Keto controversy? Experts say it's here to stay

Keto controversy? Experts say it's here to stay

Experts dispel myths and highlight the science behind low-carb and ketogenic diets for chronic disease management.

With the global increase in chronic diseases, the need for effective lifestyle interventions is more urgent than ever. Low-carb (“low-carb”) and ketogenic (“keto”) diets have gained significant attention—both support and skepticism—and the public and scientific communities.

A recently published work inNutrientsProvides evidence-based expert analysis of the effectiveness, safety and sustainability of these diets.

The need for nutritional solutions

Over 90% of American adults either have lifestyle-related risk factors or are being treated for cardiometabolic diseases such as obesity, diabetes and heart disease. Identifying effective nutritional approaches could play a key role in reducing these risks.

Thousands of clinical studies have shown that carbohydrate restriction can reduce the risk of cardiometabolic and mental illnesses. Several medical organizations in the USA, Europe, Canada and Australia have recognized these results.

Groups such as the Obesity Medicine Association and the American Heart Association (AHA) have recognized that low-carbohydrate diets may provide greater benefits than simple calorie restriction, particularly for overweight or obese individuals. Reported benefits include weight loss, improved blood sugar control, better cholesterol regulation, and reduced blood pressure.

While some health professionals focus on potential downsides — like the “keto flu,” a temporary period of fatigue and discomfort — these symptoms are typically mild and manageable. Simple solutions like increasing electrolyte intake have been well documented since 2011.

Other researchers have pointed to studies indicating an increased risk of mortality with low-carb diets. However, many of these studies involved diets with up to 37% of daily calories from carbohydrates. In contrast, true low-carb diets only allow up to 26% of calories from carbohydrates, while keto diets limit intake to less than 10%.

This latest paper provides a balanced discussion of the benefits and challenges of carbohydrate and keto diets, based on extensive research and clinical experience.

Benefits of low-carb diets

Ketosis, a state in which the body burns fat for energy instead of glucose, is a hallmark of the keto diet. Contrary to misconceptions, ketosis is different from ketoacidosis, a dangerous condition that primarily affects individuals with type 1 diabetes.

Low-carbohydrate diets have been shown to improve most cholesterol markers, with the exception of LDL cholesterol (LDL-C). However, LDL-C elevations are typically seen in lean individuals, and current evidence does not strongly link this to a higher risk of heart disease.

One significant study found that a keto diet improved 17 of 20 cardiovascular risk factors except LDL-C. After two years, participants had a 12% reduction in risk score (10-year atherosclerotic cardiovascular disease).

These diets also help normalize blood sugar and insulin levels while reducing inflammation. In particular, several clinical studies suggest that the keto diet can reverse type 2 diabetes, with more than 50% of participants able to achieve remission within 10 weeks.

One study followed diabetes patients with an average disease duration of eight years and found that blood sugar levels remained normal for two years.

Unlike diabetes medications – such as insulin, sulfonylurea or thiazolidinated – the keto diet promotes weight loss and enhances its metabolic health benefits. GLP-1 agonists, although effective for weight loss, have potential side effects such as pancreatitis.

Additional benefits of the keto diet include symptom relief for conditions such as gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and obesity dysfunction. It may also improve gallbladder function, while low-fat diets have been linked to a higher risk of gallstones.

Concerns based on common concerns

A common misconception is that low carbohydrate diets negatively impact healthy cells or tissues. In reality, the body only needs a small amount of glucose, which can be produced naturally through gluconeogenesis – the conversion of amino acids and fatty acids into glucose.

According to a 2005 report from the National Science Academies, the essential carbohydrate requirement for humans is effectively zero.

The concerns about saturated fat and red meat consumption on a keto diet are also frequently raised. However, rigorous reviews of existing evidence do not show a strong link between saturated fat intake and heart disease. Similarly, red meat consumption was not clearly linked to heart disease, cancer or diabetes.

Higher protein intake does not harm kidney function in healthy individuals. In fact, low-carb diets can be beneficial for diabetes patients with up to stage 3 chronic kidney disease and can even improve kidney function over time.

Low-carb diets consistently result in greater weight loss compared to low-fat diets and do not cause nutritional deficiencies. They also support high levels of HDL cholesterol levels.

Compared to plant-based diets - often followed by people who are already at lower risk - low-carbohydrate diets have stronger evidence to support their effectiveness in diverse populations.

Sustainability and affordability

Compliance is a crucial factor in the success of any diet. Studies show that people on low-carb diets (less than 100g of carbohydrates per day) typically stay on for at least a year, with over a third going beyond two years while maintaining their weight loss.

These diets also promote satieties, helping people feel full and reducing cravings, supporting long-term adherence.

From an environmental perspective, the U.S. Environmental Protection Agency reported in 2019 that livestock accounted for only 4% of the country's total greenhouse gas emissions. Additionally, raising cattle has been found to improve soil health in several ways.

Economically, low-carb diets are feasible. In 2019, the estimated additional weekly cost per person was only $9. These diets provide essential vitamins and minerals while supporting physical performance for both athletes and military personnel.

Affordable and nutrient-dense options like eggs and ground beef make low-carb eating accessible. Additionally, free resources are available for those looking for budget-friendly keto meal plans.

Diploma

Evidence supports the effectiveness of low-carb diets for people who choose them. Many common concerns about their health effects are not supported by scientific research. These diets provide all the necessary nutrients without any adverse effects, making them a viable and sustainable option.

For those looking for an alternative approach to managing weight and metabolic health, low-carb and keto diets offer a well-supported, practical choice.

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