When I first started this website a little over a year ago, I did so with the intention of discussing low-carb diet research and other low-carb topics. So I want to thank any long-time (well, at least a year!) followers who have stayed with me despite my veering off course now and then.  In the beginning I was very green with respect to the benefits carbohydrate restriction as a viable option for blood sugar and weight management (in my training as a dietitian, the Atkins diet was routinely dismissed as unhealthy and unsustainable), and I began spending a lot of time on dozens of low-carb sites, including many with a Paleo/Primal approach. The Paleo diet seemed quite healthy:  It was based on whole foods, grass-fed meat, and organic plant foods. However, it contained a lot less dairy and nuts than I was eating and which I continued to consume in fairly large amounts.

In the latter part of 2011, I began adding in some starchy foods like sweet potatoes and rice based on recommendations found on various Paleo sites. Although I'd been consuming 30-35 grams of total carbs per meal at that point with occasional postprandial hyperglycemia, the addition of starchy foods definitely worsened my blood glucose control, particularly after lunch and dinner (for some reason my post-breakfast readings were and are almost always good).  Researching other people's online experiences with reintroducing starch reassured me that this was likely a temporary thing that would improve as my body adapted to eating this type of food again. I continued eating the same way and monitoring my blood sugar about three or four times a week. 

I tried not to get too upset seeing my readings routinely in the 150s-170s and occasionally as high as 200 1 hour after eating, telling myself it would eventually get better. But after 9 months, it never did. Even replacing the starches with an equivalent amount of carbohydrate from fruit or dairy didn't help. Although others may be able to tolerate higher amounts of carbohydrate after a reasonable adjustment period, I had to admit that this wasn't the case for me.  I was already eating pretty low carb (about 90-110 grams total or 65-80 grams net), so where to go from there? Obviously, lowering my carb intake was the only thing I could do, short of medication. And since my fasting blood sugar has remained normal, there weren't a lot of pharmalogical options anyway.

In researching my ADA article on low carbohydrate diets, I found a study in which many subjects on a very-low-carbohydrate, ketogenic diet (VLCKD) achieved such significant improvements in blood sugar that they were able to greatly reduce or even discontinue their diabetes medication. There is also research on the hormonal benefits of VLCKDs for polycystic ovarian syndrome (PCOS) as well as weight loss. In addition, I found  many online anecdotal reports  of improved mental clarity and well being with this approach.  So I decided to reduce my carb intake further and begin eating  a VLCKD containing 40-50 grams of net carbs per day. To be honest, although I've been eating low-carb for about a year and a half, I had some sort of mental block about not wanting to go into ketosis. I'd done enough research to know it wasn't dangerous, but I still resisted the idea on some level. A few months ago I wrote a post stating I didn't think it was necessary for most people. Turns out it may have been just what I needed.

Although it's only been 6 days, the results so far are pretty impressive.  My highest 1-hour postprandial reading has been 128, but most of the time I'm well below 120, and after 2 hours below 100.  I haven't seen numbers like this in such a long time, and I must say it's a welcome change!  In addition, I feel great, with more energy and focus but less 
hunger -- not a  surprise given my previous unstable postprandial blood sugar coupled with the appetite suppression of ketosis.  I've lost a couple of pounds, which I know is water. I routinely count calories when I eat (again, that dietitian training!), and I'm consuming the same 1500-1800 I've been doing for years, so I don't anticipate losing any additional weight, nor do I want to.  I know I'll be perfectly happy eating a very small amount of fruit and avoiding starches entirely (maybe a small bite of dessert once in a while). Not to sound obnoxious, but anyone who knows me personally would say I'm a pretty disciplined eater (sometimes annoyingly so). In addition, I like all kinds of food and look forward to experimenting with very-low-carbohydrate recipes.

It's quite apparent to me that eating at a ketogenic level is not only safe but could be very desirable for people with blood sugar or weight management issues. In my previous post, I said, "Starting off at ketogenic levels may provide a psychological benefit due to early rapid weight loss that usually occurs, but there is certainly no indication to remain in perpetual ketosis for weight management purposes." But maybe for some people eating at this level indefinitely is appropriate. The T4 to T3 conversion problem I mentioned in that post most likely is due to cutting calories and losing weight rather than lower carb intake per se, as it occurs with all types of diets. I know that several doctors who follow the same VLCKDs they prescribe for their patients -- including but not limited to Dr. Steve Phinney, Dr. Jeff Volek, Dr. Jay Wortman, and Dr. Richard K. Bernstein -- enjoy this way of eating, remain very healthy, and plan to continue for the foreseeable future. Of course, I still feel people should decide how many carbs they feel comfortable eating based on their blood sugar levels, weight, and most importantly how they feel. I don't think a ketogenic diet (or a nonketogenic low-carb diet, for that matter)  is for everyone, and I may ultimately decide it's not the best fit for me. But I'm excited to learn more about the benefits of eating very low carb and will likely be blogging about these sometime soon.

***  I will end with my standard advice to always consult with your physician prior to adopting a low-carbohydrate diet or making any other dietary changes. You may also find the following books very helpful:
The Art and Science of Low Carbohydrate Living by Dr. Stephen D. Phinney and Dr. Jeff  S. Voleck
Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars by Richard K. Bernstein, M.D.


References:
1. Yancy WS, et al. A low-carbohydrate, ketogenic diet to treat type 2 diabetes. Nutr Metab 2:34, 2005 
2. Mavropoulos JC, et al. The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: a pilot study. Nutr Metab 2:35, 2005 
3. Manninen AH. Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood "Villains" of Human Metabolism. J Int Soc Sports 1(2)7-11, 2004. 

As those of you who read my blog regularly may have noticed, I haven't been posting as frequently as I used to.  The major reason for this is simply the desire for a more balanced life with the majority of my free time spent away from the computer (I'm already on my PC for several hours at my day job). But to be honest,  I've also become a bit irritated by the Paleo/Primal/Weston A Price vs. Low Carbohydrate vs. Very Low Carbohydrate discussions ("safe starches" and others)  that dominated some of the online communities over the past several months. Some feel that their way of eating is superior for weight control and blood sugar issues and have made over-the-top claims about what people can expect from following a specific plan. I think that all of the above-mentioned ways of eating can work  and disagree that choosing a different plan will eventually  lead to health problems.  I personally continue to follow a moderately low-carbohydrate, whole foods approach to blood sugar management. There is a relatively new  book (published last May) I feel lays out the pros and cons of carbohydrate restriction in a  comprehensive, no-hype, easy-to-understand  fashion.

Jenny Ruhl is a woman with Type 2 diabetes and author of the acclaimed 2008 book "Blood Sugar 101: What They Don't Tell You About Diabetes," which I reviewed at the end of last year. She also maintains the popular website Blood Sugar 101.  Although Jenny has not had professional training in medicine or nutrition, she has done an extensive amount of research on diabetes, particularly Type 2, and in my opinion is one of the most knowledgeable and trustworthy voices on blood sugar management around.  Her latest book, "Diet 101: The Truth About Low Carb Diets," is hands-down the best book I've read so far this year and will likely be my favorite read of 2012.

"Diet 101" is an exhaustively researched and referenced work that would be an invaluable resource for anyone embarking on a low-carb diet as well as someone who has eating this way for years. Rather than promoting carb restriction as a way to "turn your body into a fat-burning machine," Jenny focuses on its proven benefits:  significant improvement in blood glucose and  reduced hunger.  She disputes claims asserting there is a metabolic advantage to very-low-carbohydrate ketogenic diets and instead makes the case that ketosis provides greater initial weight loss due to release of water and glycogen,  and that continued  loss occurs due to lower caloric intake as a result of a decrease in appetite.  Furthermore, there is good research suggesting that moderate carb restriction can be just as effective in achieving weight loss and, for some, improvements in blood glucose as well.  

Jenny spends a lot of time discussing why and how low carbohydrate diets work (as well as their potential side effects), which many people may not truly understand given the sensationalism with which certain authors have characterized them.  She cautions against trusting the conclusions reached in very-low-carb ketogenic vs. low-carb vs. low-fat research without understanding what actually occurred during the studies. For instance, how many people from each group dropped out? How many were actually following the prescribed diet six months later?  Were these ward studies where food was controlled or was intake self-reported?  Jenny also devotes a good amount of space to carb restriction's effects on chronic disease, the impact of macronutrient composition and weight loss on the hormones which regulate hunger (leptin, grehlin, peptide yy), nutritional supplements purported to promote weight loss and/or improve blood sugar levels, and the truth about why insulin resistance develops (despite what you might have read, she believes it's not the result of eating too many carbs). She is a strong advocate for "eating to your meter" to determine the optimal amount of carbohydrates that is right for you as an individual.  Some people will do well at very low carbohydrate intakes indefinitely, while others may experience the same results by adopting a more moderate low-carb approach.

The organization of "Diet 101" is another strong point.  Each chapter builds on the previous one, the Kindle version has links to references for all the studies, and there is a "Points to Remember" summary at the end of every chapter and a "Notes" section  at the end of the book with further information many will find helpful.

I  enjoyed reading "Diet 101" even  more than I thought I would -- knowing Jenny Ruhl, I had some pretty high expectations! I highly recommend this book to anyone interested in learning about the latest information on 
low-carbohydrate diets and what you can realistically expect from adopting one in a down-to-earth, balanced, and well-written guide.