things as the writer of this article. Our health service actively promotes a carb rich diet for t2d. Not an excessive amount of calories, but a “healthy” amount of whole grains, fruit, whole rice etc. It was not until I did some actual research and looked at the science that I came to see that what I had been taught and what I really did believe to be the best advice was quite simply wrong.
I am not going to go on about the benefits of keto, because everyone else has admirably covered that, but I would like to address some comments made in the article.
One simple thing is that at the beginning it says that most of the vegetable s are root veg. This is incorrect.
Also, as I believe is mentioned, this diet has been around for along time and was the only way to treat diabetes. And some people did die. However, people still end up dead from t2d even after all the diet advice from educators and with all that pharmacy has to offer. An industry which gains nothing if people just choose to eat less. But has lots to gain if we just keep taking the tablets.
A keto diet was/ is not just used for diabetics. It is a very useful tool for epilepsy. It is extremely successful in reducing the number of seizures per day, mainly in children but also in adults. I am sure that followers of the epilepsy diet, which has been used since the 1920s have not all starved to death. Iwould also think that the followers of this diet are also motivated to stay on it, not eat a slice of birthday cake and keep all thier brain cells.
I think what bothered me most about the article was the way in which the writer has put her own fears about living without cake onto the shoulders of any diabetic she might treat. In the same way an epileptic might choose a life without cake in order to remain seizure free I choose a life without cake to remain “undiabetic”. I must admit that when I was researching this diet I did worry that I would not have the stamina, but the thought of going blind is a useful motivator.
Iwould hope to meet a diabetic nurse in the uk who was open minded about keto, but that has not been my experience as a patient. As a nurse speaking to colleagues as an equal and frmy experience has been very different. I have not spoken to one nurse with personal/professional interest in this subject that has said if they were diabetic they would follow the guidance of our health service. All have said they would do keto.
It is very difficult to admit that something you have believed to be true is wrong . Even harder when you have made your living by telling people that you knowhow to keep them healthy when in fact your advice has done the exact opposite. But that is no reason not to research, look at and try and understand the science. And maybe change your mind.
Incidentally , there’s a very informative article on the bbc website about one of the last remaining hunter/gather societies left in the world, living in Tanzania. They have amazing gut health and no t2d. Would you like to guess at the type of diet they follow? This would be the caveman diet that the writer mentions, and yes these people might not live as long as us but the cause of death is never a lack of motivation to stay on a keto diet.
Lynn,
I would just like to share with you that my patients are HORRIFIED if their physicians ask them to cut out “everything white” in their diet. This is what some doctors ask for…essentially asking for the Ketogenic diet and most of my patients are in shock! Not only would I never want to skip a year of my birthday cake, but I wouldn’t ask my patients to either! One slice of cake is certainly not going to harm anyone with diabetes and hopefully you know enough about carbohydrates and their short term effect on BG levels to know this too! I am not a Registered Dietitian, so I couldn’t speak to this diet in regard to children with epilepsy. Are you a Neuro RN? TheDiabetesCouncil did just post another article where 25 Registered Dieticians weighed in regarding the Ketogenic Diet, so I would encourage you all to check that out!
It takes a very special, highly motivated patient to maintain this type of diet for the rest of their life. If you are one of those people, good for you! I wish you well!
WOW. I guess I must be a very special, highly motivated patient then. I, of course, would never have said that about myself. My high motivation is trying to get over the hatred of food that being Diabetic gave me. I don’t feel that way anymore, and am finally happy cooking, again. (My doctor DID tell me exactly that, BTW. Even to the extent of telling me to not include the tsp of agave that I was having in my coffee once a day because sugar is sugar.)
All I can give is my own experiences.
I was diagnosed as T2 diabetic in Jan 2014 with an A1C of 10.4 and a fasting BG of all over 200. I come from a family dominated with T2 diabetics.
3. 5 years later I just got my results back with an A1C of 4.8. And fasting usually in the low 80s. I’ve lost around 20 pounds since I was diagnosed and could stand to lose about 20 more.
No meds, I’ve done it all worn a ketogenic diet.
Diabetic complications run rampant in my family. Kidney disease and dialysis, retinopathy, neuropathy, etc, Two days ago my brother had all of the toes on his left foot amputated.
I intend to use my success as an example of what a ketogenic diet can do for diabetics.
Is the diet hard to follow. Of course it is! Go out to a local resturaunt and show me a ketogenic friendly option that doesn’t require you to grill the wait staff and get as many substitutions as possible. I dare you. You’d be amazed at the hidden sugars and starches in foods.
As for what an ethical dietician would recommend. The one I was sent to had me on 45g net carbs per meal and 15g per snack 3 times a day. I was supposed to eat at least every 4 hours. I still have the sheet he gave me. For a 5’1″ middle aged woman.
He also told me that I was in horrible shape, that I would need a lot of medication, and that because I was T2, insulin would do nothing for me. I still remember walking out of the building after. I felt like shooting myself. My brother had just gone blind from retinopathy 2 months earlier. There was no hope for me. High numbers were inevitable. Complications were inevitable.
I followed the guidelines I was given with little improvement and a lot of depression. I now do 30g total (not net) carbs a day and no medication with an A1C under 5.0 and I feel like I can easily do this for the rest of my life.
Most dieticians I have met are over rated and under educated. This article somewhat proves me out. Congratulations on your accomplishments. I have been in Ketosis for a couple of months now. I have lost 28 pounds. I feel great. No sugar No Bread Nothing from a box lol. Only good fats and Meats and good veggies(dark greens mostly) and a few macadamia nuts now and again and a few berries now and then. I think even the dieticians being human are also addicted to sugar and unable to give it up so they play down ketosis unconsciously because they are just jealous! lol
I am sorry you had this experience. I feel that this educator was not giving you good advice. All my women who want to lose weight are recommended to consume 30 grams of good carbohydrates at each meal, and 15 at each snack. If you were not trying to lose weight, I would have recommended 45. I find this is all it usually takes to begin to lose some weight as you start to get active. Patients set their own goals with motivational help from their Certified Diabetes Educator. Our intent is never to insult, and you should not have gone through that. It sounds that you have now found the right path. There are many CDEs who could help you, so see what tools and motivation others may offer. I wouldn’t let one bad apple spoil the whole bunch. Many CDEs are also diabetic.
“The one I was sent to had me on 45g net carbs per meal and 15g per snack 3 times a day. I was supposed to eat at least every 4 hours. I still have the sheet he gave me. For a 5’1″ middle aged woman.”
That is what she said, actually, and it didn’t work for her… maybe there is a problem with listening to the issues…
Keto Diet is NOT strictly 20 grams of carbs per day. Not only are you biased but you are not being truthful. 20 grams per day is just the recommended guideline for maintaining ketosis. Many people can consume 40, 50 even 60 and 70 grams of carbs per day and stay in ketosis. It depends on the person. Age, size lifestyle and exercise all factor into how many carbs can be allowed and maintain ketosis. It is ok to not recommend a diet but when you leave out important aspects you do both your readers and yourself an injustice. Don’t base your article on one or two 3 page leaflets you read on ketosis written 20 years ago.
You even have root vegetable and a picture of a carrot. Carrots are not part of a keto diet and as far as I have seen never were. They have 2 much sugar content and are discouraged except in very small amounts. Are you sure you tried it? Sorry. Great article in many ways but outdated in others. I don’t think people go into thinking they will “do it forever” How long can I last? I think that is missing the point entirely. So many people are getting their triglycerides down, losing weight reducing stroke possibilities lengthening their very lives. It is just not fair to not at least point out a few of these things as much as the risks you made sure to point out. albeit they are very important. How about the risks of not doing something? How about the list of people that found this and turned their lives around. Also, I know several people who have been doing keto for years.
Hello John,
I will speak with the editor about switching out the picture of the carrot. I will tell you the story of a friend of mine, whom I worked with. He has a website. You may view it here:
http://www.lowcarblikeme.com/
He has been on keto diet for at least 3 years now. I think that he is some proof that yes, it does work. And it may be that some people do need keto. However, I don’t believe that everyone needs keto diet to get reversal. I have had reversal with regular ADA diet in my clinic. Not just a few! Many have reversed. However, I just want for keto dieters to find a clinical trial. We do need more information. We must understand what happens in the long term on keto diet. I personally did Atkins years ago, which was 20 grams. I had a very hard time to stay on it. I lost 20 pounds, and then I did gain it back. I just could not live without some more carbohydrates than this allowed. I don’t know about being on 60 to 70 carbs, and staying in ketosis. It seemed I was out of it at 22 carbs. Anyway, this was not for me. Maybe it is for you. No one is saying that one should never go on a keto diet, but we are wary of it. We need more science behind it. Therefore, I am just going to put this out here now. I will paste it down the page so that others may see it. They are taking participants. If you fit the criteria, please help us to get more than people’s opinion about this diet. Then we can be more positive about it, and recommend it if the science is there. Here is the link to the clinical trial. Thanks for your comments:
https://clinicaltrials.gov/ct2/show/NCT02069197
What about those of us who are not, or never have been, obese?? Let’s find a study group that wants to find proof that it helps people with their diabetes, not necessarily lose weight.
Very well pointed out statements about ketogenic diets from many of the commenters.
And I will add that I’m NOT diabetic.
As Tammy points out, diets are diets, and many people nowadays think/feel that diets are a “time/value-based goal”. “If I just get my weight down, or if I just fix this, then I’ll be all set…” WRONG!!! There in lies the first problem. How long can it be maintained? Well that’s a good point. The real question is, how long is one committed to changing their life, and how strong is their desire to do it. ALL things that one wants to change in life, require a change in to the way their living and/or perceiving life. They require a life-style change. One could attempt a Mediterranean diet, and yet relapse back to “normal” eating after 3mos, 1yr, 3yrs, etc.. It doesn’t really matter if the change isn’t first on the mental and emotional level. Unfortunately, many first-world daily diets (namely American) incorporate many foods that are addictive which can cause cravings. And yes, the cravings are scientifically prove-able, and have been proved. We grow up thinking that it’s “normal” to have your cake (since its the carb of debate lol) and eat it too, because why?… Well because that’s how they were raised. Simply as that. Conditioned living if you will. There are many cultures on this planet that DO NOT grow up eating as many carbs and sweets as the American Diet, and do perfectly fine without all the sugars and carb cravings. And incidentally, they also lead healthier lives too… Go figure.
I’ve been following a ketogenic based “Way of Eating” or almost a year now, and I’ve never felt better. Fats are the main source of calories with it—NOT protein. Fats and proteins ARE essential for the body. Carbohydrates are not. The 20g of carbs are for net carbs, NOT total carbs. This means you can have a great deal of fiber from very nutrient filled veggies that don’t spike your blood sugar.
With fats being my main source of calories, my body and energy levels have never been better. When I educated myself on it and understood the science behind it, it was clear to see why my joints started feeling better, and ailments started to go away. I now have more “oil” lubricating my cells so they’re more receptive/flexible/malleable to the nutrients in my foods. People can loose weight very fast, but honestly the first 10lbs or so is a lot of water weight so that’s really nothing to write home about.
I believe that nature teaches us in wonderful ways about what works. Take the four seasons for example. I’ve adapted a ketogenic way of eating that is a cyclic method. I workout a lot, and a focus of mine is increasing muscle mass and strength. While I wouldn’t be able to maintain and/or increase those two factors with the amount of intense workouts I have, I don’t follow a strict ketogenic “diet”. I go about 3 weeks of being in keto, and then for a couple of days, I eat whatever I want. That means, I can eat cake, cookies, pies, whatever I want, for those two days. I even get to enjoy birthday cake ;). Then after that, I go back to keto. It’s work WONDERS. It’s EXTREMELY maintainable, I’m still loosing weight and achieving my goals. I’ve also been getting better at listening to my body and understanding how certain foods affect my body—which is something we’re not taught. It’s really amazing how we have such intelligent systems that are ALWAYS communicating with us. We just have to understand how to listen to them. Truly. The problem with a lot of our society, is that we are stuck in the high-end of the cyclic, or the feasting mode, and we think it’s normal! Hence the many ailments and medical conditions that keep increasing. The point is, there are many variations of following a ketogenic way of eating, and it DOES require a life-style change. Just like any other recommendation from a dietician or educator.
I will refer you to the comment above to John J Dozier, Jr.
Here is the link for the clinical trial:
https://clinicaltrials.gov/ct2/show/NCT02069197
I am a T2D, finally fully keto starting at the end of March. I am down 28 lbs. My goal is 50, so I am feeling encouraged and fitting into smaller sizes already. In May my A1C was 5.6. This morning, according to a home test kit I purchased from CVS, my A1C is 5. I believe that is fairly accurate based on my blood sugar readings, which are staying well below 100.
I feel great. I am sleeping better, my emotions are very even, I have a noticeable improvement in my energy level, and I am enjoying what I eat day to day!
The keto lifestyle sounds daunting, but it really is not. One thing many fail to mention is the hormonal shifts that occur that regulate your appetite. Give this a little time, and you will be astounded at how easy it becomes to pass on the stuff you found addictive previously. There are many factors that influence one’s success or failure, and the key is to get the information and support you need, and to stick with it long enough to see the benefits. I fine this way of eating completely sustainable, and I’m in for life.
I will refer you to the comment to John J Dozier, Jr above. Here is the link to the clinical trial:
https://clinicaltrials.gov/ct2/show/NCT02069197
Thank you for this info. I will be copying the link to send to some folks ready to jump on this new trend. In fact I had a resident (I am a CDM) come in to our re-hab facility in pretty bad shape. He was unable to speak with me so I spoke with his wife. The man had come in after having a TIA. He was a diabetic, as well. The wife told me that she had her husband 9and herself) on a keto diet. When she saw the size my eyes got for some reason she got angry and very defensive and screamed “Forget everything you have been taught. It is all crap”. I understand when folks are worried abut their loved ones they can get pretty emotional. I asked my standard question about chew/swallowing, UBW and food allergies and quickly left. I spoke with the RD (a CDE) about what had happened. She tried to speak with the resident and his wife and got the same treatment. The RD said to me “He will have another stroke in a week”. He had one in 3 days. Unfortunately with this stroke, he got anew diagnosis of severe dysphagia. SLP tried and tried but he would aspirate on everything. He had to be pegged. He was brought back to the facility. The wife was taught how to feed him through the tube. He left the facility and passed quietly about 3 weeks later. I reached out to the wife on his second stay and we became fairly close. She said she thought she was doing the best thing for him because he was over weight. I get it. She only wanted a healthy husband. She apologized for being so quick when we met. I thanked her for actually educating me on this diet. I was not aware there was such a thing.
I recently had one of my previous cooks post that she was going to do this diet and should she start with 20 grams or 30 grams. She has been a cook in the healthcare business for about 8 years so she understands the different diets but not the physiology behind them (yet. I am trying to talk her into taking the CDM course). I told her to consult the RD at her facility before she embarks on such a trend. She won’t because all her friends posted their weight loss stories.
I feed sick people for a living. I love being a CDM. I am grateful for the time I get to spend with the RD because I always learn something.
I am not saying “Don’t!” “Don’t do this diet”. I am saying before you start if you have ANY extenuating circumstances, please consult your doctor. Better yet, consult a RD. This is what they do!
Hi Teresa,
Do you think the keto diet is what caused the diabetic husband’s strokes? Or the choking? I’m not sure I understand. I’m curious as to why. I think some folks are being rude and hard on here and I apologize for all of them. If I could tell you how good it feels, you might understand.
G
I believe the keto diet caused the TIAs, as did the RD that I worked with at the time. The choking (dysphagia) was not an issue until the second stroke .The TIA caused the aspiration. Yes, I believe it was the diet. If it works for you; Great! But this should never ever been tried on a man that was already sick, CBGs out of control and elderly to boot. The wife said she got it from a website such as yours. There should be warnings posted that this is diet is not for everyone and for goodness sake talk to a professional before jumping on the trend bandwagon. It can cause (and did) irreparable harm.
This is why we need research before we recommend a keto diet based on opinion. Thank you for sharing this comment, Teresa.
Yes, this diet needs medical professionals following you. If anyone is on a keto diet, please have them enroll in a clinical trial so that we may study its effects further. Thanks for your comment.
https://clinicaltrials.gov/ct2/show/NCT02069197
Great article! Sustainability is key and Keto diet is extremely restrictive compared to others. Many of the comments I see don’t understand the importance of many years of research before stating something has a “significant difference” than the recommendations that are already in place. Also, understanding the pro/carb/fat balance in each meal instead of focusing on just carbohydrates. We have practiced the same modified Mediterranean diet at my practice where someone can enjoy life, eat complex carbohydrates and years later they are still successful and hundreds of pounds have been lost for good 🙂 Thank you for the reminder (and the comparison of Adkins supported research).
I have been on a low carb diet for over 2 years. I was diagnosed a diabetic with a blood glucose over 400 mg/dl and an A1C of 12. I tried my doctors recommendations for about a year and took all the medications they told me to take. not much changed. they wanted to put me on insulin after a year. I told my doctor that I thought I could control my condition with diet and he said, “you are to far gone for that”.
So I fired him. 2 years, 75 pounds less, off all medications, and an average A1C of 5.7. No one can ever tell me ketosis and ketogenic diets do not work if followed correctly. It has saved my life.
I am a former earth scientist as well as a current health consultant, so it would really help me to know the answer to this question I have that keeps me up nights:
First – let’s admit that there are several different types of diets that produce dramatic improvements in weight loss and diabetes. The vegan diet is one of them (and one which also reduces risk in most other diseases better than the others) – but it is by unquestionably by far the very best diet for the environment and the survival of the planet. High protein (high meat and/or dairy) diets are absolutely TERRIBLE for the environment and are not sustainable in any way. A vegetable diet will END world hunger because we DO have enough earth to grow enough vegetables for everyone and we definitely do NOT have enough earth for meat eaters even at current levels.
So my question to all of you is: why do most people trying to improve their health appear to not care at all about how their food choices impact the earth and the future of all our children? (Not to mention the horrific conditions that the great great majority of animals bred for food endure?) Is it because you have not been told or do not believe how bad it is (our society has many many who are in total denial about global warning, for instance), or is it because you truly don’t care?
Thank you in advance for any responses! Joanna
Oh yes global warming is real and so is global cooling. About 3 years ago it was officially recognized that the earths axis has tilted a 10nth of a degree. the north pole is now pointed more towards the sun than before making the northern hemisphere warmer. It has nothing to do with mankind at all! it’s called natural and is somewhere between the last ice age and the next.
I have T2D and IBS and my blood sugar readings were degrading. I was going to have to take a second daily dose of Metformin and the first one already played havoc with the IBS. I started a low-carb diet because my T1D husband had been inspired by a podcast by Sam Harris with scientist Gary Taubes, author Why We Get Fat, Good Calories, Bad Calories and the Case Against Sugar, and started dumping the majority of his carbs a month previous. He had cut his insulin use literally in half and lost 15 pounds. He was feeling better and visibly had more energy. I was resistant to the diet and even the idea of it. I have been on Atkins and Sugar Busters and while I did fine on Sugar Busters back in the day, Atkins was too fat-based and that was the opposite of how I had been raised to think about dieting. I knew that the Diabetic diet given to me by the Diabetic Educator had never been enough and I get carby binge cravings even though it offers plenty of carbs and calories. I also knew that it’s a cycle for me-eat more carbs, want more carbs, and never really feel satisfied. On top of that, when my stomach hurts I seek carbs, and it hurts quite often. I did Weight Watchers and the Diabetic diets because they let me “cheat” and have my carbs while dieting. To be fair, just the act of tracking my food improved my outcome on either. But I got mad at WW when they upped the points for carbs on their system and made it so I couldn’t eat cake for lunch if I wanted to. Not that I made a practice of it, but it was principle of the thing. Long story short, I was pretty doubtful that I would be very successful on Atkins or Keto. To humor my husband I began a low-carb diet that started out as Atkins 20 or Keto and has morphed to more of an Atkins 30-40 for my personal comfort while using Keto, Atkins, and Paleo recipes and ultimately cutting all gluten. That means 30-40 net carbs per day, rather than per meal and a lot of natural non-processed foods. The first week was quite terrible. But even through the Keto Flu I recognized that my IBS symptoms felt better. I started to suspect that if I felt that bad just from quitting carbs that maybe there was more to the idea of sugar addiction than I wanted to believe. I’m six weeks in now and I’m losing a steady pound a week plus my sugars have dropped radically. A pound a week might not sound like much but it’s more than I’ve lost in 10 years. I have PCOS and insulin resistance so I’ve had a fasting blood sugar that ranged from 109-113 since my early twenties. It was flying high around 160-170 before the diet, now I’m reading between 119-139. Even more than that, my IBS symptoms stabilized. I’ve been tracking all my food using the free Atkins meal tracker so I started trying to narrow the foods that caused flare ups. I’m lactose intolerant but I knew that and used lactose free products or Lactaid for the cream based dishes. I had my gall bladder removed and so have always put down my symptoms to an inability to process dairy and fats. Big surprise to find that a higher fat, higher dairy diet was making my symptoms disappear. Gluten is the only common factor so far. Celiac? Just a food sensitivity? I don’t know, but that will be the next investigation. It is an investigation that I would never have thought to start on the Diabetic diet. Like the author, I’m very fond of cake and carbs. Luckily there are low-carb, no-gluten recipes for muffins and cakes. They aren’t exactly the same and some are definitely better than others, but they are out there. Plus, there is nothing wrong with having true birthday cake once a year if that is really what you need and if you don’t have a reason to avoid it, like binge symptoms or IBS flare ups. My husband let himself have a piece of cheesecake the other day and felt physically awful for two day after, plus he had to use a lot of insulin to counter the spike. It’s a pretty good deterrent. Just a side note but I had other symptoms of inflammation as well. My ankles were swelling to golf ball size and painful, it was difficult for me to stand and walk comfortably when this happened. While they haven’t stopped completely, the discomfort has gone way down as has the swelling and frequency. What’s my point? I’m not a salesman for a particular diet. Everyone is different and some people might respond very well to Keto and/or Atkins while others may not need anything that extreme. I’m not knocking the Diabetic diet. My dad lost 150 pounds 38 years ago on a very low calorie/low carb Diabetic diet that gradually increased and he has kept the weight off all this time and kept his blood sugar steady with medication, but has not had to go to insulin even at age 84. Also, he was a smoker, a diabetic, had hemochromatosis and was over 300 pounds with an apple body shape. He has had some fall out from this-he didn’t stop the smoking until a heart attack 20 years ago and that didn’t help. But he has made it to 84 and when he walked into his doctor’s office 40 years ago I’m guessing the doctor wouldn’t have put any money on that survival rate. Unfortunately, it looks like I need the lower carb version and will continue to need it to manage my symptoms. I didn’t want it, that’s for sure. But Diabetics are locked in a death struggle with Diabetes and it won’t give up just because we are tired or want our sugar. So for me, it has to be Very Low Carb for Life. Others may find they need this too and discouraging them from trying it is not doing them any favors. Hopefully I will continue to find this sustainable. I just need to keep reminding myself that I am more fond of my feet and my vision than my birthday cake.
LowCarbFTW
Hello,
would you see if you may qualify for a clinical trial? We need more information on the keto diet to think of recommending it widely to patients. There are clinical trials going on. Here is the link to one of them:
https://clinicaltrials.gov/ct2/show/NCT02069197
thank you for commenting
How interesting. I’ll take a look.
I would also like to leave this clinical trial tool here. If anyone is interested in participating in clinical trials, this link is from JDRF. These are for Type 1 Diabetes only. The tool will match you with clinical trials that you may be qualified to be a subject in.
http://www.jdrf.org/research/clinical-trials/
Just curious … have there been studies done on the current diet recommended by the ADA?
Hi – you mentioned “You will not receive enough of the recommended carbohydrates, vitamins and nutrients necessary for yourself and your growing baby on this diet.”
I’m trying to figure out what you would be talking about – since carbs are not an essential nutrient? What specific nutrients are missed for anyone (including pregnant women) by exclusively eating plants, meats, nuts, seeds, healthy fats?
I was hypoglycemic as a teen because I avoided eating most carbs because obesity and diabetes runs in my family. When I got pregnant the dietician scared the he’ll out of me by telling me I was going to starve my baby if I continued to eat like I was. I immediately added good carbs into my diet and developed grata Iona’s diabetes and had a hell of a time controlling it. After I had my baby I went back to avoiding carbs and got back from yo where I was before my pregnancy. My brother died from complications due to his diabetes and at my mothers urging I went to a dietician and talked about food and what’s healthy and what’s not. I was once again scared that I was making a grave mistake and added in the carbs, I never should have. I developed diabetes and 80+ pound weight gain. After trying like hell to control my diabetes their way I’m back to my way. I’m tired of beating myself up for not being able to “apply” their recommendations correctly and the condescending attitude of the dietician when I tried asking about my old way of eating. I know me best and that’s it.
Diabetes is a dietary disease, HERE IS THE SECRET
1. INTERMITTENT FASTING
2. KETOGENTIC DIET
THIS IS HOW I DO IT AND I KEEP MY SUGARS AT 80 AND MY AIC IS AT 5
SKIP BREAKFAST, EAT AT 12 NOON THEN EAT AT 6PM, STOP EATING AFTER 8.
The foods I eat are part of the ketogenic diet (avocado, wild caught Alaskan salmon, greens etc..)
If you follow these simple steps you never have to step foot to a doctors office.
Doctors do not fix the disease they are treating the symptom which keep bringing you back as for more copays, procedures, deductibles and expensive medication that you will need mail order because you will be taking this the rest of your life, WAKE UP PEOPLE YOU CAN SOLVE THIS ON YOUR OWN.
You mention “How healthy do you think it is for your body to be in a starvation mode, then in a feeding frenzy, making up for lost time?”
But you are not in starvation mode ever in keto. You still eat like 1500 to 3500 calories per day depending on you caloric needs.
You lower your carbs count and increase your protein and fat count to compensate, while meeting your caloric intake needs.
First I want to just say that I do appreciate that, as an educator, you were actually willing to discuss the keto way of eating.
However, it was very obvious from early on in the article that you have a bias against keto, and you let that bias reign throughout. Don’t get me wrong, I get it…we all have bias that we gain throughout our lives, and it tends to color our views of most things.
I read through the article, and then through all of the comments…and there is one thing that seemed to be your battle cry: “We need more studies, more clinical trials, and more evidence.”
I’m sorry…no we don’t. Sure, more studies will happen, and more information is always good. But, we KNOW that keto works. You can argue that all you want…but in truth, facts don’t care about your feelings. There are plenty of studies, both in groups and in individuals, that prove beyond any reasonable doubt that going on a proper keto diet WILL improve your life as a diabetic, and will often allow the person to reverse diabetes completely (type 2, obviously). Not to mention the weight loss and the myriad of other health benefits it provides.
If you had never heard of gravity…how many times would you have to fall off of something to KNOW that gravity is a thing, and that you need to take it into account? Sure, you might not understand it completely, but you KNOW that it works.
It’s the same with a keto way of eating: there is a ton of research and studies out there, and we KNOW that it works. Sure, more studies will come, and the new information will help us refine it, and we will learn how it specifically affects certain individuals in different ways…but the truth about the basics of it are all there, in the open, for all to see.
The problem is: it flies in the face of the way we have been taught. Our society (as an American), and our medical community, have preached for years that FAT is bad, and you should limit it. However, recent FACTS beg to differ. So many people rail against the keto diet because they just feel that it can’t be good…after all, you eat so much fat on it, it can’t be good for you! Facts are facts…they don’t care about your feelings. Fat is not the enemy. Sugar is.
You may ‘feel’ that the keto diet is hard to follow, and that you could never give up cake. But the truth is, for most of us, switching to keto was a life saver, and the thought of going bake to eating cake is almost repulsive.
I was diagnosed with Type 2 diabetes back in June, 2017. They wanted to put me on a special diabetic diet, and have me take two medications. I had done previous personal research into ketogenic diets. I also have a close friend who was diabetic, on meds, as well as medications for high blood pressure. He went on a ketogenic diet, and a few months later was off all of his medications.
I told the nurse that I would not take the medications, and I would manage it with diet. She looked at me skeptically, and said “I would not recommend that.”. They had me scheduled for a follow up in a month and a half, so I told her that I would do my own thing for that time, and if my numbers did not improve, we could discuss the medication further.
I went onto the ketogenic diet immediately, and within a few weeks felt much better. I had my follow up appointment as scheduled. When my numbers came in at the first appointment, in June, I had a BG of 255 and an A1C of almost 12. When I had my blood tested at the next appointment, only 6 weeks later, my BG was at 135 and my A1C was at 8.4.
The nurse looked at the numbers and said “They aren’t were we want them to be, but they have come a long way in just over a month. Just keep doing what you are doing. The medications seem to be working out well for you.”
I chuckled and said “I haven’t taken any of the medications. I’ve just changed the way I eat.”
She looked at me wide eyed and said “REALLY? That’s amazing.” She could not believe that I had changed my numbers so drastically without taking the medication.
My numbers have continued to improve, and I will never go back.
The truth is though, her reaction is part of the problem. “I can’t believe your numbers improved so drastically without taking the medication.” THAT is the main problem with our medical community. They have been taught, and most have bought into the lie, that everything is better with medication. Medication is the go to. That is why we have so many health issues in this country. Let’s eat a crappy diet because our government/medical community recommends it…and then when that diet leads to medical complications…let’s throw drugs/medication at it. Many, if not the majority, of the medical issues we have could be done away with if we actually ate as we should. But no…we want cake.
I know it is hard when you have been taught something, and believed it, and taught it to others…only to be shown that what you have been taught is not the end all be all that you were led to believe. It sucks. But, you can choose to ignore the truth, and continue to follow the incorrect path. Or, you can look at the facts, and realize that what you have been taught is not the truth…and you can take a new path, which will lead many to wonderful new lives.
Have you noticed that our obesity and diabetes have gone to epidemic levels? Have you also noticed that they started to skyrocket when we, as a nation, bought into the ‘low-fat’ way of eating? Hmmm…interesting, isn’t it.
Keto has been around longer than anyone that is currently alive. It will be around long after all of us have died. Unfortunately, many will die because they are not willing to make a few changes. Even though, for most, after making those changes, they never look back.
I truly hope, for yourself, and your patients, that you take a better look at the facts that are out there. It really is life changing.
Thank you for this comment. It is truth! I keep telling people about this diet. It is literally the best diet I have ever been on. I can eat good food, I feel full, my weight is dropping, I feel better and I can actually feel the difference. While it is great for a professional to be skeptical of emerging diet trends (and lets face it, most diet trends are garbage peddled by snake oil salesmen), this one actually has science from some prestigious institutions behind it, not a marketing scheme.
I always try to explain keto to people in more visual terms. I set it up as this:
Imagine your body is a home with a fireplace in the middle and the heat required to keep it at a comfortable\livable temp is keeping the fireplace burning at a manageable and constant pace. To do this you have two fuel-types at your disposal: Kerosene and Charcoal. (in this analogy Kerosene is carbohydrates and coal is fat). American diets are high in carbs, which is like throwing a bucket full of kerosene on that fire. Will it keep the house warm? Sure, but it burns down fast so you have to keep throwing bucket after bucket on it to keep it going, consuming tons of kerosene, and you get these huge spikes in heat. It is much harder to control the strength of the flame, and thus much harder to keep the house at a constant, comfortable temp.
Coal, on the other hand, burns evenly, and continues to burn for hours. Not only that, but it is fairly simple to adjust the amount of coal you burn to keep the house nice and warm, but not hot, for extended periods of time. The only problem is, it is kind of a hassle to get it to start burning at first (again, in the analogy we are assuming you are simply trying to light bare coal on fire, no aids). But once it is started, maintaining it is no sweat. So what is the solution? You use a tiny bit of kerosene, which lights easy and burns hot, to get the coals started (we need a few carbs, but not much).
But what I think is funny is that the keto diet has been staring us in the face forever. Look at Inuit tribes that survived off of blubber in a region that grows next to nothing most of the year. Yet their people didn’t die out or show signs of metabolic disorders or heart disease until introduced to the modern western diet that prioritizes carbohydrates over fat. Here is an interesting link, however I find the conclusion disheartening and frankly more than a little suspicious. (Basically the people in charge decided to drop the study and introduced a bunch of “what about…” questions to obfuscate a clear pattern in observation across many indigenous people from across the face of the planet and decided the outcome “wasn’t enough” to introduce into public policy…)
http://www.cardiobrief.org/2016/07/29/changes-in-eskimo-diet-linked-to-increase-in-heart-disease/
Or I should say, I am not disheartened by the conclusion of the study, but the reaction from professionals to it that amounts to basically dismissing it as a “fun” or “interesting” little study, despite literally decades of data staring them in the face… personally held biases are truly some of the hardest to break.
This was the prescribed diet for children with epilepsy in the early 20th century and for Alzheimer’s patents. Doctors of diabetic patience always prescribe a low carb diet, but they stop at 40 carbs per meal.
I have LADA (latent autoimmune diabetes in adults), something the ADA has been very slow to acknowledge. More adults get type 1 diabetes than children, yet the ADA promotes misinformation on it. Around 10% of adults diagnosed with type 2 actually have type 1. The worst part is that type 2 meds speed the progression of type 1.
I have multiple autoimmune diseases. I fought 4 doctors, all of whom told me that adults can’t get type 1. I finally went to the Jefferson Diabetes Center. Yup! Type 1 diabetes. I’m slender, do marathons, bp 100/60, triglyceride/HDL ratio 1.08. And I STILL fought 4 doctors because of the ADA misinformation. All it takes is a simple blood test to look at antibodies. That’s all it takes, but the test is almost never run.
The good news is that you can slow the progression of LADA by years. How you might ask? KETO!!!!
My endocrinologist said it can add 2 years of pancreas life. Two years! If I ever needed incentive, that’s it! I’ve been keto for 8 months now. It’s much easier than I thought it would be. I eat dessert every single day. I’d never have done that before. I simply use erythritol as my sweetener, and almond flour/coconut flour to bake with.
I forced my a1c down to 5.1 with diet alone! I’ll eventually need insulin, but keto bought me time. In addition, my RA is the best it’s ever been. My inflammation levels dropped to NORMAL, and I’ve been able to discontinue the hated methotrexate, and just use my biological alone. That’s a huge improvement in life quality.
The keto diet is NOT what you seem to picture. I laughed at your description as I was eating lamb chops, cauliflower rice, broccoli, followed by cheesecake. How deprived I was! You should relook at what the diet really is. By the way, my cardiologist highly recommends keto. Most people see a drastic decrease in their triglyceride/HDL ratio. Looking at total cholesterol or LDL alone is 20 years out of date! Even the AHA has caught up, and now says that it’s NOT how heart health should be judged.
I agree!! I too..have /had Diabetes II..at age 66 and retired RN, we were taught for so long the WRONG way to eat and I taught that way, the high carb, grains, etc, way to eat. KETO saved me. Dropped my A1C and I feel great. The author of this page is wrong when saying 5-10 percent of our diet, carb eating, should be root veggies like ‘carrots”…so wrong. For goodness sakes, get KETO right by educating yourself, Tammy Shiflet~ Horribly wrong! There are so many studies and physicians, brain scientists, etc out here who understand what this diet is about. Read, and educate yourself….Please! Diabetes is a symptom of the Government’s education mistakes. Sugar, Wheat, Grains…horrible for us. Get with it, we live in 2018 and the information is out there; if you need a list, just ask.
Sadly the childhood obesity rates of Greece and Italy are now the highest in the world.
Yes! It is hard for someone addicted to carbs and opiate mimicking lectins (gluten) to imagine living without them dominating their diet – but like all addictions there is hope. Why does bread make you fat – well that’s just the AGW lectin that mimics insulin but never lets go of the cellular insulin receptor.
I’ve been ketogenic for 5 years now and laugh when people suggest that it’s a restrictive diet – on the contrary – it’s always their diets that are both restrictive and addictive.
The aim is far broader than suggested by the article here: It’s not just about what you put in your mouth – it’s also about timing and exercise. There are three ways to be in ketosis – which simply means that “fat burning” and not being dependent on sugars. Fasting puts a man into ketosis in 3 days and a woman by 2 days. Endurance exercise gets you there in a couple of hours. Eating a high fat diet will do it too. The goal however is hidden by the detail – it is to acquire a “Flexible Metabolism”. The aim is to switch on the full fat burning capacity and keep it running – which takes from between 4 to 12 weeks physical adaptation (for the muscles to fully be able to use ketones). The heart runs approximately 27% more efficiently on ketones than on glucose! The brain works better too – Alzheimer’s being referred to by researchers as “diabetes 3”. Once you have a Flexible Metabolism you can consume carbs during or after exercise without dropping out of ketosis – though this depends on your own bio-individuality. I can eat quite a lot of carbs – without losing ketosis – my partner cannot.
You have about 160,000 Kcals of fat available to burn – producing your own glucose in the process when needed (for anaerobic bursts). In contrast you only store around 400 to 500 Kcals of glucose/glycogen ready for use so if you are not adapted to burning fat then you are physically dependent and addicted to eating carbs. When you hear of a runner “hitting the wall” it’s only because of their unnatural carb addiction – an efficient fat burning athlete can run all day and will never have this problem. The human body is specifically designed to run long distance and can outrun almost every other animal on this planet – we can even run though intense heat because we sweat.
In nature, historically, there were very few ways to store carbs – which were available only for a short time seasonally. The solution to this is that when eating the available fruit in the autumn the sugars switch off the fat burning system and then use insulin to store the sugars as body fat. Carbs signal our body to go into fat storage mode. When the carbs run out then slowly the fat burning more resumes – first of all feeding ketones to the brain and other vital organs and then eventually to the muscles.
Next time you hear an idiot doctor telling you that the brain only burns glucose – walk away!
How much research has been done on the prescribed ADA diet? The author implies more research needs to be done on a Keto way of eating but I can’t seem to find any real research that indicates the current ADA diet improves the diabetic condition.
Once I saw the following this sent up a big RED FLAG
Let me answer this very clearly, there is currently no cure for diabetes. “Once you have been diagnosed, you have it for life.”
Change your life style to include exercise, eating properly/healthy, stop making excuses and question everything the “Medical” system to include doctors and nurses tell you. Only you can take care of yourself.
Google diabetes, watch the movies, read the articles.
If you have a GOOD doctor they can assist you in the KETO diet, once again take it with a grain of salt, always question what they say and do.