The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed

• Published in: The Journal of nutrition Vol. 150; no. 6; pp. 1354 - 1359
• Main Author: Ludwig, David S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020; Oxford University Press; American Institute of Nutrition
• Subjects: Alzheimer disease; Blood glucose; Blood Glucose - metabolism; Calories; cancer; Carbohydrates; cardiovascular disease; Clinical medicine; Clinical trials; Diabetes; Diabetes mellitus; Diet; Diet, Ketogenic; Dietary Carbohydrates - administration & dosage; Glucose; High fat diet; Hogs; Humans; Insulin; Insulin - blood; Insulin Resistance; Issues and Opinions; Ketogenesis; ketogenic diet; ketones; Ketosis; Long-term effects; Low carbohydrate diet; Low fat diet; Nutrient deficiency; Nutrition; Nutrition Policy; Nutrition research; Obesity; Obesity - diet therapy; Obesity - metabolism; Public health; vegan diet; Weight Loss; cardiovascular disease; low-carbohydrate diet; ketogenic diet; Alzheimer disease; vegan diet; low-fat diet; cancer; ketones; diabetes; obesity
• ISSN: 0022-3166; 1541-6100; 1541-6100
• DOI: 10.1093/jn/nxz308

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.