A physician’s warning on the keto diet

The keto diet has recently garnered much fame for its apparent ability to improve diabetes and obesity – results so impressive the Journal of the American Medical Association recently highlighted the diet and thereby christened it as something more than a low-carb craze. However, not all the evidence supports such a positive outlook, leading the diet to straddle the increasingly blurred lines between faddist snake oil and sanctified medical therapy.

For starters, the keto diet is not new. Nearly a century ago, prior to the discovery of insulin by Frederick Banting and Charles Best, the keto, or ketogenic, diet was used as a crude way to stave off high blood sugar levels, which was then inevitably fatal. By foregoing carbohydrates, the body utilizes fat, either stored or consumed, as its main energy source without raising blood sugar levels. In the process, ketones are produced, and thus giving the diet its name.

By avoiding carbohydrates altogether, blood sugar levels do no spike, but the underlying glucose resistance may still be present. Although some small non-randomized studies show improvements with the diet, a larger meta-analysis of diabetic patients on either the ketogenic diet or a high-carbohydrate, low-fat diet for more than one year showed no difference in hemoglobin A1cs or glycemic levels between the two diets. If the diet produces results no different than a high-carbohydrate, low-fat diet, then what about its effects on weight loss?

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