A Dose of Dr. E: The Keto Diet: A High Fat Fad or Freaking Fabulous?

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    I follow a modified keto. What is important to remember is that no matter what eating plan you follow you need to customize it for you. One size does not fit all

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    If the long acting insulin is set correctly, I think the rapid acting insulin should be the one to decrease, which is to cover carbs/food and hyperglycemia (and not the long acting one).

    • You are right in that fast acting insulin should be used to take care of the carbs we eat, and basal is for in between meals and overnight.

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    I’m not sure your dietician is qualified to speak on the sustainability or long term effects of the ketogenic diet. I have followed this lifestyle for 3 years without difficulty. There are many healthy sugar substitutes that help. This lifestyle is great for weight loss, but more importantly it prevents insulin spikes and improves the way you feel.

    • If it works for you, that’s great. I have many other patients just like you doing extremely well. Carbs are not king!

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    Thank you for the insights into keto. A lot of info out there, but your information is clear and totally trustworthy!!

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    As a type 2 diabetic, heart disease patient, and one who struggles from weight gain, I cannot believe the Ketogenic diet could be good for anyone. Not only is it dangerous and reckless, it is extremely difficult to monitor the damage it is doing to your internal organs. Without strict monitoring from a physician, I believe it can become life threatening. Keto acidosis can become extremely dangerous, besides, as you pointed out in your discussion, one starves the brain from it’s very important nutrient, glucose. Which causes brain fog, slow recall, and a myriad of other problems not noticed, and certainly not studied. Caution!!!!

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    Please check the newer research. VIRTA Health, Stephen Phinney In California, Sarah Hallberg in Indiana and Eric Westman at Duke University. The cholesterol is very clearly explained by Dr. Jeffry Gerber and Ivor Cummins in their book Eat Rich, Live Long. I myself have been on a ketogenic diet since 2017. The results include a 100 pound weight loss, elimination of 185 units of insulin per day, discontinuation of blood pressure medication and all oral diabetes medications. I am still eating this way and feeling better than ever since my T2D diagnosis (in 2003). This way of eating is really simple and sustainable. It is not hard at all. There are people who have been doing this for over 10 years and are very healthy.

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    Hi. Dr. E asked the question about using NET Carbs as your value for carbs, but the question was not answered. So, with the Keto diet, do you use Net Carbs or Total Carbs?

    Also, why is Ketosis okay for your body, but Ketoacidosis not okay?

    Larry Nardolillo
    Diabetic since 1984.

    • Hi Larry,
      Typically people use net carbs when they’re on the keto diet, otherwise it might be impossible to stay under 20 grams a day. There’s a big difference between DKA and ketones from restricting your carbs. In the former, you do not have enough insulin, and that causes the brain to metabolize fat and cause ketoacidosis. On the keto diet, there’s not a deficiency of insulin.

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    Thanks, good info. I am T1 and have found many delicious recipes on line that I’ve tried because of the low carb factor. I am not following the diet since I dont need to lose weight, but have incorporated the recipes into our daily menus. Common sense comes into decisions too. Popular “fat bombs” and fried pork rinds just aren’t healthy, but a stuffed spaghetti squash is!

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    I am very interested in how intermitant fasting (either with or without low carb focus) and how healthy it is for Type II diabetics. The Diabetes Code by Jason Fung, MD Nephrologist claims that this will improve Blood Sugar control by first not loading carbs into system all day long and burning fat out of midsection and particularly omental/liver fat. Believes the fat choked fatty liver disease is wehre the Insulin resistance comes from. Makes great sense. There ar many variations of How long one fasts.
    Of course one needs to adjust meds to prevent hypoglycemia.
    I have cut my insulin by 2/3rds so far. Blood sugars are more even. My next A1c is scheduled for March. Weight loss is moderate but continual I was following the predictable Type II progression of weight gain, higher insulin, and higher A1c’s. I am very active and was always HUNGRY!
    What is your take?
    I highly respect your input!

    • Hi Warren,
      One thing I know for sure is that there’s no one perfect diet. It’s totally an individual choice of which diet works the best for you. Intermittent fasting and the keto diet might be perfectly fine for you, and it sounds like you’re doing well. Good luck and thanks for checking in with us.

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    Good information!

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    Been on Keto over a year and it’s not hard to do.
    My A1c is now 5.7 and my good cholesterol went up and the bad cholesterol went down.
    My doctors are very happy.

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    Finally, a registered dietitian gives the accurate picture of a keto diet! Thank you so much!!!!

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    Well done, thank you!

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    My 35 y/o T1 did keto. Lost 20 pounds and reduced his TDD by 20 units. We kept notching down the basal/bolus and only one low (forgot to eat breakfast and passed out). He boogie boards, and carries gel packs in his swim trunks. Very hard to stick to keto, cheat days weekly, but the overall weight loss and reduced insulin need is stellar. See you in Hawaii!

    Nancy and Steve

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      Mahalo for sharing your experience! Definitely an individual choice on what works best for each person.

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    Does eating lots of protein over time threaten kidney health? As a T-1 that’s why I haven’t tried the Keto diet.

    • High protein damage to the kidney has not been proven in a solid way. However, vegetable protein and white meat are supposed to be better than red meat. If your kidney function is normal then I do not think there is any risk. If your kidneys are not 100% you need to clear this with your nephrologist. For any person with T1D, short term keto is not an issue.

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    The keto diet seems to have thrown a lot of old beliefs about what to eat out the window because of its unusual combination of foods allowed and lack of others. Would it work for someone with claudication? Right now, I’m keeping to the Ornish idea of low fat eating. Also, Ornish sees no difference between “good” and “bad” fat when it comes to artery plaque. I sure would love to eat a lot of quacamole!

    • The keto diet is not for any individual that has to keep their cholesterol low, such as people with claudication, prior heart attacks, etc.

  17. I cannot view videos because they are blocked at work.
    Can you look into closed captioning future videos?
    Or perhaps offering a print version, please?

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      Hi Diana,
      We have recently started transcribing videos, so moving forward you will be able to read the text! Thanks for your comment!

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    i was diagnosed with type 2 10 days ago i had a blood sugar of 290 i had no saliva in my mouth i went to the doctor, they told me i had bs of 290 and the other h1AC like 11.4, i went on a friday, she prescribed me mdaformin and insulin, i took one pill that night, two pills the next day and a shot of insulin and then on sunday a shot of insulin i stopped taking med 2 days after diagnosis w those high numbers, i had one meal at 2-3 pm a few eggs, half avocado and salad, , maybe a small piece of salmon, ive done that for ten days now, after 3 days i was at 137 tonight im at 85 just thru keto and fasting i got off meds in 2 days and am stable under 100 thats my story hope this helps someone,,,,,,,,,,,,,

    • Testing your glucose is so important, and a very low calorie diet with low carbs. Limitations can work. Please stay in touch with your doctor, and congrats.

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        yes its been 3 weeks now saw the doc today, blood sugar 92 aic 9.2 so 290-92 and 11.4 to 9.2 in 3 weeks, thru keto and fasting, only took meds the first two days, anyway thanks for ur article, good luck

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    Since most protein is catabolized through the kidneys, is this diet not recommended for a pt with ckd, or proteinuria??

    • The old wives tale is that too much protein, especially red meat, is harmful to the kidney, but I don’t think that holds to this day. A temporary keto diet is no problem, but over the long term, I don’t think anybody knows.

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    A well intentioned doctor once advised me that I could manage Type 2 Diabetes through diet. This approach initially succeeded in lowering my fasting glucose levels. However, due to my lack of strong, sage-like willpower, I struggled to adhere consistently to the diet, leading to frequent high glucose readings. I chose to ignore other doctors’ recommendations for medication, instead imperfectly following the dietary advice of a certain doctor (whose name I won’t mention). My journey was marked by progress and setbacks, like taking four steps forward and five steps backward. I believe this inconsistency contributed to my Chronic Kidney Disease a decade later. Now, I’m on medication and have achieved my glucose targets. I’m grateful to be alive. If you find it challenging to maintain a strict diet, I urge you to consider medication. Always consult a diabetes specialist and seek second or third opinions if unsure. Remember, you are valuable, as are your organs. Apologies for my lengthy explanation. I hope my experience can help others who struggle with generic ‘lifestyle advice’ that doesn’t account for individual differences. Not everyone is ascetic; such discipline is not universal.

    • Thanks for sharing Vinny. Lifestyle choices play a role in optimizing overall health, but there are so many great medications now that can help manage diabetes in addition to other related conditions.

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