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Cited by 219Diet and metabolism studiesDietary Effects on HealthNutritional Studies and Diet

The ketogenic diet: Pros and cons

O'Neill, Blair, Raggi, Paolo·2020·Atherosclerosis
DOI 10.1016/j.atherosclerosis.2019.11.021
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Abstract

Diets have been at the center of animated debates for decades and many claims have been made in one direction or the other by supporters of opposite camps, often with limited evidence. At times emphasis has been put on a single new aspect that the previous diets had overlooked and the new one was to embrace in order to improve weight loss and well-being. Unfortunately, very few randomized clinical trials involving diets have addressed the combined question of weight loss and cardiovascular outcomes. The recently introduced ketogenic diet requires a rigorous limitation of carbohydrates while allowing a liberal ingestion of fats (including saturated fats) and has generated a flurry of interest with many taking the pro position and as many taking the cons position. The ketogenic diet causes a rapid and sensible weight loss along with favourable biomarker changes, such as a reduction in serum hemoglobin A1c in patients with diabetes mellitus type 2. However, it also causes a substantial rise in low density lipoprotein cholesterol levels and many physicians are therefore hesitant to endorse it. In view of the popular uptake of the keto diet even among subjects not in need of weight loss, there is some preoccupation with the potential long-term consequences of a wide embrace of this diet by large segments of the population. On the contrary, numerous lines of evidence show that plant-based diets are associated with reduction in oncological and cardiovascular diseases and a prolonged life span. The debate reproduced in this article took place during a continuous medical education program between two cardiologists with largely differing views on the matter of effectiveness, sustainability, and safety of the ketogenic diet compared to alternative options.

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  • Weight loss induced by ketogenic diet is relatively modest and appears comparable to other dietary interventions effective for short-term weight loss, such as intermittent fasting and Mediterranean diet.

    “Furthermore, weight loss induced by KD is relatively modest and appears comparable to other dietary interventions that are effective for short-term weight loss, e.g., intermittent fastingand Mediterranean diet [55–57].”

    From Effects of ketogenic diet on health outcomes: an umbrella review of meta-analyses of randomized clinical trials (2023) · cites this paper as [55]

  • These dietary patterns and practices tend to be high in saturated fat consumption, which can increase plasma LDL-C and risk for premature cardiovascular disease.

    “These dietary patterns and practices tend to be high in saturated fat consumption which can increase plasma LDL-C and risk for premature cardiovascular disease [34, 35].”

    From Benefits of low carbohydrate diets: a settled question or still controversial? (2021) · cites this paper as [34]

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Authors
O'Neill, B., & Raggi, P.
Affiliations
University of Alberta (CA)
Corresponding author
Raggi, Paolo
ORCID
Raggi, Paolo
Venue
Atherosclerosis
Publisher
Elsevier BV
Published
2020-01
Volume
292
Pages
119-126
ISSN
0021-9150 (ISSN-L)
DOI
10.1016/j.atherosclerosis.2019.11.021
OpenAlex
W2990060012
Cited by
219
References
59
Citations by year
2026: 17 · 2025: 37 · 2024: 45 · 2023: 45 · 2022: 31 · 2021: 29 · 2020: 15
FWCI
2.21
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Atherosclerosis (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Physiology › Diet and metabolism studies
  • Health Sciences › Medicine › Physiology › Dietary Effects on Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
Keywords
ketogenic diet, weight loss, cardiovascular risk, LDL cholesterol, type 2 diabetes, glycemic control, saturated fat, plant-based diet, diet sustainability, diet safety
MeSH terms
Diet, Reducing, Humans, Diet, Ketogenic

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