High intake of dietary fat is commonly believed, by both scientists and the general public, to cause obesity, diabetes, and cardiovascular disease. Although many Americans adhere to dietary guidelines that focus on reducing intakes of saturated and total fat, rates of many diet-related chronic diseases have markedly increased.
Ketogenic diets, which provide ≥ 70% of calories from fat, have been dismissed as fad weight-loss diets. However, ketogenic diets have a long history in clinical medicine and human evolution. Noting that ketogenic diets have elicited controversy, David Ludwig (New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School) provides a comprehensive review, published in The Journal of Nutrition, of evidence-based studies on the effects of ketogenic diets for a wide range of health conditions.
Ketogenic diets may be more effective than low-fat diets for the 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 resulting in reduced risk of certain cancers, 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 type 2 diabetes.
High-quality clinical trials of ketogenic diets will further scientific understanding of long-term effects and their full potential in clinical medicine. Key unresolved questions that warrant further investigation include: How does LDL cholesterol elevation with carbohydrate restriction affect cardiovascular risk versus triglyceride elevation with fat restriction? Does the reduction in blood glucose and insulin on a ketogenic diet improve vascular health? Are there susceptible populations or conditions for which a ketogenic diet would be contraindicated? What is the efficacy of a ketogenic diet for long-term weight loss and behavioral change? Does chronic ketosis provide unique metabolic benefits, beyond those obtained by a low-glycemic index, moderate-carbohydrate diet?
References Ludwig DS. The Ketogenic Diet: Evidence for Optimism but High-Quality Research Needed. The Journal of Nutrition, Volume 150, Issue 6, June 2020, Pages 1354–1359, https://doi.org/10.1093/jn/nxz308.
Dr. Kathy Beerman teaches in the School of Biological Sciences at Washington State University. The author of several published articles, she is interested in research that focuses on the efficacy of a novel approach to treating iron deficiency anemia in rural regions of Guatemala and Ecuador. Dr. Beerman teaches an undergraduate nutrition course for health majors, as well as a course that prepares students to participate in a 10-day medical mission to Guatemala. Since joining the faculty at Washington State University in 1990, she has been the recipient of several teaching awards (the Burlington Northern Faculty Meritorious Achievement in Teaching Award, the R.M. Wade Foundation Award for Excellence in Teaching, and the Sahlin Faculty Excellence Award for Instruction). More recently, she received the CAS Outstanding Achievement Award in International Activities (2017) and the President’s Award for Leadership (2018). Other scholarly activities include co-author of two introductory nutrition textbooks (Nutritional Sciences: From Fundamentals to Food and NUTR).
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