Are there differences in approach to keto between T2 diabetics and non-diabetics


(Cat Onisko) #1

Hi everyone, a very happy Friday to you all.

I’ve been eating ketogenically now for around 4 weeks (with the exception of one slip up last week). I’m not diabetic, and my markers are all very good according to my most recent Thriva blood test. I’m just an overweight 34 year old!

I’ve tried to do my own research on this topic but I’m not really getting anywhere.

My question is, is there anything at all I should be doing differently because I am not diabetic? I’ve read some things about occassional carb-ups to assist in female hormone regulation. I’ve also read that 50g net carbs is fine etc.

I’m asking because I’m not actually feeling any different than my former lifestyle of eating carbs in moderation. In fact, I seem to have more headaches (more like a pinching feeling from time to time) and more fatigue than usual.

Do I stand to feel better eating more net carbs while still staying under the 50g mark that Phinney and Volek talk about in their book? Is the 20g net carb limit specifically for T2 diabetics and not for those wanting/needing to simply just lose excess fat?

I also remember the 2KetoDudes on a podcast mentioning very briefly that for around 2-3% of people, keto won’t work. I wonder who these people are and why it doesn’t work for them? Because I’m not feeling great and losing much weight (4 pounds total in a month, and today I’ve gone up so I’m only 2 pounds down in a month), I’m starting to question if I’m somehow one of the unlucky people that doesn’t tolerate a keto way of eating.

Essentially, do non-diabetics like myself perhaps fare better being less restricted because we aren’t actually insulin resistant and can theoretically handle carbs better than a diabetic can?

I want to start feeling better, but I just don’t really. Oh, and my weight is currently up and down like a yo-yo for the past week, no matter what I do.

Any anecdotes/personal experiences are very welcome!

Thanks all you lovely lot!

PS: A typical day for me consists of the following:

  1. 2-ish BPCs in the morning
  2. I break my fast between 2pm-4pm with a 3-egg omelette with cheese, a spinach salad with mushrooms and garlic cooked in butter, bacon or avocado on top, and some olive oil.
  3. If I fancy a bit of something in the afternoon, I’ll have some mac nuts or some cheese.
  4. For dinner I have steak/pork belly/salmon with veg cooked in butter.

(Bacon by any other name would taste just as great.) #2

I would keep carb intake low until you are fat-adapted. Everyone’s limit is different, and yours may well be higher than the 20 g/day we recommend, but we find that waiting until after fat-adaptation is a good strategy.

The headaches are probably the result of not getting enough salt. In the absence of carbohydrate in the diet, insulin drops, and the kidneys are no longer inhibited from excreting salt. So keeping salt intake up and drinking to thirst is something we need to pay a bit more attention to. Not only that, but several recent studies have shown that most people need quite a bit more salt than governmental recommendations allow.

The fatigue is most likely the result of your muscles’ having to limp along on ketone bodies. As their fatty-acid metabolic pathways are reactivated and their mitochondria heal from the damage caused by excessive glucose, you should start to feel more energetic. Give yourself another four weeks, at least. Many people report that, not only do they return to previous performance levels, but they often exceed them.

The 20 g/day limit on carb intake is the official recommendation on this site. Carl and Richard, the Two Keto Dudes, chose it to ensure that people would be as successful as possible on this way of eating. We offer people the choice of whether to count total carbohydrate or net (non-fibre) carbs. Dr. Phinney’s recommendation to his patients at Virta Health is a strict limit of 50 total carbs, in the hope, as he says, that the patients will end up under 20 g/day net carbs.

The carb limit we suggest is for two reasons: first, the minimum amount of carbohydrate the human body requires is 0 (zero) grams. That’s right, zero. The body does need a certain very small amount of glucose circulating in the bloodstream, but it is perfectly capable of making that amount as needed. Glucose levels above that can be dangerous, and a long-term diet rich in carbohydrate causes damage. Glycated haemoglobin, for example, makes blood much more likely to clot, thus elevating the risk of stroke and other cardiovascular problems.

Second, hyperglycaemia (too much blood sugar) is not only damaging, but can be fatal, so it is met with a surge in insulin, which drives it out of the blood and into fat cells for storage as fat and into muscle to be metabolised. But chronically elevated insulin does its own damage over time. Elevated insulin interferes with the proper regulation of blood pressure, causes systemic inflammation, and prevents stored fat from leaving fat tissue to be metabolised, among other things. A diet low in carbohydrate, moderate in protein, and enough fat to satisfy hunger eliminates this excessive insulin response.

The late Dr. Joseph Kraft studied Type II diabetes for most of his career, and he was convinced that most diabetics were diabetic long before their official diagnosis, which relies on serum glucose level. He was convinced that it was possible to diagnose diabetes as much as two decades earlier, from the pattern of the insulin response during an oral glucose tolerance test. His term for it was “occult diabetes” or "diabetes in situ.


(Bob M) #3

I believe I was non-diabetic when I started, though I don’t know. Blood sugar was only just above 100, but never got fasting insulin or HbA1c at that time.

Headache and the like might be as easy as salt. Since your insulin is going down, your body retains less water (thus, your blood pressure should go down), and you lose electrolytes. Salt, magnesium, potassium are all suspects, though salt is the easiest to correct. And, no, I have no idea how to adjust these – after 7 years, I still get leg cramps sometimes.

The rest of this might be a transition period. It takes longer to transition than 2 weeks or even 4 weeks.

What I’d recommend is keep trying for a few weeks longer to see what happens. If you do think you need more carbs:

  1. Eat them at the end of the meal (reduces the blood sugar and insulin response).
  2. Try to eat better carbs, ones that don’t cause cravings or gastro issues.

For me, for instance, I’ll sometimes have some mashed potatoes at the end of a meal if we’ve ordered out and I forgot to ask for veggies or no substitutions were allowed. Those do not cause me to overeat (once I have some bites of them, I’m good). Something like tortilla chips, though, I could eat a whole bag of those.


(Cat Onisko) #4

Ok, I shall stick to my 20g of carbs then for now, thank you!

I do eat bacon or cheese every day, and because these are salty foods, I’ve not thought that salt was an issue. Am I mistaken here? Even while eating cheese and bacon I should add even more salt?

I suppose my thoughts are that whenever I try to read about keto, it’s so heavily focused on T2 diabetics, and I am not one. And so I wonder if I am doing the right thing, imitating a diet that is for a diebetic. I have no family history whatsoever of diabetes, but do have a family history of heart disease.

I’m sure you see this a lot with people new to keto, but I just feel like I am really putting the work in here, and yet I feel absolutely no different with a minimal amount of weight loss that I probably would have seen with the dreaded CICO method (I know, I know).

I would love to be able to see inside my body and know that things are getting better, but of course I can’t!

I shall continue on this path, and hopefully will see some positive changes soon.


(Michael - When reality fails to meet expectations, the problem is not reality.) #5

Short answer: no.

Longer answer: As already mentioned, you’re in the transition period when the initial withdrawal from eating a carb-centric regimen causes some discomfort for many. It will pass. Nutritional ketosis brings with it a multitude of health benefits and specifically metabolic benefits that don’t occur otherwise. Remaining consistently in ketosis reinforces the benefits, while playing footsie with border-line low carb and/or in/out of ketosis inhibits.

Keto requires an attitude adjustment. From the attitude of ‘I’m making a huge sacrifice giving up all this great food and how soon do I get my reward…’ to the attitude of ‘I’m doing the best thing I have ever done for myself. There’s a lot of damage to fix and it may take a while to fix it…’ And by the way no matter what anyone says, there is no minimal daily carb requirement and no carb deficiency disease. We already have a built-in mechanism to make all the glucose we need. There is zero need to eat it.


(Bacon by any other name would taste just as great.) #6

If you are getting headaches, you might need a bit more salt. Constipation is another symptom.

I personally get migraine auras if I don’t eat enough salt. Fortunately, a pinch of salt on the palm is often enough to clear up the aura within minutes. The studies I mentioned all suggest that sodium in the range of 4-6 g/day is the healthiest range, and that translates to 10-15 g/day of sodium chloride (table salt), including all the salt already present in food, of course.


(Cat Onisko) #7

Do you think I should add more salt even when consuming bacon and cheese, pretty salty foods?

I’ll keep sticking to 20g carbs then; that seems to be the general consensus.

Perhaps give it another 2 weeks? That would take me to 6 weeks of eating keto. That should be enough time to begin experimenting with things a bit more freely?


(Cat Onisko) #8

That’s great advice, thank you I appreciate it. I do feel at times I am making a sacrifice yes, I can totally admit that here.

I miss chocolate, I miss pasta, I miss a lot of things. It’s completely physchological, no doubt about it. I don’t think I was ever particularly addicted to carbs, in fact I’ve been the weird girl that would always choose meat over chocolate any day. But I do find it difficult to keep on ketoing on and restricting things that others don’t restrict, when I’m not gifted with any sort of confirmation either via the scales/tape measure or of ‘feeling’ better after 4 weeks of solid effort. There’s definitely a culture of ‘nowness’, where we seek instant gratification and instant results; the advertising industry and social media has definitely played a massive part in this I feel!

I will keep forging ahead and have more faith in what I am doing :slight_smile:


(Michael - When reality fails to meet expectations, the problem is not reality.) #9

You’ll be amazed at how much water passes through you once you’ve been eating keto for a while. Lots of sodium and other water soluble minerals go with it. Adding to what @PaulL said about salt intake. I think a practical rule of thumb is eat more salt - the total combo of what’s in the food plus what you add to the food - until you start getting ‘loose’ bowels. Then back off a little.

It’s also important to stay hydrated simply because you’re passing more water that needs to be replenished. For example when I’m at work all day I carry a liter bottle of salted water with me and drink whenever I feel thirsty. Don’t drink according to some arbitrary ‘8 glasses of water…’ drink when you’re thirsty, stop when you’re not. Your body knows when it needs water and when it’s had enough.

Best wishes.


(Laurie) #10

You lost 4 pounds and there’s been a bit of up and down. This seems like success to me. If you don’t feel that you’re losing enough, I don’t see the logic in increasing carbs.

People have their own approaches to keto, and it’s easy for a beginner to become confused. But I think it’s best to keep things simple at first. Between zero and 20 grams of carbohydrate.

Maybe you can ignore mentions of Type 2 diabetes for now. I’d also ignore any discussions about increasing carbs for any reason (e.g., sports/weightlifting) until you’ve been doing regular keto for a while.

Good luck!


(Joey) #11

Almost certainly. It’s pretty hard to consume too much salt - especially once you restrict your carbs.

Personally, in addition to heavily salting my food, I’ve been adding a scoop of sea salt to my daily bottle of drinking water for some time now (also a scoop of magnesium citrate powder) to maintain electrolytes. It actually tastes great, like gatorade but without the sugar, suggesting my body needs it. And we piss out excess salt within reason :wink:

Well worth a read: “The Salt Fix” by Dr DiNicolantonio. Science-cited research and simple explanations. Changed my views (and health) on this confused topic.

(BTW, I’m not a T2 diabetic either. Yet keto has vastly improved my health - and my wife’s health, too - in ways we never imagined/expected. Stay the course).

Best wishes! :vulcan_salute:


(Cat Onisko) #12

Funnily enough, I’ve just put some salt in my water bottle! :joy:

I shall look into magnesium now! I do use magnesium flakes when I have a nice hot bath, but this is 2-3 times per week, so perhaps a daily supplement will be better :slight_smile:

Advice is much appreciated, thank you!


(Cat Onisko) #13

Thank you for this, yes it is a success isn’t it :slight_smile:

I remember seeing a post here called ‘The more I read, the more confused I become’ and I can completely understand this! My whole life has become listening to keto podcasts, reading keto forums and books and while I am learning more as I go along, I’m also reading contradictions (a perfect example for me is when people are at a plateau, some say fast and others say eat more!), and it really does become a case of how do I know who to listen to.

But you are right, I’m sticking with my basics: 20g carbs, eat fat to satiety, adequate protein.

I am learning things through trial and error already (heavy cream makes me gain weight overnight, no matter how much or how little I eat), but as I said in a previous post, we live in an ‘everything now’ culture and I’m finding it difficult to accept that this is going to take a while.

Thank you for your kind words, I do feel better now and am getting my head back into the game.


(Bob M) #14

I’ve been eating/drinking a ridiculous amount of salt, and my blood pressure was 110/69 this morning. Almost 8 years of data, where the lower blood pressures were due to fasting (really drops insulin), and the boxes are no longer in the right spots (I keep adding data, but the boxes don’t move):


(Bob M) #15

As an example of what fasting does, see 3/4/21, fasting for34 or so hours:

At one time, I was fasting 36 hours twice per week and doing many, many 3.5-5.5 day fasts. Longest was 5.5 days, and I stopped only because when I stood, I got dizzy.

That’s how much my blood pressure decreases with fasting.


(Joey) #16

@ctviggen Ah, yes, thanks for the reminder…

I should have added that, while consuming all this salt, my BP (and that of my wife) are consistently low, comparable to yours.

Neither of us are on any BP meds. But after going keto, my wife was taken OFF of her high blood pressure Rx by our internist.

If anything, we often have to be careful not to get up too quickly and run off somewhere without giving our blood pressure a chance to catch up. It’s called postural hypotension… in layman’s terms: our blood pressure levels are extremely healthy for long term internal plumbing integrity.

'nuff said :wink:


(Cat Onisko) #17

This is all very interesting and encouraging re salt, fasting and blood pressure etc, way to go guys!

I think this is where people who are not on any medications and do not have any health conditions can sometimes get frustrated though. Where my only goal is fat loss (I’m not on any medications, nor do I have any health markers that I need to improve and therefore monitor), and fat loss isn’t really happening, it can become frustrating, and rightly so. I can’t imagine many people wouldn’t be frustrated.

I’m reading so many wonderful stories about people lowering their insulin doses and certain medications in a relatively short amount of time which is really cool and tangible evidence that this WOE is working in their favour, but when fat loss is my only goal, and it’s not happening (I know I’ve lost 4 pounds in a month, but according to my scales, my fat % has not changed), I ineviatably start to question things.

I don’t track my food and I don’t count calories, I just don’t eat carbs except for incidentals in vegetables. Perhaps my protein is too high, perhaps I am actually eating too many carbs and I just don’t realise (I find this to be highly unlikely), perhaps I am just eating too much food for my 5 foot 2 frame, but something definitely has to change in the next couple of weeks. Perhaps I should incorporate longer fasts (I naturally do 16:8 with ease).

So many variables to consider!

I’ve just dug out my old dusty copy of The Obesity Code, perhaps Dr Fung can show me the way :slight_smile:


(Joey) #18

@cateli I can understand with your frustration… your primary motivation for going down this keto rabbit hole is not (yet) being met. That’s hard to deal with for now.

FWIW, I had no interest in losing weight/girth, but lost 25lbs and 4" at my waistline in surprisingly short order (6 mos or so). I was an active, healthy guy - not a “heavy dude” - now being 60+ yrs old, about 5’ 10" who weighs 140lbs with a 31" waist. But to be clear: the weight & waist sort of melted off, this was never my goal. My motivation was (1) to encourage my wife along the path for her health and family history and (2) see if I could feel better in the process.

Well, yes, I began to feel amazing in every respect imaginable - lots of “aging” issues disappeared miraculously. But more importantly, my wife came off her meds (BP and statins) under supervision of our doctor, and she lost about 20 lbs and looks fabulous. But being post-menopausal, it was a LOT slower for her. Also, she is not 100% as keto-diligent as I’ve been, so there’s probably that too.

But women commonly report having a much harder time for keto to produce weight loss - a primary objective for many who frequent this forum - and those in menopause are especially prone to such complaints. Yeah, it works … but slower and more internally long before the external evidence becomes clear.

I hope that a parade of women with personal experiences come to weigh in (sorry, bad pun). Meanwhile, my advice: recognize that everyone’s experience is different (you are your own n=1 experiment) and what works quickly for some may work much more slowly for others. There are lots of reasons for this; there’s no point in expecting to be “average” in anything.

Most importantly, the “How do you feel?” question should remain central to your eating/exercise habits. Stay hydrated and eat foods that really nourish your body. This is your only one and it deserves the best you have to offer. :vulcan_salute:


(Todd Allen) #19

When I started keto to I found I needed to keep carbs very low and protein moderate to achieve good blood glucose, ketones and minimize symptoms I associated with diabetes such as frequent urination, night sweats, etc. My tolerance for protein and carbs improved rapidly over the first couple years and I think has continued to slowly get a bit better since then. My guess is someone who has no issues with T2D or insulin resistance could likely start out eating as much protein as they want without issue and probably double the carbs of T2Ds.


(Michael - When reality fails to meet expectations, the problem is not reality.) #20

What many/most folks don’t realize is that excess fat is a symptom of metabolic disorder. When stored fat exceeds some amount (individually variable, of course - what’s not?) it can become a problem of its own. But long before that, it’s an indication that something’s not working right. A healthy metabolism does not store excess fat. Given that some variation of SAD is prevalent, the most likely suspect of early disorder is insulin resistance. As @PaulL pointed out, Kraft determined that pre-diabetes and even diabetes can be present decades before showing up as elevated glucose and insulin.


Blood Glucose level dipping too low on keto but very low ketone blood concentration. What should I do?