Essential Keto Course: FAQs
Questions and Answers
Q. There is no mention of ketogenic lifestyles in the latest NICE guidelines.
A The NICE guidelines allow clinicians to work with people who enquire about a ketogenic diet as part of their lifestyle choice.
It is unfortunate that the information has not been made available in the current guideline.
Q. I am concerned that patients have not heard of ketogenic diets and how I will help them to adopt real food ketogenic eating habits.
A This is covered in the modules on what to eat, and this is duplicated on the patient-orientated site. Those with eating disorders or food addiction might need more help. The methodology of transitioning to keto in this course is safe as it involves techniques of carbohydrate counting and insulin estimation that are already familiar to the patient.
Q I am concerned about the patient’s ability to adjust insulin when ‘taking the plunge’.
A This is a common concern amongst all clinicians who are involved in managing Type 1. There are insulin management issues for those with T1 undertaking sports, physical activity, eating out, and infection. Most people with Type 1 are skilled in adapting to situations as they face challenges daily. Transitioning to keto is no different. Evidence has found that people on even a low carbohydrate diet have six times fewer hypoglycaemic episodes overall. The technique set out in this course is common among those who have adopted a keto lifestyle. Safety is paramount, and the course will provide information on how to approach transition for those with insulin resistance and complications. The parallel patient-orientated course also goes through the transition with the same level of detail as the professional course.
Q I am concerned that my patient will be at risk of diabetic ketoacidosis (DKA)
A This is still a commonly expressed belief. It is true that people who are on a keto diet are still at risk of DKA but this is not because of the diet. Nutritional ketosis that happens when anyone adopts a ketogenic metabolism is not a risk factor for DKA. This is explained in the course in detail.
Q Patients who attend secondary care are discouraged from keto diets.
A This is becoming less frequent. In a survey of 20 people with Type 1 on a keto lifestyle, 40% said that their healthcare professional was not against them using this diet.
Of the remaining 60%, all had reasons for discouraging the keto diet. 75% of their reasons were based on bias or personal learning needs. 25% were based on concerns about long-term evidence, which is valid. However, these concerns were mostly based on the amount of fat in the diet and the risk of heart disease based on evidence from a high-carbohydrate diet. There is as yet little evidence of how lipid markers behave in a fat-burning, ketogenic metabolism compared to a fat-storing carbohydrate-based metabolism, as will be discussed in the course. However, almost all proxy markers of monitoring point to successful outcomes. The risk management of lipid markers and poor glycaemic control points overwhelmingly in favour of managing the latter. There is an information sheet for patients on a keto diet about how to approach an annual review to have a positive experience. This can be found in the parallel free area for people who live with Type 1. It is also included in the professional’s course for information.