JAMA. 2018;319(3):215-217.

Rick Hecht, MD, is research director of the Osher Center for Integrative Medicine at the University of California, San Francisco, where he studies nonpharmacological approaches to chronic disease. He said more data are needed on long-term outcomes of the LDL level increases resulting from a ketogenic diet. But, he adds, “For people with type 2 diabetes, I think the risks of poor glycemic control from excessive carbohydrate intake far outweigh the risks of saturated fats, and most people with type 2 diabetes should focus on limiting carbohydrates—particularly simple carbohydrates—as a greater priority than saturated fat.”

Hecht is also cautious about people doing the ketogenic diet on their own for weight loss, particularly if they have diabetes. In addition to the medication considerations, he said most patients need significant training to follow the diet. Additionally, although some people—especially those with insulin resistance—need to drastically cut carbs to lose weight and improve glucose levels, others can get good results from a Mediterranean diet.

“I don’t think everyone should be carbohydrate restricting to the level of a ketogenic diet just because they want to lose weight,” Hecht said. “We need to understand better the predictors of who’s going to benefit from this diet.”

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