Ketosis and the Ketogenic Diet: Debunking 7 Misleading Statements
Let’s face it.
The ketogenic diet is arguably the most popular
dietary trend in our world today.
Especially for those living with diabetes,
it’s likely that you’ve been tempted to follow
ketogenic diet to lose weight, drop your A1c,
and flatline your blood glucose.
Even though it
may seem tempting to enter the metabolic state
of ketosis, it’s important to understand the
caveats of ketosis so that you fully understand
your risks for developing long term
What exactly is ketosis and why is ketosis
a popular recommendation for those
living with diabetes?
A ketogenic diet is a very low-carbohydrate
diet by design, containing a
maximum of 30 grams of dietary carbohydrate
At the base of the ketogenic food
pyramid are eggs, dairy, meat, oil, and fish,
which make up the bulk of calories eaten.
starchy vegetables contain too much carbohydrate
energy and are avoided, while not starchy
vegetables (or green vegetables) are included,
along with nuts, seeds, and a very limited
amount of fruit – mainly berries.
Now, the ketogenic diet explicitly prohibits
of grain products (even whole grains), as
well as pasta, refined sugar, milk, corn,
(including lentils, beans, and peas), as well
When you eat ketogenic diet your muscles
and liver switch from oxidizing glucose as
their primary fuel to fatty acids as their
And in order to withstand a very low carbohydrate
intake, your liver manufactures ketone
bodies as an emergency backup fuel for your
brain when the state of ketosis.
If you’re living
with diabetes, this may sound like a great
idea because your pancreas is provided with
opportunity to reduce insulin production,
due to low carbohydrate intake.
Now millions of
people around the world who eat a ketogenic
diet achieve a flatline blood glucose profile
greatly reduce or eliminate their need for
oral medication and insulin.
If you’ve experienced this
yourself, you may be thinking, “Great I solved
Eating a ketogenic diet is keeping
my blood glucose in control and therefore
my diabetes health is going up.”
In addition, the
state of ketosis induces a number of short-term
benefits including rapid weight loss, reduced
fasting glucose, reduced post-meal blood glucose,
reduced A1c, reduced total cholesterol,
reduced LDL cholesterol, and flatline blood
The problem is that eating a ketogenic diet
significantly increases your risk for chronic
disease and premature death in the long-term.
researching the advice from the top ketosis
gurus we made a list of the seven biggest
dangerous) misconceptions about ketogenic
In this video we’ll go into detail about the
truth underlying ketosis and refute many common
statements backed by misleading science,
incorrect biochemistry, and a fundamental
lack of understanding of human biology.
Misconception #1: “Insulin is your fat storage
Now you may have heard people in
the ketogenic community refer to insulin as
your fat storage hormone, and that by adopting
very low-carbohydrate diet, you prevent your
blood glucose from spiking after a meal.
hold on a second.
Open any biology textbook and you’ll find
that the PRIMARY function of
insulin is to help glucose exit your blood
and enter tissues, but that insulin ALSO helps
acids and amino acids exit your blood and
It is absolutely critical to understand
that the primary function of insulin is to
help transport GLUCOSE out of your blood and
tissues and the secondary effect of insulin
is to help transport fatty acids and amino
acids out of
your blood and into tissues.
Simply because insulin has the ability to
transport fat into tissues
does not mean that it’s factually correct
to label insulin as your “fat storage hormone.
This is a
gross exaggeration of the actual role of insulin
and is meant to scare people into believing
any amount of insulin in circulation will
make you fat.
Now insulin triggers macronutrient
uptake in this order.
Priority #1: Insulin transports glucose into
tissues to either be burned for
energy or to be stored as glycogen for later
Priority #2: Insulin transports fatty acids
tissues to be immediately burned for energy
or to be stored as triglyceride for later
#3: Insulin transports amino acids into tissues
to be synthesised into new protein, to be
for energy, or to be converted into other
Understanding this insulin priority
hierarchy is very important because it reinforces
the concept that insulin’s primary role is
handle all things related to glucose metabolism
BEFORE it begins directing fatty acids and
amino acids into tissues.
Now insulin is the most powerful anabolic
hormone in your body,
meaning that it promotes more growth and more
fuel storage than any other hormone, and
ketogenic dieters exaggerate this fact, condemning
insulin entirely, claiming that even small
amounts of insulin will make you fat.
Fact: Insulin is the most anabolic hormone
in your body,
responsible for more fuel storage and cell
growth than any hormone in your body.
promotes more growth than testosterone.
Fact: Insulin promotes more growth than estrogen.
Fact: Insulin promotes more growth than growth
Fact: Insulin promotes more growth
The truth is that all mammals secrete insulin
because insulin is absolutely REQUIRED
Your dog secretes insulin.
Your pet hamster secretes insulin.
Your neighbor’s cat
Monkeys secrete insulin.
Racoons secrete insulin.
Your non-diabetic co-worker
In fact, insulin is so important that if your
body stops manufacturing it, you die.
Without insulin your dog would die.
Your pet hamster would die.
Your neighbor’s cat would die.
Your non-diabetic co-worker would die.
In truth, a physiologically normal amount
of insulin is
absolutely required to stay alive.
But secreting or injecting EXCESS insulin
is what substantially
increases your risk for coronary artery disease,
atherosclerosis, and cardiovascular disease
Ketosis Misconception #2: “Eating carbohydrates
spikes your blood glucose.”
Proponents of the ketogenic diet often argue
that eating any food containing carbohydrate
energy will spike your blood glucose and that
the only way to avoid dangerous blood glucose
spikes is to avoid carbohydrate-rich foods.
Technically speaking, when you eat carbohydrate-
rich food, your blood glucose will rise.
Furthermore, reducing your carbohydrate intake
keep your blood glucose more stable.
For these reasons ketogenic dieters maintain
carbohydrate intake less than 30 grams per
day, representing less than 10% of total calories
What those in ketosis don’t understand is
that the amount of glucose in your blood is
not only determined by the amount of carbohydrate
that you eat, but instead a reflection of
BOTH your dietary carbohydrate AND your dietary
Now we have written extensively
about the detrimental role that excess dietary
fat plays in the development of insulin
resistance, leading to high blood glucose,
increased insulin requirements, high cholesterol,
cell death, and increased risk for many chronic
It’s important to understand that only
paying attention to how much carbohydrate
you eat will mislead you into thinking that
single macronutrient controls your entire
blood glucose profile, when in reality your
glucose is determined primarily by how much
fat you eat and secondarily by the amount
carbohydrate that you eat.
To understand how your blood glucose responds
macronutrient profiles, let’s explore how
a ketogenic diet, a Standard American Diet
and a low-
fat, plant-based, whole-food diet affect your
When operating in a high-fat
ecosystem on a ketogenic diet, the primary
reason why your blood glucose remains flat
because of the near absence of carbohydrate-rich
In this way, eating a high-fat diet is
very effective at flatlining your blood glucose,
because carbohydrates are kept below 30 grams
As long as you avoid carbohydrate-rich foods,
your blood glucose is likely to stay very
But the minute you choose to eat carbohydrate-rich
foods such as a banana, a potato, a
bowl of quinoa, your blood glucose is likely
to increase significantly due to a hidden
fatty acid-induced insulin resistance.
Now the Standard American Diet is a perfect
example of a
diet that is high in both carbohydrate and
high and fat, which increases your risk for
glucose, insulin resistance, and diabetes.
Because both fat and carbohydrate are present
large quantities, controlling your blood glucose
becomes increasingly difficult over time.
because a low-fat, plant-based, whole-food
diet is low in dietary fat, your carbohydrate
tolerance (or your ability to eat carbohydrate-rich
food) increases substantially, resulting in
maximum insulin sensitivity and the opportunity
to completely reverse insulin resistance
When operating in a low-fat ecosystem on a
plant-based diet, it is quite easy to
maintain flatline blood glucose as long as
your total fat intake is maintained below
approximately 30 grams per day and your carbohydrate
intake comes from whole foods like
fruits, vegetables, legumes, and whole grains,
and not from products containing refined sugars.
Ketosis Misconception #3: “Diabetes is carbohydrate
toxicity and insulin resistance is a state
Those in the ketogenic community often label
diabetes as a
problem of carbohydrate toxicity, suggesting
that dietary carbohydrate is the primary cause
the disease process.
In addition, ketogenic dieters believe that
insulin resistance is CAUSED by
insulin itself, triggered by an excess consumption
of dietary carbohydrates.
I cannot tell you
how many people tell me, “Cyrus, insulin resistance
is not caused by fat it’s caused by insulin.
This, my friend, could not be farther from
In order to make these statements factually
correct, it’s necessary to go back to basic
biochemistry principles and understand that
majority of people who develop insulin resistance
do so by eating a diet containing large
amounts of dietary FAT, as we discussed earlier.
Now the research world has known this for
more than 85 years.
This was first established in the by the pioneering
work of Drs. Rabinovitch
and Himsworth, then further proven by Dr.
Kempner in the 1950s, and by Dr. Anderson
Despite this, the cause of insulin resistance
and carbohydrate intolerance remains one of
the most debated subjects in the world of
diabetes even today.
Now think of insulin resistance
as a series of metabolic dominoes.
The dominoes are arranged in this order.
Number 1: You eat
a diet containing dietary fat greater than
about 15% of total calories.
Number 2: You go and eat
a banana or potato or a bowl of rice, and
check your blood glucose two hours later to
your blood glucose meter reads a high number
You point your finger and say, “Hey.
I guess these foods are bad for me because
clearly when I eat them
they increase my blood glucose.
Now, the reason this happened is not because
potatoes and rice are bad foods but because
insulin receptors in your muscle and in your
have become dysfunctional due to too much
circumstances, the glucose from these carbohydrate-rich
foods are accompanied by insulin, and
insulin’s job is to say.
I have some glucose.
Would you like to take it up?”
Normally, cells in your liver and muscle would
Bring it on in.
But when you’ve eaten
your way into insulin resistance, insulin
receptors say, “You’ve got to be kidding me!
Do you see
how much energy I already have inside?
I’ve got to burn this stuff FIRST and then
then) will I allow glucose in.
For now, you stay in the blood!”
So when glucose becomes trapped
in your blood due to these dysfunctional insulin
receptors, you have a choice: either you avoid
carbohydrates like the plague and continue
to re remain in ketosis, or you drop your
and GAIN the ability to eat carbohydrate-rich
So if diabetes is not a problem of
carbohydrate toxicity but a problem of fat
toxicity, then the correct statement is this:
resistance is a state of carbohydrate intolerance,
FIRST created by the consumption of excess
Ketosis Misconception #4: “Carbohydrate is
not an essential nutrient.”
ketogenic world is quick to point out that
“there is no such thing as an essential carbohydrate”
in contrast to required nutrients like essential
fatty acids and essential amino acids.
statement is technically true, labeling glucose
as a non-essential carbohydrate implies that
there is no use for glucose in the human body.
Once again, we have to return to basic human
physiology in order to understand the truth.
Now, your liver, your muscle, and other peripheral
tissues are capable of oxidizing glucose,
amino acids, and fatty acids for energy.
however, cannot oxidize either amino acids
or fatty acids for energy.
Your brain can ONLY run
off of glucose for energy, and does not possess
the biological machinery to store glucose.
result, your brain must oxidize glucose on-demand,
importing glucose from your blood Since
glucose is your brain’s principle on-demand
fuel, carbohydrate-rich foods are your brain’s
primary fuel source.
Now, when you consume a low-carbohydrate diet,
you force your liver to
synthesize an emergency backup fuel known
as ketone bodies to prevent against brain
starvation, and you enter the state of ketosis
in which ketone bodies become your brain’s
Ketogenic diet were originally invented for
people with epilepsy and are effective
at reducing seizure incidence.
However, ample evidence shows the ketogenic
diet come with a
laundry list of unwanted side effects that
simply CANNOT be overlooked, including, but
Diarrhea, nausea, constipation, vomiting,
acid reflux, hair loss, kidney stones, muscle
cramps, muscle weakness, hypoglycemia, low
platelet count, impaired cognition, inability
concentrate, impaired mood, disordered mineral
metabolism, stunted growth in children,
increased risk for bone fractures, osteopenia,
osteoporosis, increased bruising, acute
pancreatitis, hyperlipidemia, high cholesterol,
insulin resistance, elevated cortisol, heart
arrhythmia, myocardial infarction (or heart
attacks), menstrual irregularities, amenorrhea
loss of periods in women), and increased risk
for all-cause mortality (or premature death
Yes that’s right.
People who eat low-carbohydrate diets die
sooner and suffer from
more disease in the long-term.
If that’s not enough to dissuade you from
eating a low-
carbohydrate diet, I’m not sure what is.
Therefore, labeling carbohydrates as “non
not only factually inaccurate, it results
in a wide variety of chronic health conditions
ultimately shorten your lifespan, decrease
your quality of life and accelerate your risk
Ketosis Misconception #5: “Low fasting insulin
means high insulin sensitivity.”
People in the ketogenic community often measure
their fasting insulin levels as an indicator
their insulin sensitivity.
A fasting insulin test measures the amount
of insulin your pancreas
must secrete in order to control your blood
The lower the number, the less work your
pancreas is performing.
This is a good thing.
Ketogenic dieters often report very low fasting
insulin levels and then draw the conclusion
that their “insulin sensitivity has increased.
could not be farther from the truth.
The only way to actually measure your insulin
to utilize a “glucose challenge” in which
you either drink a solution containing glucose
in water, or you eat a food containing carbohydrate
In the clinic, your doctor may order
a glucose tolerance test to measure your insulin
The way that you measure insulin
sensitivity using an oral glucose tolerance
test is straightforward.
Step 1: You drink a solution
containing dissolved in water.
Step 2: A medical professional samples your
blood at 0, and 180
Step 3: Your blood samples are analyzed for
glucose and insulin.
Step 4: Your
performance is measured against a standard
to determine your insulin sensitivity.
your glucose and insulin area under the curve
(AUC), the worse you perform on the test and
higher your level of insulin resistance.
The lower your glucose and insulin areas under
curves (AUCs), the lower your level of insulin
The reason why this test is so valuable
for measuring insulin sensitivity is because
it measures the ability of your muscle and
uptake glucose from your blood.
When challenged by a food or drink containing
measuring your fasting insulin or fasting
blood glucose independent of a glucose challenge
insufficient information to conclude anything
about your level of insulin sensitivity.
many ketogenic dieters and medical professionals
fail to understand this concept entirely.
you never challenge your glucose metabolism
with carbohydrate-rich foods or with a glucose
solution, it is simply impossible to measure
Despite this, those in ketosis
often claim that their insulin sensitivity
has increased even though they avoid eating
carbohydrate-rich foods at all costs.
Ketosis Misconception #6: “Low-carbohydrate
diets are not
Let’s go into detail to understand the caveats
of this statement.
question to ask is this: What proportion of
total calories constitutes a high-protein
according to the scientific evidence?
Now, according to the evidence, diets containing
than 10-15% of total calories in protein increase
your risk for cardiovascular and diabetes
mortality, especially if the majority of your
protein originates from animal foods.
studies have shown that protein intakes in
excess of 15% of total calories increases
your risk for
heart disease, for high cholesterol, for aetherosclerosis,
for diabetes, and various forms of
As a result, any diet containing in excess
of 10-15% calories from protein is considered
It turns out that it is practically impossible
for a ketogenic diet to be low in
It’s actually quite simple: Because cheese,
eggs, meat, butter, poultry, fish, nuts,
seeds, vegetable, oil, coconuts, and avocados
make up the bulk of calories on a ketogenic
With the exception of vegetable or coconut
oil which is 100% fat, every food that I just
not only high in fat but also higher in protein.
Ketosis Misconception #7: “Evidence based
research shows that low-carbohydrate diets
Low-carbohydrate diet advocates
are masters of documenting the efficacy of
their philosophy using studies with small
sizes conducted over short time periods, often
over either weeks or months.
studies are helpful at assessing the short
term benefits of ketosis, they fail to document
long-term effects of a ketogenic diet.
A classic example of this is a paper that
was published in
2017 documenting the results of 10 weeks of
a ketogenic diet in 262 patients following
containing less than 30 grams of carbohydrate
per day and an average of 175 grams of protein
Now, the researchers document how ten weeks
of ketosis resulted in an average A1c
decrease of 1%, an average weight loss of
7.2%, and how more than 56% of participants
reduced their need for oral medication.
These are all GREAT outcomes.
The problem is that the
study was conducted in a small cohort over
a relatively short period of time.
Now, in order to
determine the true effectiveness of any diet
you have to do two things.
Number 1: Study your
diet in large numbers of people, which is
tens or hundreds of thousands of people.
Study the outcomes of people following your
diet over long periods of time, greater than
approximately 5 years.
Studies conducted in tens or hundreds of thousands
of people over 5+
years indicate that low-carbohydrate diets
promote the following disastrous outcomes:
Number 1: Increased risk for cardiovascular
Number 2: Increased risk for hemorrhagic
Number 3: Increased risk for hypertension.
Number 4: Increased risk for atherosclerosis.
Number 5: Increased risk for diabetes mortality.
Number 6: Increased risk for obesity.
7: Increased risk for cancer.
Number 8: Increased risk for all-cause mortality,
premature death from any cause.
No matter how you slice it, low-carbohydrate
patients and doctors into believing that ketosis
is an excellent long term dietary strategy
in reality the long-term consequences are
often worse than the initial condition they
designed to reverse.
Now the next time you consider adopting a
ketogenic diet, ask yourself a
simple question: “Are the long-term consequences
worth the short term benefits?”