A: Ketogenic diets are very low carbohydrate diets that put the body into a “fat burning state” called ketosis.
Q: Are ketogenic diets dangerous?
A: As long as you are under a doctor’s supervision, and you have the correct diet prescribed for you based on you medical history and the results of your blood work, Ketogenic diets are NOT dangerous.
Q: I heard of people with diabetes dying from ketosis. Why would I subject myself to ketosis?
A: It is a common misunderstanding (even in the medical community, you’d be surprised!) how many people mistake ketosis for ketoacidosis. Ketosis is a state in which the body, when subjected to a very low carbohydrate dietary plan, burns primarily fat instead of sugar (carbohydrates). Diabetic ketoacidosis is a state of complete insulin depletion, that is life threatening and dangerous. The only thing that these two very different states have in common is the word “keto” in their name.
Q: My blood sugars are mostly normal, but my insulin levels were high during a 2 hour glucose tolerance test. I was diagnosed with insulin resistance. What is insulin resistance?
A: It seems like the root of a lot of the health issues in diabetes (and I am mostly referring to type 2 diabetes, as type 1 diabetes is a completely different entity from a pathophysiological point of view) is insulin resistance. Insulin resistance is a state, as the name suggests, where the tissues are unable to respond to the high levels of circulating insulin. The pancreas (the organ responsible for insulin production) is making more and more insulin, but the peripheral tissues are unable to sense it. Compare this situation to a person who is trying to communicate to somebody who can’t hear. He or she, not realizing that the person in front of them can’t hear, will end up raising their voice, louder and louder, ending up screaming, in order to be heard. The same thing happens to the pancreas. It keeps making more and more insulin (screaming louder and louder) because, for whatever reason, the tissues have become “deaf” or somehow unresponsive to the current circulating increasingly higher insulin levels.
Q: What is a solution to insulin resistance that does not involve large doses of expensive medications?
A: The solution is a very low carbohydrate, high fat, high protein diet, in other words, a ketogenic diet. Even though the mechanisms are only partially understood, a low carbohydrate, high fat diet is making the hearing impaired person in front of us (as described in the previous question), the peripheral tissues unable to sense the insulin that the pancreas is generating, hear again.
Some people consider this solution miraculous.
By changing the way we eat, by lowering insulin levels and making our bodies sensitive to insulin we can heal many of the conditions that affect humanity today and some of them include diabetes and pre-diabetes.
Q: Will I be able to lose weight?
A: Yes! A very low carbohydrate diet (ketogenic) is conducive to weight loss.
Q: Will I be hungry all the time?
A: You will experience some “withdrawal” from carbohydrates symptoms the first few days after starting a low carbohydrate diet.
Q: Is a ketogenic diet good for my heart?
A: By lowering insulin levels we end up lowering the cardiovascular risk that our body is facing due to diabetes or pre-diabetes and we end up preserving our brain health. There is more and more scientific evidence that high insulin levels are associated with numerous deleterious effects. By lowering insulin levels, we end up thinner, healthier and happier!
Q: What does the term “ketogenic diet”mean in terms of amounts of carbohydrates/protein/fat?
A: A diet that limits the amount of carbohydrates to less than 40grams a day (not including the carbs that come from fiber). The calories coming from the carbohydrates should be around 10-12%. Calories coming from protein about 20% and calories coming from fat at about 68-70%.
Q: Are there certain food groups that need to be avoided completely?
A: Yes: processed foods, refined carbohydrates, sugar, grains and soy, vegetable oils, starchy vegetables, most fruit and alcohol, but the sacrifices are well worth the benefits gained for one’s health.
Q: What are acceptable food options in a ketogenic plan?
A: There are plenty of options to choose from to make a ketogenic diet fun and delicious: grass-fed beef, wild salmon, eggs, avocado, nuts and seeds, salads and olives, non-starchy vegetables, fermented sauerkraut, berries etc. These are just a few examples to make you think of the possibilities.
Q: For how long have you been in practice?
A: I am a Board Certified Endocrinologist in practice for almost 15years. I have used the ketogenic diet with excellent results in reversing diabetes/pre-diabetes/insulin resistance for many years now. For most people, it is a safe and effective way to lose weight, lower blood sugar, improve sleep, gain mental clarity and overall better health.
Q: Are ketogenic diets for everybody?
A: There is a small percentage of patients who can’t tolerate a ketogenic diet. Also, a small percentage will have an increase in the “bad’ (LDL) cholesterol and a ketogenic regime is not recommended.
Q: Why are you interested in insulin resistance?
A: This mini-book was written from a desire to help my patients who are struggling, the way I have been struggling with my weight since the birth of my daughters. Pregnancy can mark the beginning of many metabolic changes for women, and increasing levels of insulin. It’s been one of my life’s passions to diagnose and treat insulin resistance. Sometimes, in my free time, I read and listen to lectures about the possible mechanisms involved in the success of the ketogenic diet, read books about Keto recipes and try various Keto recipes on myself and my family!
Q: What resources do you recommend for further reading?
A: One of my favorite websites isdietdoctor.com. It is user friendly, practical, and very well researched. An excellent book on the topic is Dr. Matthew Runyan’s book “Conquer Type 2 Diabetes with a Ketogenic Diet: A Practical Guide for Reducing Your HBA1c and Avoiding Diabetic Complications” .
Q: Can you give some examples from real life?
A: Recently, my beautiful patient Jessica F. posted on Facebook a picture of her recent A1C. She managed to lower her hemoglobin A1C from 8.8% to 5.3%. She was beyond happy. She reversed her diabetes, through her hard work, (following a version of the Keto Diet) so she can be there for her three kids, her husband and her amazing life.
Or, take Theresa, a beautiful woman in her 50’s, with trouble sleeping, and sudden recent weight gain of 7lbs. Nobody took her seriously, since her body mass index was still within the normal range, but for her petite frame, 7lbs was a lot of weight. Again, after extensive testing (and not just your typical hemoglobin A1C screening test), it turned out Theresa was very insulin resistant. Keto diet helped her get back to her normal weight, her insulin levels went down to the optimal range and her sleep improved significantly.
Q: Some of my family members are vegetarian.
A: You will always encounter the well meaning family members and friends who will tell you that this type of high fat diet can’t possibly be good for you, that it will clog your arteries and you will have a heart attack. Nothing is further from the truth. For most people, reversing diabetes and insulin resistance ends up lowering the cholesterol levels and lowering the cardiovascular risk tremendously. Perhaps after showing your vegetarian family members the abundance of credible research backing the ketogenic diet, they too can benefit from it! There are plenty of low carbohydrate, high fat, vegetarian food sources!
As always, please consult your doctor before making any drastic changes to your diet.