The next dietitian’s objection (Dietitians Weigh in on the Low Carb/Ketogenic Diet) is:
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
This objection really stumps me. The plan is very low carb but not ketogenic? The patients can stick with very low carb but found it hard to stick with keto long term?
Not sure what the objection actually is. I answered the hard to comply question already (Objections to the Keto Diet – Part 1 – Lack of Variety).
Fortunately, the question of which diet is better has been answered in studies (Keto Diet vs Low Glycemic Index Diet). I looked at another study here (Effects of Eating Low Glycemic Index Foods on HbA1C). Here’s a third look at the same subject (Glycemic Index vs Glycemic load (Reprinted from Aug 2016)),
I tend to like the low GI and low GL approach not because it is effective enough but I like it because it gets people aware of the impact of carbohydrates on their blood sugars. They can learn for themselves what food affect their blood sugars and which foods don’t. They can then make smarter choices.
Other GI/GL Issues
Another limit with the GI/GL method is that there’s a significant person to person variability so it may be hard to generalize to a larger population. Short of individual testing of blood glucose it’s hard to know the individual impact. Here’s the study itself (Estimating the reliability of glycemic index values and potential sources of methodological and biological variability. Nirupa R Matthan Lynne M Ausman Huicui Meng Hocine Tighiouart Alice H Lichtenstein. The American Journal of Clinical Nutrition, Volume 104, Issue 4, 1 . October 2016, Pages 1004–1013).
These data indicate that there is substantial variability in individual responses to GI value determinations, demonstrating that it is unlikely to be a good approach to guiding food choices. Additionally, even in healthy individuals, glycemic status significantly contributes to the variability in GI value estimates.
Here I think the particular dietitian just needs to review the current literature. My earlier posts leaned towards low GI/GL because it does segregate food into higher and lower carb foods.