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

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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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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: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Atherosclerosis (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Physiology (medical) › Diet and metabolism studies
Health Sciences › Medicine › Physiology (medical) › 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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