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Chapter 11: From Low Carb to Keto

Looking back now, when I first tried the keto diet, I was not well-prepared. As you may have realized by now, I am impatient, a bit of a workaholic, with a dash of obsessive-compulsiveness. I want everything done yesterday! But, especially when it comes to the delicate balance of the human body, rushing can backfire. For example, transitioning from the low-carb to the keto diet isn’t as simple as it appears.

My aim had been to try out the diet and share the results with my fellow diabetics, so I began my journey with only a shallow understanding. As you heard in the previous chapter, my new diet lacked potassium and magnesium, leading to problems with my health and heart rate. In the end, I was still in a rush to find out all I could - it seems this is just my nature.

I remember when I started at Tsinghua University and suddenly noticed how intelligent all my classmates were. Back in middle school, I could play while studying and still stroll through my classes with high grades. The director of the farm even came to my home to try to persuade my parents to get me into the local high school, in order to scale up their grades! Among my classmates at Tsinghua, that proud feeling quickly evaporated. I was so anxious that I could not sleep at night and even developed canker sores, but it was all over nothing. After chatting with my classmates, I realized that everyone was as anxious as me.

Making the transition from being a big fish in a small pond to a small fish in a bigger pond is never easy. But that does not mean that you should stop striving. My transition from the low-carb diet to a keto one was challenging. But I had a worthwhile aim - I was fighting for the wellbeing of my fellow diabetics. I couldn’t give up.

Why was I determined to try keto? On a low-carb diet, diabetics will inevitably consume a tiny amount of starch, which is then converted to glucose. This glucose sits, like a beast lying in wait, ready to strike at any time.

On the keto diet, the intake of carbohydrates is near-zero, which means the beast is no longer a threat. Furthermore, if the low-carb diet passively fights against diabetes by reducing the intake of carbohydrates, then the keto diet would theoretically be even more effective in treating it. On the keto diet, the supply of basic nutrients is guaranteed, and the calorie-in-calorie-out equation is balanced, with the intake being less than the consumption, which can increase the sensitivity of insulin and improve the insulin-glucose ratio. Improving insulin sensitivity has an active treatment effect on diabetes.

For the sake of resolving future problems together with my fellow diabetics, I had to see the journey to its end. Simply put, the keto diet has a comparably higher fat intake and a strict limit on carbohydrate intake. When a human body has little or no carbs at its disposal , the liver will convert an appropriate amount of fat into ketones and release them into the bloodstream. The ketone concentration in the bloodstream is maintained at 0.5-3 mmol/L, and although the blood glucose concentration drops, the pH value of the blood does not change. The human body can function in a healthy condition while combating diabetes.

Although the keto diet can be seen as an upgraded low-carb diet, it actually came into existence earlier than the high-fat, low-carb diet. It first appeared as a treatment for childhood epilepsy. The accepted treatment at the time was controlled starvation but this negatively affected the patients’ long-term metabolism, as well as being obviously unpleasant.

In 1921, Dr. Wilder of the Mayo Clinic in the U.S. first proposed a type of keto diet that simulated the metabolism effects of famished conditions. A study of 17 epilepsy patients was undertaken, and in a 1924 report by American Dr. Peterman, 10 of them managed to get their condition completely under control. Of those 10, 9 used only the keto diet without any other supplementary treatment methods.

After the development and production of special medications for epilepsy, the keto diet was left by the wayside for some time. In the 1960s, it was a popular choice for athletes who were part of intensive sports, since they needed to maintain a large energy intake while controlling their weight.

Later on, more and more knowledgeable people started using the keto diet as a practical way to combat diabetes.

●The ski-lover Dr. Jay Wortman has been following the keto diet plan faithfully for 16 years and providing a keto prescription for his diabetic patients.

●The American scholar Sami Inkinen, who rowed 4,000 km from California to Hawaii, highly recommends the keto treatment via his company Virta Health.

●Steve Phinney has been living a keto life for over 40 years. He is over 70 years old but is still healthy and active.

However, the debate over the keto diet is far more heated than over the low-carb diet. We have already seen how pressure from for-profit corporations has reduced support for the low-carb diet. When it comes to Keto, things go up a notch. Messages about the supposed dangers of the diet can be found everywhere.

For example, some say that the keto diet causes a rise in blood fat content and a lack of micronutrients and minerals, and that it leads to a higher risk of kidney stones. Moreover, when the body is taking in less carbohydrates, it will start to break down fat, which can easily produce acidic metabolites and even lead to metabolic acidosis, also known as ketoacidosis.

This all sounds terrifying, but we have seen the tricks that for-profit corporations used with smoking and still use with diabetes treatments. So, can we make an educated guess that the harder they deny a treatment, the more effective for reversing diabetes it actually is?

Even for the regular low-carb diet, I had to spend several years finding out the reason why my doctor did not provide it as a treatment option before I felt confident to share it with my fellow diabetics. As for the keto diet, which has sparked off even wider debates in the medical field, I needed more time to learn about and apply it before sharing my conclusions.

That time has arrived.

A fellow diabetic asked me on WeChat, “How do I check for ketoacidosis?” This is a very common question. Generally speaking, the main reason for concerns over the keto diet is ketoacidosis. This is a serious topic, so I must explain it through professional medical terms.

Ketone bodies are a metabolite that is created when the liver breaks fat down into fatty acids. They include acetoacetic acid, β-hydroxybutyrate, and acetone. Under normal circumstances, the body produces a small number of ketone bodies, which are then delivered to the heart, lungs, kidneys, and skeletal muscles via the bloodstream to be metabolized into energy. The ketone body concentration in the bloodstream is very low, usually under 1.0 mg/dL, and it usually cannot be detected in urine.

When the body does not have enough insulin or sugar, such as in starvation, fasting, severe gestation reaction situations, fat will be over-metabolized, and the concentration of ketone bodies will be too high. Some of the ketone bodies can be expelled from the body through urine. When the liver produces more ketone bodies than can be used by other tissues and organs, the blood-ketone-body concentration will be too high, causing ketonemia and ketonuria. The acetoacetic acid and β-hydroxybutyrate found in ketone bodies are acids and can lead to acidosis, also known as ketoacidosis, when too much of those are built up in the bloodstream.

In other words, ketoacidosis only occurs when the liver produces more ketone bodies than can be used by non-liver tissues. It is not yet known whether there is a causative connection.

In reality, over-consumption of alcohol or insulin can cause hypoglycemia, which signals the liver to start breaking down fat and even muscles in the body, leading to ketoacidosis. Does that mean we should never drink and never take insulin? No sensible for-profit organization would promote abstinence from alcohol and insulin consumption.

By the way, many believe that diabetics should quit drinking alcohol completely, but that is not necessarily true. There can be some benefits for diabetics to drink an appropriate amount of alcohol. Our blood glucose level drops after drinking alcohol due to our liver metabolizing the ethanol and producing less glucose.

You cannot take anything you read at face value. Rather you must carefully filter the information around you.

The structure of the keto diet is as follows:

A. Net carbohydrates: less than 50 g/d.

B. Proteins: 1 g/ (kg ·d).

C. Fat intake should depend on the base metabolic rate. Consume foods that are rich in omega-3 fatty acids such as salmon, tuna, saury, and sardines. Also consume foods that are high in mono-unsaturated fats and fatty acids such as avocado and olive oil.

D. Dietary fibers: 30 g/d, split into two meals of 15 g each.

E. Water: at least 2,000 mL/d.

F. Sufficient dDaily vitamin and micronutrient supplements.

The dietary structure above is a typical outline, as the specifics will vary from person to person. In light of the strictness of the keto diet and everyone’s body being different, these three points should be carefully considered.


Just as the labels on medications tell you to always follow the physician’s directions, the keto diet is best followed under the guidance of a professional institution. I consider the keto diet to be very similar to Chinese herbal medicine. Historically, Chinese people have all considered themselves to be a traditional Chinese medicine practitioner to some degree.

They will brew some honeysuckle or chrysanthemum tea when they are feeling dryness-heat or stew some liquorice or siraitia when they have a sore throat. But that does not mean everyone can just be their own doctor. The herbs will cause problems if used in excess.


It is best to gradually reduce your carbohydrate intake. The keto diet is usually split into 3 steps:

The beginning stage (2-12 weeks):

This jump-starts our bodies’ own fat metabolism functions through a reasonable keto diet and a suitable amount of exercise combined with comprehensive guidance and follow-up service from a professional nutritionist.

The transitional stage:

After basically reaching the goal of reducing our blood glucose level, we gradually transition from the beginning stage diet to a regular low-carb diet.

The sustaining stage: