I tend to think of Dietitians as the enemy when it comes to the Low Carbohydrate/Ketogenic diet. I was surprised to see this article where 32 Dietitians (Experts Weigh In On Ketogenic Diet for Diabetes Type 2). It seems like many of the Dietitians don’t support the diet but there are a surprising number of keto supporters on that page. Even among the practitioners who don’t support the ketogenic diet there seems to be support for Lower Carb intakes as part of control of Type 2 Diabetes. Very few advocate for ad libitum eating (as much as you want).
What Were the Objections to Keto Diet?
The objections offered the keto diet listed are:
- “The challenge with the ketogenic diet is patient satisfaction and compliance. The majority of my patients … are turned off by the lack of variety and restriction.”
- “…ketogenic diets are low in fiber.”
- [ketogenic diets are a] ‘…rather unnatural way”
- “…long-term medical consequences are not yet well researched”
- “…comes with some a slew of risks. These risks can start with symptoms such as headaches, fatigue, fogginess and if left untreated, possible coma and death. There biggest risk is diabetic ketoacidosis which is the result of too many ketones in the blood, a lack of insulin and blood glucose spiking too high. Left untreated, diabetic ketoacidosis can be potentially fatal.”
- “Have I seen positive outcomes from it? Yes, though mainly with my more active population.”
- “The fear with the ketogenic diet is that it’s too low in carbohydrates, but more than that – it’s also lacking in protein, which is important in a diabetic diet.”
- “Carbohydrate foods from unprocessed or minimally processed sources provide essential nutrients, antioxidants, fiber, and help ensure a healthy gut microbiota.”
- “there is the possibility of low blood sugar, or hypoglycemia, from restricting carbs too much” (linked from one comment)
- “When you have too many ketones, you may be at risk for developing diabetic ketoacidosis (DKA). Although rare, DKA is a possibility in type 2 diabetes if ketones are too high.” (linked from same comment)
- “Ketogenic diet emphasizes on one macronutrient (Fat) while ignoring the importance of others (carb, protein and natural sources of vitamin & minerals). Thus, leading towards nutritional deficiencies if followed long term.”
- “While trying to control blood sugar levels in diabetics through ketogenic diet, one can exacerbate the symptoms of cardiovascular disorders, or may increase the risk of developing it in case of absence.”
- “I would consider suggesting the Consistent Carbohydrate Diet“
- “…my plans are very low carb and low GI/GL. I think I stay away from ketogenic for long term eating because it is hard to stick to.”
- “…though ketogenic diets [sic: short term] were found to produce the greatest weight loss compared to other diets, in the long term there was no difference”
I may tackle some of these objections to the ketogenic diet. Many of them are not supported by the science.