Nutritional Ketosis, Treating Type 2 Diabetes

Nutritional ketosis is a natural metabolic state in which your body adapts to burning fat rather than carbohydrates. It is clinically proven to directly reduce blood sugar (HbA1c), improve insulin sensitivity (HOMA-IR) and reduce inflammation (as measured by white blood cell count and CRP).

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Dr. Phinney answers viewer’s questions:

Q: I am interested in reversing type 2 diabetes – is a ketogenic diet recommended?? Thx! —Susie T.

Dr. Phinney’s Answer: Insulin resistance is the hallmark of type 2 diabetes and manifests as carbohydrate intolerance. Like other food intolerances, the most logical and effective approach to managing carbohydrate intolerance is to restrict sugars and starches to within the individual’s metabolic tolerance. A well-formulated ketogenic diet can not only prevent and slow down progression of type 2 diabetes, it can actually resolve all the signs and symptoms in many patients, in effect reversing the disease as long as the carbohydrate restriction is maintained.

For complete answers to this and the other questions please copy and paste this link into your address bar

Q: Appreciated your article on the concerns about prolonged fasting. Could you comment on the utility and safety of shorter durations of fasting (i.e. 16 hrs of fasting/8 hrs of eating or 20 hrs of fasting/4 hrs of eating over a period of 1 day)? —Anonymous

Q: Can you achieve this on a vegetarian diet too? A lot of people I know from India, including my wife, are vegetarian and prediabetic or T2D. I am a T1 and now on keto diet, but I am not able to convince the vegetarians to eat meat. —Anonymous

Q: Does the amount of fat I eat in a ketogenic diet interfere with my ability to burn body fat? —Marcos C.

Q: Why are blood ketone values lower in the morning than in the afternoon/evening? —Nikola S.

Q: When I started my cholesterol was fine. Now my glucose has dropped 40%, but my cholesterol is 241. Should I be worried? —Kerry J.

 Q: Since families often (and should!) eat together, is there any concern about children who are eating high fat diets at breakfast and dinner with their ketogenic parents, but higher carb foods at lunch/snacks at school? —Tera N.

 Q: What are your inflammation biomarkers? —Tekla B.

 Q: Can long-term keto diet contribute to hypothyroidism? —Sonia Z.

 Q: Why some people’s LDL goes sky high on keto diet? —Sonia Z.

Dr. Phinney: The changes we see in total and LDL cholesterol levels are much less predictable than the changes in triglycerides and HDL cholesterol. For the full answer click the link below.

Q: There is a lot of concern about protein intake and gluconeogenesis kicking people out of ketosis. As stated in your book, moderate protein is .6-1 gram/pound of lean body mass. As long as you stay within that protein range is GNG something to be concerned about? —James F.

 Q: Does Diazoxide helps in the ketone production? Thanks a lot for sharing your knowledge. Your influence is bigger than you think. —Salomon J.

 Q: Does athlete fat oxidation rate vary continuously with carb intake? Or is keto the only way to get it above 0.5g/min?—Norman T.

 Q: My daughter has high uric acid on KD, we don’t know if she did before KD, have you seen this before?—Justine L.

 Dr. Phinney: Yes, blood levels of uric acid usually double in the first week of a ketogenic diet or with fasting. This is because there is a competition between ketones and uric acid for excretion by the kidneys early in adaptation. As the adaptation process proceeds over a few months, the uric acid level comes down to normal levels even as nutritional ketosis continues, Thus this is a process of clearance (i.e., excretion), not over-production from dietary protein, and this temporary elevation in uric acid is usually harmless unless one is prone to gout. That said, the precursors of uric acid are pretty high in organ meats like liver and kidney, so if these are part of one’s diet, they should be eaten in moderation. You can learn more about keto-adaptation here.

Q: Thoughts on patients suffering from depression and/or hypothyroidism and keto diets? Also, interested in your thoughts on “The Fast Metabolism Diet” by Haylie Pomroy, which encourages a 5x/day eating plan, which includes a couple days of a keto-like diet after some carb and protein-heavy days each week over the course of a month. Thank you for what you do, sir. Appreciate your work. —Tyler S. 

Q: Love your and Dr. Volek’s low carb performance book – amongst the ‘good’ fats you talk about high-oleic safflower being acceptable (better PUFA ratio). Are high-oleic SUNflower oils OK and can you cook with them? —Chris B.

 Q: Could blood ketones, along with blood sugars, be used to fine-tune insulin dosing? Too little insulin with someone with type 1 and we get DKA. With too little insulin ketones disappear. Could we use ketone levels are consistently below 0.3mmol/L as a signal that we have too much basal insulin? —Marty K.

 Q: Does Virta know the benefit of whey protein for diabetes? Not sure in the context specifically of DM, but it is a very high quality protein source – BCAA, immunoglobulins —Salomon J.

 Q: Why NOT eat certain oils, such as safflower and sunflower oil? Do these oils impact ketosis or is it for other reasons? —India K.

Q: Can you please explain hair loss on Keto? —Jessy G.

Q: Thanks for all you do!! There are groups that advocate the potassium to sodium ratio at 4 grams to 1 gram per day. Does that fit into your view of those two. Also, is 400 milligrams of Magnesium appropriate? Thank you! My ketone level ranges from .3 to 1.2. —Mark K.

 Q: Are you looking at Cardiac Calcium Score? —Lincoln C.

 Q: Hi Dr. Phinney. I have chronic pain and take a lot of medications. Also have controlled type 2 diabetes. Do you think taking 4400mg of gabapentin a day could be why I am not losing weight that easily. I am eating under 30 grams of carbs a day and I don’t eat a lot of fat. I eat just twice a day, and only around 950-975 calories. Thank You! —Teresa R.

 Q: While someone pursuing a therapeutic ketogenic diet for the management of cancer, epilepsy, Alzheimer’s or dementia may want to reduce protein to achieve elevated ketone levels, do you think someone trying to manage diabetes or lose weight needs to consciously worry about “too much protein” or can they just follow their appetite when it comes to protein intake? —Marty K.

 Q: If you are trying to reduce saturated fat but maintain ketosis, what fat sources do you recommend? —Gail K.

For answers to the questions above please copy and paste this link into your address bar

For more information please refer to the book that Dr. Phinney and Dr. Volek co-authored the New York Times Best Selling “The New Atkins for a New You” published in March 2010. Available at

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As always, I am interested in your thoughts on these topics.

May you Live Long Healthy.

Yours truly,

Lydia Polstra


Author: 2healthyhabits

My goal in life is to experience the exuberance of true good health by returning my body to the healthy state it was meant to have.

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