The postprandial hypoglycemic episodes are very rare in people that don't have diabetes, being most of the time a sign that the first-phase insulin action is impaired.

T2D is a disease of glucose intolerance, but diabetics actually deal with two problems ... insulin resistance, which the keto people focus most on, but they also deal with impaired insulin action, i.e. the ability of the pancreas to respond is impaired. What happens is that the first-phase insulin action is delayed such that later insulin action is exaggerated, causing the subsequent blood sugar crash.

And this is still not T1 diabetes, there are people in which insulin action is impaired before the insulin resistance sets in and it's still classified as T2D.

Keto proponents love to talk about this problem, but it's not a common phenomenon, not even in people that are overweight or pre-diabetic.

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Speaking of which the Keto diet does lead to impaired insulin action, coupled with physiological insulin resistance — mostly due to the "glucose sparing effect", a natural phenomenon that's reversible — but this is why the ocasional treat can send your blood glucose through the roof.

When people on Keto start measuring their glucose, they are surprise to discover just how much the starchy treats can raise their blood glucose, however this effect is misleading, because you wouldn't get the sugar spike if you weren't on Keto ;-)

This is one of the reasons why endocrinologists recommend diets that are over 100 grams in carbs per day to T2 diabetics. Because a very low carb diet requires total compliance, otherwise those hyperglycemia spikes can wreak havoc.

Keto proponents don't like to admit, but high carb diets made mostly of whole plants can be even more effective in keeping blood sugar in control, in dropping HbA1C and in losing weight.

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> "I think it's the fat that most effectively satiates"

This is a myth. Fat might be more satiating per gram, but not per calorie.

If you look at the satiety index, the foods that are most satiating tend to be low in fat and many of those items are high in carbs (by keto standards). We are speaking of items like boiled potatoes, legumes or vegetables, or lean meats like chicken breast or cod. Potatoes are what you call a "high-glycemic index" food and yet boiled or baked potatoes stay on top in every satiety test.

You should be able to see for yourself actually — compare chicken breast with chicken thigh. Same animal, same kind of protein, different fat and calories amount per gram. Eat the same amount of calories on different days and see how you feel. We have a brain hardwired to seek foods high in calories and a chicken thigh is less satiating than a chicken breast simply because the former has more calories due to the fat and thus we end up liking it more.

More importantly we've got studies on the subject and high fat diets lead to less satiety and more calories being eaten versus low fat diets:

https://europepmc.org/article/med/9225171

Also see this paper on the Swedes:

https://www.researchgate.net/publication/281229072_Politiciz...

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N.b. foods like boiled eggs are satiating in spite of the fat — unless you're talking about protein and "protein leverage", fat and carbohydrates are energy macros and do not promote satiety in any way, unless you're talking about fiber.

So what promotes satiety is:

1. fiber and volume (found in whole plants)

2. protein (e.g. the "protein leverage" theory, which is still under debate, but at least we've got some evidence for it)

3. blandness

Reasons (2) and (3) are the real reasons Keto works short term. But appetite always comes back, esp in a high fat diet. When I was on Keto I used to binge eat plain full fat butter and used to eat 1 Kg of grilled fatty pork cuts in a single sitting. And I gained weight of course.