The purpose of this study was to evaluate the effects of a low-carbohydrate, ketogenic diet (LCKD) in overweight and obese patients with type 2 diabetes over 16 weeks. Specifically, we wanted to learn the diet's effects on glycemia and diabetes medication use in outpatients who prepared (or bought) their own meals. In a previous article, we reported the results observed in 7 individuals [10]; this report includes data from those 7 individuals along with data from additional participants enrolled subsequently.
In addition, on the day the diet was initiated, diabetes medications were reduced – generally, insulin doses were halved, and sulfonylurea doses were halved or discontinued. Due to the possible diuretic effects of the diet soon after initiation, diuretic medications were discontinued if of low dosage (up to 25 mg of hydrochlorothiazide or 20 mg of furosemide) or halved if of higher dosage. Participants were also instructed to take a standard multivitamin and drink 6–8 glasses of water daily, and were encouraged to exercise aerobically for 30 minutes at least three times per week.
After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[18] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[45]
Foods that are low in carbohydrates are a smart choice for people who have certain medical conditions. Carbohydrates are broken down by the digestive system as sugar, which makes high-carb foods a risky bet for diabetic patients. Low-carb pasta is less likely to cause blood sugar spikes than regular pasta since its carbohydrate content is made up mostly of fiber, which the body does not convert into glucose. Of course, if you have any condition that affects your diet, you should always consult with your doctor before consuming new foods.
Haven’t ever really eaten turnips? It’s time to give them a second look. They’re inexpensive and their natural sweetness makes them seem like a real treat. Leave the skins on the turnips before roasting to make this already super-easy recipe even quicker. Try them alongside your favorite burger or sandwich recipe for a fry that’s a vegetable in disguise.
These didn’t come out right but that was my fault. I didn’t have a large enough baking pan so that my silpat would lie flat which caused the batter to pool in the middle and it took a long time to cook (11 minutes) and I had to keep pulling it out of the oven, cutting off the cooked part, etc. Having said that, they were pretty good even though some of them were kind of thick. I made beef and noodles and simmered the noodles in the crockpot on low for about 20 minutes. I ordered a new pan and will try this recipe again because I think it will be good if made correctly. Also, I doubled the recipe 2 oz of cream cheese, 4 eggs, and 1/2 tsp of vital wheat gluten. Thanks so much for posting..
If you are trying to get the kids to eat healthier and not rely on sugary cereals you might find this keto one will win them over. It has a great texture from the nuts and seeds and has a sweet warming flavor from the cinnamon and sweetener. This cereal is great with your choice of milk or can be made a bit more filling by adding in some fresh berries.
Thanks so much for sharing your results. You look so good, and you have inspired me to try a more structured version of the Keto Diet. I lost some weight recently on HCG 2.0, which puts you into ketosis (keto flu and all!). I have tried to maintain my weight loss with a version of the Keto Diet, but I know that I am probably still eating too many carbs and not enough fat. I am 47, and I contine to have issues with keeping the weight off despite a healthy diet and exercise. I am sure it is hormone-related.
Almond flour recipes typically require more eggs and more leavening agent to help them rise properly. I also like to add a little dry protein, like whey protein powder, as I find this can help [with rising?].  Almond flour recipes may also contain less oil and liquid as well, to account for the high fat content of the nuts. In my experience, low carb, gluten-free batters are thicker than their conventional counterparts. Resist the urge to thin them out, as you may end up with a soggy mess.
I greased the inside of the mould with melted butter first making sure I didn’t miss the cone or donut hole. I baked in a foster oven until there were 5 mins left. 3.25° for 30mins. When 5 mins were left I turned off the oven and let them sit in the remaining heat for 5 mins. Took them out and set them to cool for a while. Once they were cool I turned them over on to wax paper and they came out no problem nothing stuck even the donut hole.

At Diet Doctor, we believe many people may do best starting out on a strict keto diet. This will give you the best idea of whether you like how you feel, how it impacts you and what sort of results you get. Then, as you hopefully achieve your health and weight goals, you can decide whether to add more carbs back into your diet to a level where you feel your best and can maintain your health goals.

Almond flour is a great low carb pasta alternative. It contains 1.6 grams of carbohydrates and 1.6 grams of dietary fiber, resulting in zero net carbs[*]. White, bleached, enriched flour contains over 76 grams of total carbohydrates with only 2 grams of fiber[*]. Almonds are also an excellent source of healthy fats, vitamin E, manganese and magnesium[*].
i made these for my husband and me today. I used a blue silicone donut pan that i purchased from amazon. I followed the recipe exactly. I oiled the pan with coconut oil. I let the batter sit for 10 minutes before putting it in pan, like one of the other comments suggested. I let it cool for 20 minutes and they came right out…perfect. He had one at 3:00 and just now another at 9:00. He’s not happy about being on keto most days, but his comment after eating both times was: good, very very good! Thank you so much for sharing your life and time with us.
I don’t make pancakes often and never waffles, but I have definitely used it for the crepes A LOT. The key to the crepes is that the liquid is super thin–like cake mix, not like brownie mix. The xantham gum is really not a huge amount for the full recipe. It is under 1 TBSP per cup of other dry ingredients. Let me know if you like it better with the wheat gluten. Thanks for writing!
I am a recent convert to using freeze-dried fruit and if you try this amazing crunchy granola you will see why. The fruit has a much more intense flavor than fresh berries and helps to add that fruity note to the nuts and coconut flakes. It also makes this cereal more child-friendly because the fruit turns the milk pink! This granola can also be formed into bars to give you a boost of energy through the day.
First, you DO NOT need a silica mat. I made these in a huge oven-safe frying pan sprayed liberally with cooking spray and it worked great. After the five minutes cooking time, I took the pan out of the oven and just let it sit. Everything firmed up nicely, I lifted one edge of the “noodle” and the whole thing peeled out beautifully. I rolled it up and sliced into fettucine and it worked AWESOME. I also added a pinch of Kosher salt, a pinch of black pepper, and a half pinch of garlic powder to the batter. ABSOLUTELY PERFECT. These are NOODLES folks, not slimy oddly-textured whatever-the-hecks, but real noodles. The texture is just right. These are what I’ve been looking for forever. God bless you for this!!!!!. We’re having pot roast for dinner, and while my girls have noodles with their sauce, SO WILL I!!!!!!
Everyone responds to different levels of carbs, fat, and protein differently. It’s not enough to just eat what you think is a low amount of carbohydrates. Your metabolic history, daily activities, or any other factor may mean you can only tolerate 25 grams of carbs per day before getting kicked out of ketosis whereas someone else can tolerate up to 100 grams of carbs per day.
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[18]
Consequently, when you begin a ketogenic diet, it acts as a metabolic stressor on the body. In the process of relearning how to burn fat for energy, a mild metabolic stress is inflicted upon your mitochondria. This stress is just powerful enough to kill off old and dysfunctional mitochondria which stimulates the growth of new and more powerful mitochondria (5). The end result is more energy and a higher level of vitality.
Participants returned every other week for 16 weeks for further diet counseling and medication adjustment. When a participant neared half the weight loss goal or experienced cravings, he or she was advised to increase carbohydrate intake by approximately 5 g per day each week as long as weight loss continued. Participants could choose 5 g carbohydrate portions from one of the following foods each week: salad vegetables, low-carbohydrate vegetables, hard or soft cheese, nuts, or low-carbohydrate snacks. Diabetes medication adjustment was based on twice daily glucometer readings and hypoglycemic episodes, while diuretic and other anti-hypertensive medication adjustments were based on orthostatic symptoms, blood pressure, and lower extremity edema.
When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks.[17] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness.[19] The level of parental education and commitment required is higher than with medication.[44]
Made these donuts this morning, and they are delicious. The simplest and one of the best low carb donut recipes that I have tried. I did add a scoop of whey protein powder for structure, and that worked great. I used Swerve in the donuts and a small amount of Truvia (which contains a little sugar–but okay in this tiny amount per donut) for the topping. I got 8 donuts out of the recipe, but I think I actually could’ve gotten 10. I have two 6-cavity nonstick Wilton donut pans like the ones pictured in your link. Great recipe, Maya. Thanks!
Try to replace all soda and juice consumption with something that has no sugar or only trace amounts of sugar. Switch out fruit juices for low-carb smoothies and tea. Tea comes in a variety of flavors that can help you get through the day if you get tired of water. There are a variety of different smoothies you can make for a meal replacement or as a quick snack as well.
If you’re new or just still learning the ropes for the keto diet food list, your biggest questions probably revolve around figuring out just what high-fat low-carb foods you can eat on such a low-carb, ketogenic diet. Overall, remember that the bulk of calories on the keto diet are from foods that are high in natural fats along with a moderate amount of foods with protein. Those that are severely restricted are all foods that provide lots of carbs, even kinds that are normally thought of as “healthy,” like whole grains, for example.
Here are a few of the most common side effects that I come across when people first start keto. Frequently the issues relate to dehydration or lack of micronutrients (vitamins) in the body. Make sure that you’re drinking enough water (close to a gallon a day) and eating foods with good sources of micronutrients. To read more on micronutrients, click here >

The most common and relatively minor short-term side effects of ketogenic diet include a collection of symptoms like nausea, vomiting, headache, fatigue, dizziness, insomnia, difficulty in exercise tolerance, and constipation, sometimes referred to as keto flu. These symptoms resolve in a few days to few weeks. Ensuring adequate fluid and electrolyte intake can help counter some of these symptoms. Long-term adverse effects include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.


I bought this as an alternative to the Medi-Fast Oatmeals. This one has similar caloric, protein, fat, and carb content, with lots of vitamins, without the price tag you get with MediFast. I liked the taste of it and will buy it again as a result. The nutritional content is better than any of the Quaker Oats products involving Oatmeal, and for someone who is constantly battling obesity, having a thick bowl of oatmeal is a welcome addition to my diet.
If you are trying to get the kids to eat healthier and not rely on sugary cereals you might find this keto one will win them over. It has a great texture from the nuts and seeds and has a sweet warming flavor from the cinnamon and sweetener. This cereal is great with your choice of milk or can be made a bit more filling by adding in some fresh berries.
One of the central questions new adherents to the ketogenic diet must answer is whether or not they want to incorporate meat into their new diet. It is entirely possible to consume adequate levels of healthy fats whether you approach the diet as an omnivore or a vegetarian, so this decision is largely a personal one. However, if you choose to incorporate meat into your version of the ketogenic diet, it is crucial to ensure it is grass-fed, organic, and free of antibiotics. Furthermore, it is important to focus primarily on above-ground leafy vegetables, with meat serving as a side dish. An example of the perfect plate for a keto omnivore would be a sizeable portion of colorful, above-ground leafy vegetables covered with a healthy fat like olive oil, paired with a 3-5 oz serving of high-quality meat.

Since your carbohydrate intake will be restricted, you'll have to rely more on healthy fats, like nuts, seeds, and avocados, for energy. You can also use oil, butter, and nut butters in your cooking to enhance the flavor and richness of dishes. In general, an appropriate serving of healthy fat is roughly the size of your thumb, though you can safely have a little bit more or less depending on your hunger and energy requirements.
It sounds like the bread needed to bake for longer. Sinking is the first tell-tale sign that it was not finished baking. Even when it passes the toothpick test, the top should get very crusty before removing from the oven. I’ve found that even with the same oven and correct calibration, the exact baking time can vary a bit. Unfortunately, it will not work the same way if you take the bread out, let it cool, cut it, and return it to the oven afterward.

The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[43] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]
Weight loss is a common target for disease management, as well as health promotion. The prevalence of obesity remains high among U.S. adults (36.5%) (5), as well as children and adolescents (17%) (6). Importantly, obesity is a significant contributor to increased morbidity and mortality, as well as being a primary driver of increasing medical expenses (4). Despite much effort and cost, there has been little success on this front and obesity remains a public health crisis.
I have never made waffles with this mix as we don’t make waffles. However, I would think it would be similar to pancakes, which I have made. Did you use 1/4 cup of Xantham gum? More than this seems to make a pastier batter. When making pancakes, I found that I needed to batter to be way thicker than most pancake batters. I also found that I needed more eggs. As for what else this mix can be used for, I have recipes at the blog for cookies, cupcakes, biscuits, and crepes using this mix. I have dozens of recipes in various stages of testing that use this mix. Some of my favorites are quick breads and muffins and cookies. Cake type recipes (muffins, small loaves of bread, cupcakes, cake, etc.) really turn out well with this mix. Let me know how some other dishes turn out for you! Thanks!
Hi Maya. I LOVE your site!! Interesting, informative with fab recipes and ideas. Hubby and I have just started eating low carb and I have to say, we are not finding it too difficult and I already feel sooo much better!! I find the hardest part is choosing low carb veg, I feel as if we are not eating enough. Any suggestions on how to get more veggies into our diet?
In contrast with standard pastas, the nutritional profile of low-carb pastas varies widely from brand to brand. There are options made using black beans, edamame, chickpeas, and other beans. Legume-based noodles may have a slightly higher carb count, but they contain a good amount of fiber and protein to keep you full and energized. Shirataki noodles are made using the root of the Asian konjac plant and are virtually calorie-free. They don't, however, offer as much of a nutritional kick as other options.

Moreover, two recent meta-analyses sought to investigate the effect of LCD on weight loss and cardiovascular disease risk. Sackner-Bernstein et al. (19) compared LCD to LF, among overweight and obese men and women. The authors found a significantly greater effect of weight loss in the LCD vs. the LF diets (-8.2 kg vs. -5.9 kg). The impact of diet on cardiovascular risk factors was split, with LCD resulting in significantly greater improvements in HDL cholesterol and triglycerides, while the LF resulted in significantly greater improvements in LDL and total cholesterol. From this the authors concluded that LCD were a viable alternative to LF diets and recommended “dietary recommendations for weight loss should be revisited to consider this additional evidence of the benefits of [low] CHO diets.” A significant limitation of this meta-analysis, however, was the authors’ definition of low-carbohydrate as a daily CHO consumption less than 120 grams. This value, while well below the standard recommendation of daily CHO consumption, still far exceeds the strict recommendation of KD (≤50 g/day), therefore the results of this meta-analysis must be approached with caution.
The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy.[26][27] It is approved by national clinical guidelines in Scotland,[27] England, and Wales[26] and reimbursed by nearly all US insurance companies.[28] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][29] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[5][30]
Almond flour recipes typically require more eggs and more leavening agent to help them rise properly. I also like to add a little dry protein, like whey protein powder, as I find this can help [with rising?].  Almond flour recipes may also contain less oil and liquid as well, to account for the high fat content of the nuts. In my experience, low carb, gluten-free batters are thicker than their conventional counterparts. Resist the urge to thin them out, as you may end up with a soggy mess.
My keto breakfast recipes are low carb, full of flavor, and perfect for you to grab and go during a busy morning. Don’t even think about skipping breakfast on the keto diet, you need to start the day with some fuel, and my low carb breakfast ideas and the best way to start the day off right. From my take on a sausage McMuffin sandwich to Starbuck’s egg bites, I have many keto breakfast ideas for you to make at home.
If you are wondering what the heck a daikon radish is, don’t worry, I was in the same boat this time last year. My first experience with daikon radish was in my CSA box. I actually got a purple daikon radish and had absolutely no idea what to do with it. So I pulled out all my cookbooks and found a recipe in my Inspiralize Everything cookbook (affiliate link).

I was a vread and sweet person as well. Once you start you will not believe that you don’t crave those things. It was not hard as I thought but what helped with the lack of cravings is starting my day with the coffee, ghee and tablespoon of coconut/mct oil. I don’t do heavey cream . Once you begin youll see thats the least worry you will have. You can do it
My children are on a low carb diet but have the occasional treat with Dad and friends with parties etc. I’m undecided on keto for children unless the child wasn’t having success losing weight on a low carb diet. I think it would be best to speak to his pediatrician if he does have a lot of weight to lose. I can say being on keto does help with sugar and carb cravings more than anything I’ve ever tried. My friend Maria from Mariabodymindhealth.com has her children on keto 100% of the time.
I think I might have been in ketosis sooner but after 1 month I took my blood test at night and I was surely in and I had felt all the good effects of it too, like no hunger between meals etc. It wasn’t difficult to reduce the carbs to 20 net because you’re replacing it with good healthy fat which is so filling. I think my body likes to hold on to the fat as stubbornly as yours and I agree stress doesn’t help, but I have always been a slow loser. I’d suggest taking measurements and body fat and pictures so you can see the difference. If you really think you’re not progressing you may have to reduce calories too.
The goal of the KD is to sufficiently deprive the body of CHO to achieve physiological or “nutritional ketosis,” a metabolic state which is characterized by blood ketone levels between 0.5 and 3.0 mmol/L (26). This “switch over” point, however, is not seamless and may take up to several weeks for individuals to become “keto adapted” (18). Supporting this idea is a significant amount evidence indicating that a “keto adapted” body has little reliance on glucose for CNS function (8,14,16) or as a source of energy for exercise (17,18,25,27).
From an outpatient clinic, we recruited 28 overweight participants with type 2 diabetes for a 16-week single-arm pilot diet intervention trial. We provided LCKD counseling, with an initial goal of <20 g carbohydrate/day, while reducing diabetes medication dosages at diet initiation. Participants returned every other week for measurements, counseling, and further medication adjustment. The primary outcome was hemoglobin A1c.
Over the long-term the KD poses possible risks as well, although the evidence remains unclear on this topic. Consumption of a high fat diet, particularly saturated fat, is associated with increased cardiovascular risk (23) and consumption of saturated fat has been shown to acutely induce insulin resistance and raise blood triglyceride levels (12). Nevertheless, many KD studies have documented improvements in markers of cardiovascular risk, including improvements in vascular function (24) reduction in inflammatory markers (10), and other markers of cardiovascular health (13,20). Methodological issues, such as clear definitions of dietary interventions, may play a significant role in obscuring the underlying principles, however, it is clear that more targeted research is warranted.
I doubled the recipe because I knew I was going to double the soup recipe. I will say that the first batch had a few issues but the 2nd batch turned out great!! On the second batch I let them bake for about a minute and then I opened the oven and king of tilted the pan around a bit to make the batter spread out more evenly because either it just wants to pool together (I did use silpat and a heavy duty cookie sheet) or my oven isn’t level. That second batch turned out perfect!!!

Hi! My donuts are in the oven right now, but they are spreading too much & not rising. Almost running off the donut pan. I only filled them 3/4 full as you show in the video. I doubled the recipe using the above calculator. I know I followed it exactly. Any idea of what I did wrong? The batter tasted yummy and so did the finished product, the donuts just weren’t as pretty as yours.
However, replacing high carb flours like all-purpose flour, wheat flour, corn flour, and rice flour with low-carb flour is not as simple as just using one for the other. Due to the difference in composition between high-carb and low-carb flours, you will need to use different amounts of low-carb flour together with other essential ingredients that you don’t typically find in traditional baking recipes like psyllium husk, xanthan gum, and protein powder.
Made the bread but it didn’t rise and it is probably my fault. My almond flour is stored in the freezer. I probably should have let it come to room temperature first. I watched the video and the loaf shown seems to be narrower than the pan I used. The texture is good. The taste isn’t bad. I just need a “taller” bread to make my husband paninis. Anything you can tell me will be appreciated.
I began my low carb diet (around 50 net per day) almost 3 months ago. I have only lost 2 lbs. I need to lose at least 30. I am 62 years old and in good health. Everything I have read leads me to believe that I am doing everything correctly. I even make my own Keto bagels! What do you think could be the issue? I tried going down to less than 20 carbs but I just cannot do it. Thanks for any help you can provide.
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)?
If you are trying to get the kids to eat healthier and not rely on sugary cereals you might find this keto one will win them over. It has a great texture from the nuts and seeds and has a sweet warming flavor from the cinnamon and sweetener. This cereal is great with your choice of milk or can be made a bit more filling by adding in some fresh berries.
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