Interesting read on the ketogenic diet




How much protein is “excessive” is determined by a couple of different factors. Most of the dietary guidelines that establish how much protein one should eat assume that patients are sedentary (since that is, or was, fairly common in typical Americans). I would like to think that most of us diabetics who are experimenting with (or committed to) low-carb or ketogenic diets are also exercising. This changes the equation quite a bit.

Simply enough, like other nutrients, the amount of protein you eat should match your lifestyle. If you work out (resistance training) consistently, the body will use protein more efficiently in order to build and maintain muscle mass (as well as connective tissues). I eat an amount of protein daily that my doctor was initially horrified by (between 160-200g per day, depending on training). However, I’ve not had elevated protein levels in the urine during bloodwork, because I use that protein to maintain my weight and muscle mass.

Also, standard nutritional ketogenic diets are not high in protein. I don’t follow keto, precisely because I need more protein. Typical keto is high fat, low carb, with very moderate protein intake.

I follow something closer to Bernstein’s suggestions (or even the old Atkins diet), which is high protein, low carb, low fat. It works for me, but I may change it if I run into kidney issues or no longer have a need to (or can’t) maintain my current muscle mass.

Examples of how protein consumption can change depending on type of low-carb diet. I plugged my stats into two different “keto calculators” for two different scenarios.

  1. Low-Carb, High-Fat Nutritional Keto diet–
    a. Assumptions–I’m 5’11", 190 lbs, 20% bodyfat, and I want to lose a bit of weight (10% caloric deficit). I’m sedentary like “most Americans.”
    b. Suggestions of the calculator–1793 calories, 148g fats, 25g net carbs, 91g protein.

  2. Low-Carb, High-Protein Ketogains diet–
    a. Assumptions–I’m 5’11", 190 lbs, 20% bodyfat, and I want to maintain weight and muscle mass, and I lift weights 4 days a week and do endurance training (“lightly active”)
    b. Suggestions of the calculator–2409 calories, 189g fats, 25g net carbs, 152g of protein.

As you can see, the range of protein consumption can vary dramatically in low-carb diets. I actually eat a bit more protein than that second calculator, because I’m currently trying to build more muscle mass. I cut my carbs accordingly to make sure that I’m in a very small calorie surplus (like 5%), since I’m not interested in packing on body fat. I tend to vary between 15% body fat and 20% body fat depending on time of year and whether I’m lifting weights or climbing mountains. Trekking and climbing on low-carb tends to lead to dramatic body fat loss!


Elyssia - One huge difference between the keto and Atkins diets is the amount of protein you’re allowed. With Atkins, there’s no cap on protein, while keto limits protein to 20 percent of your daily calories.

The other big difference is that keto focuses on being in ketosis for the entire diet, while ketosis plays a role only during induction phase of Atkins. On Atkins, you reintroduce carbs, but on keto, carbs are always limited.

Some diabetics have renal disfunction to one degree or another. I developed renal issues 20 years ago and have been protein restricted since then. I eat no more than 50 grams of protein per day (that’s the equivalent of about 5 or 6 oz of steak, as I’m on a 1,000 calorie / day limit).

Keto is very different from Atkins.


She also mention Paleo which is heavy on protein.


Would love to talk to you about keto. Just getting started. I have a tslim pump and dexcom G6 sensor. I’m on FB and email


They have some similarities, but are actually very different. Atkins didn’t restrict protein like a true keto diet does. If you consume too much protein it will kick you out of ketosis. The ratios for a true keto diet are 70% fat, 20% protein, and 10% from carbs.


So my husband and I were on keto for five days. You can see how well I did on it numbers wise in those days in posts above.

I ended up in the hospital for four days. The diet was not the cause but contributed to dehydration. It was not pretty. My sugars were remarkably low…and have remained even though I have been basically only eating toast.

I cannot even think about most of the food we were eating keto last week. Makes me sick. We will see what we decide when we have some space from the situation :mask:


I’m sorry to hear this! Drinking plenty of water (not something that comes naturally to me either) is part of the keto drill, and I should have mentioned this. Part of losing fat on any diet is high water loss. 70% of more of your “fat loss” is in fact water, which makes up the majority of what’s known as fat.

Get well soon!


Thanks @Jim_in_Calgary. Actually, I have a tendency toward dehydration when anything is out of kilter. I’ve even had dehydration send me near DKA. I drink a lot but things like this are always a reminder. I don’t know what we are going to do at this point.


Sarah - there’s plenty of time for contemplation. Your priority right now is to get better and go home.

Are you still in ketosis? Nothing hospitals feed you are keto friendly :frowning: I was up at the hospital for an appointment yesterday and browsed their confection store and coffee stand for keto friendly items and the only 2 items I saw were (black) coffee and green tea.


Jim - it seems like you really like keto diets.

Why? Simple question - what is the goal? Is it blood sugar control or weight loss or both?

What do you see the benefits of the keto diet versus a moderate carb diet IF (assume this hypothetical) you could get the same blood sugar control. If I consumed the same amount of calories on both diets, would you expect me to lose more weight on the keto diet?


George - originally, my primary goal was to lose weight. As a result of some significant medical issues and basically being sedentary, I’d put on over 20lbs and admittedly had become a blimp. I was, as they say, uncomfortable in my own skin.

I had read about some of the blood sugar benefits of running in ketosis but hadn’t imagined in my wildest dreams just how much easier life is (controlling my sugars) until I actually experienced it.

As far as what you’re proposing, how many grams of carbs a day would you consider “moderate”?

I consume (far) less than 20 grams of carbs a day, I’ve lost almost 40lbs and now maintain the keto diet primarily for blood sugar control (I’m no longer pursuing any more weight loss). My typical caloric intake is 800 cals per day (and I really don’t count calories anymore, carbs and proteins are what I limit).

When I see the issues some have with blood sugars spiking to over 200-300 or more I just can’t believe it (and yes mine used to do that too). Since I started keto, the only time I go out of range on high side (> 130 mg/dl) is when my infusion site goes bad.


Jim - You made my day, week and more. I thought I was the only guy on earth that ate less than 1000 cals per day. I have been in the 750-800 range for years and moderate exercise much of the year. Nutritionist, when I was first diagnosed said I should eat about 1500 cals a day and never went back to her in fear of being chewed out for eating so little. My weight range has always been in the 125lb-140 range for past 50+ years. My carb count is however closer to 50-60 per day or I can’t keep my A1C in the 6-6.1 range endo wants to see.


CJ - you put a smile on my face too, because here I was thinking I’m the only person I know who consumes that few calories. And let be honest - some (non fasting) days net calories are less than 400. I took an average of the past 7 days and it worked out to roughly 800 (some days as much as 1,300 when I get carried away, but usually end up paying for it).

My docs all are concerned I’m not eating the standard “1,500” a day minimum. I wonder where they all got the same number from? And my endo freaked out when he saw my 4.7 A1C. You’d think I was on death’s doorstep :rofl:

Life’s good my friend :smiley:


that’s a lot of carbs. :slight_smile:


Jim - I find the entire keto discussion very interesting. I have followed what has put together and have viewed it “as part” of a treatment program.

When you posted that video about the anointed “know it alls” which included the diabetic cookbook from 1917 it got me really interested in what they were doing 100 years ago when the only way to treat diabetes was through diet. There was no insulin, no pills or any thing else but there were a lot of really smart people not distracted by all the gadgets but information sharing was limited.

If we apply some physics to this discussion the first law of thermodynamics states that energy cannot be created or destroyed. We all learned that in high school. Viewing the body as a machine and applying this law to weight control, I think the basic formula would look something like this -
weight gain = energy (calories) in - energy (calories) out

This basically says a calorie is a calorie. To lose weight, create a calorie deficit by either eating less or burning more. To gain weight, increase calorie intake. Of course then I looked at a bunch of studies around how much more energy does it take to burn fat versus carbs and its kind of a wash so it seems a calorie is a calorie.

My problem with strict keto diets is its really hard on the kidneys. Too many people I know who have tried them ended up with kidney stones.

I also don’t like extremes. Nothing ever seems to come from doing things to the extreme.

However, when I look at the what they were doing in 1917 they were doing low carb but then mixing fats and proteins. Basically they were trying to blunt the post meal glucose spike.

Today, with little effort we can blunt the post meal glucose spike very easily and safety with afrezza. Its a no brainer but costs some money. Lowering carbs clearly reduces the spike and reduces the amount of afrezza needed, let say 150-200 grams as a moderate target.

What I am thinking for those not wanting to risk strict keto is following the 1917 guidelines and adding the afrezza. The more I review what they put together 100 years ago the more intriguing it gets.

Also, at 800 calories per day which is your intake, most people are going to lose a ton of weight which will also reduce the amount of insulin the body needs.


George - the answer is fairly straightforward.

“A calorie is a calorie violates the 2nd law of thermodynamics”. Whereas the first law is a conservation (of energy) law, the second is a dissipation law: something (negative entropy) is lost and therefore balance is not to be expected in diet interventions.

A second article explains this far more fully, specifically in terms of weight loss as it applies to carbs, proteins and fats.

I should also add that I’m not a nutritionist, merely a lifelong T1D who’s had success controlling blood sugar by eliminating all but a handful of carbs. Along the way, I lost 22% of my original weight, and also lessened or eliminated inflammatory processes (lupus), eliminated all need for BP meds (on for past 22 years), eliminated all lower limb edema (CHF) and vastly improved my quality of life.

We still don’t have access to Afrezza in Canada so I can’t offer any first hand experience with that product. There are hundreds of different lifestyles and diets in this world. There is one that’s right for each of us, at different times of our lives. If and when you find the one that works for you, then you’ve succeeded in your quest.


How much protein do you typically eat on your off workout days? I know the amount is smaller for women so this is just me being curious.


I’m curious what your typical diet for a day is and if you skip any meals? I condone you for being so diligent about it. I’m tiny anyways so I don’t know if I could handle 800 calories. :neutral_face: My friends are all about keto right now as it seems to be all the rage so it’s interesting but seems extremely difficult to follow.


Hi @Elyssia_Reedy - for the best part of the past 20 years I’ve only eaten one meal a day (OMAD), this was just a choice I made and helped me maintain a pretty constant weight.

Since on keto, I continue with the OMAD, the only thing I have prior to supper is a large coffee with 2 tablespoons heavy (35%) cream. I usually eat before 6pm as I want to eat at least 4 or 5 hrs before bed. Last night was a typical meal: 4 eggs scrambled with 30gms grated cheddar in eggs, plus 5 slices bacon.

I’ll often eat bacon and eggs, changing it up with fried or hard boiled. The bacon is for the fat, which staves off hunger the following day.

I eat plenty of tossed salads with oil/vinegar dressing, small tomatoes and lightly steamed asparagus, sprinkled with blu cheese and some red onions.

I’ll make a hamburger every once in a while - with double cheese (keto cheddar - 1 carb per slice), double bacon, mustard and keto mayo. Used to do the lettuce wrap but have found a source for keto bread that has only 1 carb per slice.

Grilled cheese and ham (again, keto bread to the rescue).

Smokies stuffed with melted cheddar cheese, bacon and wrapped in a keto friendly tortillas with onions and loads of mustard (3 grams carbs and 380 calories total)

I used to eat small portions of steak once a week but had to cut back on protein. I find it a challenge to cut a normal sized steak down to the miniscule amounts I can eat, so I’ve eliminated that temptation.

Keto spaghetti, complete with Carb free noodles, practically carb free sauce, great with finely grated parmesan nd keto garlic + cheese bread.

Lots of asparagus, broccoli and cauliflower (all good steamed with melted cheeses)

Taco bowls (ground beef with onions, cheddar, tons of Frank’s hot sauce and sour cream.)

Tacos with the same as above and in cheddar shells (made by microwaving grated cheddar then folding it while warm draped over something(.

Ham has zero carbs, so I eat that a few times a month. Chicken made dozens of ways.

There’s plenty to eat!