Going Keto To Lose Weight Or Balance Blood Sugar? This Doctor Wants You To Think Twice

If you haven't heard of it before, the ketogenic diet (also known as the keto diet) has captured the world's attention for its apparent ability to help people lose weight and treat their diabetes by eliminating all carbohydrates and focusing on a high-fat diet. However, I believe that a closer look at the science around this way of eating reveals that the results aren’t as impressive as many other dieting techniques, especially considering how restrictive it is. In fact, it may even have the risk of potentially serious side effects. Here's what I mean:

Proponents of the ketogenic diet are quick to point out that it's the best diet for weight loss, but a large meta-analysis1 comparing ketogenic, low-carbohydrate diets to high-carbohydrate diets showed less than a kilogram of difference in weight loss between the two dietary strategies after 12 months—a minimal benefit when taking into account how overweight or obese many dieters are and how much effort is required to be in ketosis, the state of producing ketones while on the ketogenic diet. It's also possible that any initial weight loss on the ketogenic diet may be more a product of water2 loss from the diuretic effect of ketones. In a randomized, controlled trial3 of 811 participants, it didn’t matter which diet a person was on as long as they limited their caloric intake.

The ketogenic diet has garnered a lot of publicity for being able to "treat" diabetes. However, withholding all carbohydrates from diabetics is not new4 and actually was a method of managing diabetes before the discovery of insulin almost a century ago. Although one can control blood sugar spikes with a ketogenic diet, the underlying diabetes remains, which is why meta-analysis1 analyzing ketogenic, low-carb, and high-carb diets showed no difference in fasting glucose or hemoglobin A1c levels (both markers of diabetes) after one year.

The keto diet encourages its followers to double down on fats, with up to 70 to 80 percent of calories coming from fat. The only population to have even come close to consuming this amount of fat are the Inuit of the Arctic regions, who—contrary to popular belief—had a high rate of heart disease despite eating large amounts of fish and other marine sources of fat. Further, the high amount of fat encouraged by the keto diet puts people who aren't quite as well-versed in nutrition at risk of consuming some fats that are unhealthy, like trans and saturated fats, which increase the risk of cardiovascular complications like heart disease and stroke.

Keto diet experts warn their followers that eating foods like fruits, vegetables, grains, and legumes will prevent ketosis due to their carbohydrate content and recommend avoiding these foods entirely to gain the benefits of the ketogenic diet. However, the costs of forgoing these foods—which have been associated with several desirable health benefits—could be pretty steep. For example, in a large meta-analysis, fruits and vegetables have been shown to reduce the risk of dying with greater benefits with additional servings consumed. Whole grains5 and legumes6 have also been shown to be beneficial by reducing the risk of heart disease, death, and cancer. If one were to get rid of certain foods from the standard American diet, getting rid of some of the healthiest foods in our diet doesn’t seem like the place to start.

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