In this article we will cover what a Ketogenic diet is and if you can manage your diabetes while on this diet.
This 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!
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.
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.
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!
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.
Edward, can you share your experience with Keto? Would love to hear from more people like you.
“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 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.
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.