“I recommend low-carbohydrate and ketogenic diets to almost all my patients, from the general public to world-class Olympic athletes. A huge variety of benefits can be seen, from improvements in metabolic health and reductions in joint pains to enhanced athletic performance. While a degree of nuance is needed for specific recommendations, based on factors like general health and goals, the general principle is to reduce carbohydrates while ensuring appropriate intake of fat and protein. This addresses the key problem of insulin resistance, which is central to many modern disease states, including cardiovascular disease and type 2 diabetes.”
A low-carbohydrate diet gives slightly better control of glucose metabolism than a low-fat diet in type 2 diabetes.[12][34] A 2018 report on type 2 diabetes by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) found that a low-carbohydrate diet may not be as good as a Mediterranean diet at improving glycemic control, and that although having a healthy body weight is important, "there is no single ratio of carbohydrate, proteins, and fat intake that is optimal for every person with type 2 diabetes".[35]
Fat is an important energy source; however, it plays a secondary role as an energy substrate, particularly during exercise that exceeds moderate intensity. For example, one of the fundamental concepts of bioenergetics illustrates this point through the axiom “fat burns in a carbohydrate flame;” clearly emphasizing the important role of CHO in energy metabolism. In the absence of adequate CHO availability, as might occur during starvation, near the end of a long endurance event or CHO-restricting diet, the body must turn to an alternate source to maintain energy for all tissues. Under normal dietary conditions there is a steady supply of glucose which the body readily uses as a primary fuel.

^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
Something that makes the keto diet different from other low-carb diets is that it does not “protein-load.” Protein is not as big a part of the keto diet as fat is. Reason being: In small amounts, the body can change protein to glucose, which means if you eat too much of it, especially while in the beginning stages, it will slow down your body’s transition into ketosis.
In part, keto diet weight loss is a real thing because high-fat, low-carb diets can both help diminish hunger and boost weight loss through their hormonal effects. As described above, when we eat very little foods that supply us with carbohydrates, we release less insulin. With lower insulin levels, the body doesn’t store extra energy in the form of fat for later use, and instead is able to reach into existing fat stores for energy.

Hi Jenn, I would not recommend the medication as it is not going to address the root cause of any sort of dysfunction that may be leading to what we are seeing on the lab. When I see elevated cholesterol levels with good Triglyceride:HDL ratios, I most commonly see an underlying thyroid issue with low free T3 levels. I would want to test your thyroid in detail and you may need some additional thyroid hormone support. With very high HDL over 90, I will also see chronic infections and food sensitivities as an issue.
If you're new to keto, watch out for hidden carbs. Generally, dairy products and nuts are a good way to meet your daily fat intake, but know that some of those items may contain more carbohydrates than you think. For example, yogurt topped with nuts may seem like a great keto-friendly snack, but a 5.3 ounce serving of plain yogurt has 12 grams of carbohydrates. Vanilla flavored yogurt has 24 grams of carbohydrates. Add an ounce of cashews, weighing in at nearly nine grams of carbs, and you’re up to 21 to 33 grams of carbs for that snack, which could knock you out of ketosis. Be sure to read nutrition labels carefully and pay careful attention to serving sizes. Track foods using a keto-specific app like Senza or KetoDiet can help you stay within your recommended daily carb intake.
“I have been applying low carb solutions to metabolic problems since the moment I closed the cover of Good Calories, Bad Calories. I share with my low-carb colleagues the wonderful experience of offering effective advice and seeing real results. In addition to metabolic and hormonal problems, I have more recently focused on flexible low-carb approaches for Alzheimer’s and other neurodegenerative conditions. I greatly enjoy the lively online low-carb community and rely on Diet Doctor as a resource for myself and my patients.”

One of the primary culprits of chronic inflammation in our society is a poor diet full of sugars and processed vegetable oils. In fact, blood sugar and measurements of insulin resistance are a much more accurate predictor of heart disease risk. I often look at values such as fasting glucose, HbA1c, and fasting insulin as a means of determining the inflammatory state of someone’s body.
The average daily goal for keto is 20 grams of net carbs. Net carbs are the total carbs in a given serving of food, minus the carbohydrates that are supplied by fiber. You’ll find carb grams quickly add up, even when you’re choosing the best low-carb foods, like spinach and avocado. Keeping your body in a quasi-keto state can be hard on you, warns Santo: “This will leave you feeling sluggish, foggy, and discouraged,” he says. “It will most likely cause a weight plateau, and maybe even weight gain.” Here’s what it’s really like to be on a keto diet.
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