The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed
Open accessAbstract
For >50 y, dietary guidelines in the United States have focused on reducing intakes of saturated and total fat. However, rates of obesity and diabetes rose markedly throughout this period, with potentially catastrophic implications for public health and the economy. Recently, ketogenic diets have received substantial attention from the general public and nutrition research community. These very-low-carbohydrate diets, with fat comprising >70% of calories, have been dismissed as fads. However, they have a long history in clinical medicine and human evolution. Ketogenic diets appear to be more effective than low-fat diets for treatment of obesity and diabetes. In addition to the reductions in blood glucose and insulin achievable through carbohydrate restriction, chronic ketosis might confer unique metabolic benefits of relevance to cancer, neurodegenerative conditions, and other diseases associated with insulin resistance. Based on available evidence, a well-formulated ketogenic diet does not appear to have major safety concerns for the general public and can be considered a first-line approach for obesity and diabetes. High-quality clinical trials of ketogenic diets will be needed to assess important questions about their long-term effects and full potential in clinical medicine.
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Many meta-analyses and systematic reviews report little to no differences in long-term weight loss between diet types.
“many of the meta-analyses and systematic reviews report little to no differences in long-term weight loss between diet types [7].”
From Benefits of low carbohydrate diets: a settled question or still controversial? (2021) · cites this paper as [7]
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- Authors
- Ludwig, D. S.
- Affiliations
- Boston Children's Hospital (US)
- Corresponding author
- Ludwig, David S
- ORCID
- Ludwig, David S
- Venue
- The Journal of Nutrition
- Publisher
- Elsevier BV
- Published
- 2020-06
- Volume
- 150
- Issue
- 6
- Pages
- 1354-1359
- ISSN
- 0022-3166 (ISSN-L)
- PMC
- PMC7269727
- OpenAlex
- W2995506097
- Cited by
- 133
- References
- 51
- Citations by year
- 2026: 3 · 2025: 13 · 2024: 13 · 2023: 28 · 2022: 26 · 2021: 37 · 2020: 13
- FWCI
- 13.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Nutrition (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- ketogenic diet, very low carbohydrate diet, obesity, type 2 diabetes, carbohydrate restriction, insulin resistance, blood glucose, dietary fat, low-fat diet, cancer, neurodegenerative diseases, diet safety, dietary guidelines
- MeSH terms
- Blood Glucose, Dietary Carbohydrates, Humans, Insulin, Insulin Resistance, Obesity, Research, Weight Loss, Nutrition Policy, Diet, Ketogenic
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