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 Based on a review of existing research, the scientific statement
emphasizes some advantages of a ketogenic, or very low-carb, diet
including appetite suppression, lower lipid levels and lower blood
sugar in people with diabetes.
But a keto diet is also associated with spikes in the "bad"
cholesterol that can build up in blood vessels and lead to clots,
known as low-density lipoprotein cholesterol (LDL-C).
Over six months, people may lose more weight with popular low-carb
diets like the Atkins, ketogenic, South Beach, and Zone diets,
according to the recommendations published in the Journal of
Clinical Lipidology.
But after a year, weight loss with these diets is similar to what
people can achieve with diets that allow more carbohydrates,
according to the recommendations. Extremely low-carb diets can also
be harder to stick with over time, and may severely restrict
nutrient-dense foods that offer cardiovascular benefits, the
recommendations stress.
There doesn't appear to be a meaningful difference between low-carb
and other types of diets for other markers of cardiometabolic health
like blood pressure.
"While some patients prefer a low-carbohydrate eating pattern, which
may be reasonable for short periods of time, long-term compliance is
challenging, and long-term benefits and risks are not fully
understood, especially with ketogenic diets," said Carol
Kirkpatrick, lead author of the recommendations and a researcher at
Idaho State University in Pocatello.
With ketogenic diets, people typically eat very few carbs and
consume a lot of fat, putting the body into a metabolic state known
as ketosis. This can make the body more efficient at burning fat for
energy and trigger reductions in blood sugar, previous research has
found.
Some people on ketogenic diets have lost two to three times more
weight than individuals with different eating habits, but much of
this is based on short-term results.
"Weight loss with any dietary strategy is difficult and there are
many factors that impact a person's ability to lose weight and
maintain that weight loss," Kirkpatrick said by email. "Behavioral
strategies, social support, and adequate physical activity have
proven helpful for enhancing weight loss and helping with weight
loss maintenance, no matter what type of weight loss diet is
employed by a person needing to lose body fat."
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People who might benefit from following an extremely low-carb diet
for two to six months include individuals with diabetes and
individuals with high levels of triglycerides in their blood,
according to the recommendations.
Patients with a history of dangerously high cholesterol levels
should avoid keto and extremely low-carb diets, the recommendations
also note.
More research over longer periods of time is still needed to
determine whether keto or low-carb diets might be harmful or helpful
to people trying to lose weight and improve their overall health,
said Andrew Mente, a researcher at McMaster University in Hamilton,
Canada, who wasn't involved in the study.
"Since there are no long-term trials of low-carb diets and health
outcomes, this review is only able to report on intermediate risk
markers rather than actual clinical outcome events like heart
attacks, strokes, cardiovascular death, new diabetes events, and
total mortality," Mente said by email.
While diets aren't one size fits all, most people should aim for a
wide variety of healthy foods, said Dr. Sara Seidelmann, a
cardiologist and nutritionist at Brigham and Women's Hospital and
Harvard Medical School in Boston.
Ideally, adopt a diet full of plants and whole foods that provides
overall cardio-protective qualities: rich in whole grains,
vegetables, fruits, nuts, and legumes; eliminate processed foods and
trans fats; limit refined grains, saturated fats, red meat and added
sugars," Seidelmann, who wasn't involved in the study, said by
email. "Adults that are interested in pursuing a very low or low
carbohydrate diet for weight loss should consult with their
clinician in order to weigh the risks and benefits of various diets
and to share in the decision making process."
SOURCE: https://bit.ly/2nK56GL Journal of Clinical Lipidology,
online September 13, 2019.
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