Diabetes
As previously discussed, Type I (insulin dependent) diabetics may have problems with
ketoacidosis if insulin levels drop too low. Since these individuals rely on injections to normalize
insulin, a ketogenic diet conceivably poses no problems. However, the lack of carbohydrates, as
well as changes in insulin sensitivity, on a ketogenic diet will affect insulin requirements (1). Any
Type I diabetic who wishes to try a lowered carbohydrate diet must consult with their physician
or health provider to determine changes in their insulin regimen.
Type II (non-insulin dependent) diabetics are frequently drawn to low carbohydrate or
ketogenic diets as they may help to control blood glucose and insulin levels (2). Individuals with
severe hyperinsulinemia and/or hypoglycemia will need to be careful when implementing a
ketogenic diet to avoid problems with blood sugar crashes and related difficulties.
Individuals with Type II diabetes may have greater difficulty establishing ketosis, as some
data suggests that liver glycogen is more difficult to deplete (3,4). Additionally, it has been found
that obese individuals, who typically suffer from insulin resistance, have greater difficulty
establishing ketosis (5). This points even more to the importance of exercise to help deplete liver
glycogen and establish ketosis.
Coronary artery disease/high cholesterol
The impact of a ketogenic diet on blood cholesterol is discussed in detail in chapter 7. For
many individuals, the ketogenic diet causes an improvement in blood lipid levels, especially in
cases where bodyfat is lost. However, this is not a universal finding. Individuals with diagnosed
coronary artery disease or high blood cholesterol must monitor their blood lipid levels for negative
changes. Individuals who show negative changes can try decreasing saturated fat intake, while
increasing unsaturated fat. Additionally, a fiber supplement may be helpful. If blood cholesterol
levels continue to respond negatively, the ketogenic diet should be abandoned.
Gout
Individuals with a past history or genetic propensity for gout should seriously consider
whether or not a ketogenic diet is appropriate. As discussed previously, a rise in uric acid levels
occurs when the ketogenic diet is started and this may trigger gout in predisposed individuals.
Since even small amounts of dietary carbohydrates (5% of total calories) appear to alleviate
problems with uric acid buildup, a less restrictive ketogenic diet may be possible for individuals
who are prone to gout.
Pregnancy
This author is unaware of any research looking specifically at the effects of the ketogenic
diet in pregnant humans. However, malformations of the neural tube occur with increased