“If someone with diabetes is [taking insulin or oral type 2 meds in the sulfonylurea or meglitinide class and is] following this diet, they need to know that their blood sugar can drop really quickly, so it’s critical that they check it more frequently,” says Toby Smithson, MS, RDN, CDE, author of Diabetes Meal Planning & Nutrition for Dummies. “Don’t wait for it to happen. Meet with your doctor or diabetes educator in advance so that you can troubleshoot exactly what to do if your blood sugar drops.” If it’s an infrequent occurrence, you may be advised to treat with fast-acting glucose. But frequent lows may require medication adjustments or the addition of more carbs to your eating plan.
Even in endurance sports that don’t require sprinting, ketogenic-style diets are disadvantageous according to a ketogenic diet and exercise article published in Sports Medicine[5]: “a high-fat, low-carbohydrate ketogenic diet may impair exercise performance via reducing the capacity to utilize carbohydrates, which forms a key fuel source for skeletal muscle during intense endurance-type exercise.” The article concluded, “At present there are no data available to suggest that ingestion of ketone bodies during exercise improves athletes’ performance under conditions where evidence-based nutritional strategies are applied appropriately.”
I have great respect for Harvard Medical School. I notice that they support their readers posting comments and I am most appreciative of the article and all the many thoughtful comments by the readers. The readers seem to have the most expertise here and I hope that the doctor who wrote the article will think long and hard about the comments by readers. After 35 years of clinical practice in mental health, I notice that all issues of emotion involve medical issues, nutrition, and the gut bacteria. I would say that these issues and all of the executive brain functions seem to improve with ketogenic principles. For those that apply it in a flexible and smart manner, it appears to improve every area of their lives. I strongly encourage the author of the article to take one class via The Institute for Functional Medicine. If he is open to more learning he can take more classes and get certified. I’m sure a fine doctor, he will be an even better doctor and personally healthier, if he gets more training. Are we all open to new learning(especially us healthcare providers)?
Forget the heavy casserole recipes and try this low-carb pot pie tonight! Nothing says comfort food like a chicken pot pie. This low-carb pot pie recipe skips the traditional gluten-filled dough of chicken pot pies and replaces it with cauliflower for a more low-carb option. I simply suggest switching out the cornstarch with arrowroot or tapioca starch.
The ketogenic diet may seem like the latest weight-loss craze, but it’s actually been around for nearly a century. Developed in the 1920s, this ultra-low-carb, high-fat eating plan was originally used to treat seizures in people with epilepsy. Today, it’s getting some serious attention for an entirely different reason. “There’s growing research showing that the ketogenic diet is effective for managing blood sugar in people with diabetes,” says William Yancy, MD, program director at the Duke Diet and Fitness Center in Durham, North Carolina. “However, because we don’t have studies [lasting] longer than two or three years, we don’t know what can happen with regard to complications over longer periods of time.”

Meanwhile, more than 70 trials have examined the health effects of a low-carb diet. They attest to the benefits64 associated with ketosis and low-carb diets, including a reduction in body weight and body mass index, improved cardiovascular risk factors including blood pressure, and the reversal of Type 2 diabetes. It is virtually impossible to imagine that a diet with so many health improvements in the ‘near term’ (2 years) could ultimately shorten life—and the study authors offer no possible mechanism to explain how this might happen.
The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[5]
Our human ancestors did not consume high-fat, low-carbohydrate diets and therefore would not have been in diet-induced ketosis. Even the most successful early hunters could not possibly have consumed enough fat to enter ketosis since african wildlife such as wildebeests, warthogs and impalas all have low body fat – well under 10%, and as low as 0.3%[6] in the dry season.
One of the most-cited worries about the keto diet is the long-term impact it may have on heart health—especially because people with diabetes are at greater risk for heart disease. In the small Diabetic Medicine study that found people with type 1 improved their A1Cs on a keto diet, participants had higher triglycerides and LDL (“bad”) cholesterol. This raises concerns about the diet’s longer-term heart health implications, as do the results of research published last year in The Lancet. That study followed more than 15,000 adults for 25 years and found that people who consumed less than 40 percent of their calories from carbohydrates were significantly more likely to die from heart disease than those whose diets contained 50 to 55 percent of calories from carbs—especially if the foods that replaced those carbs were rich in animal fats and proteins.
Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more
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