​Take-home messages🔑:  

Introduction🍽️

We derive energy from foods containing carbohydrates, proteins and fats, collectively known as macronutrients. The primary principle for achieving weight loss is to consume less energy than is expended, creating an energy deficit that prompts the body to utilise its fat stores. This is why weight loss can occur on any diet that restricts portion sizes, specific foods or overall energy intake, whether it be low-carbohydrate, low-fat or balanced (1), as well as through exercise programmes that burn energy, with or without dietary restrictions. Diets that exclude particular foods or entire food groups or emphasise single foods, can be challenging to maintain long-term due to their lack of flexibility and their effectiveness can vary due to the insulin response towards the foods consumed. Most diets reduce access to energy-dense, highly palatable foods, which aids in weight loss. Adherence to restrictive diets is often low outside of controlled research settings, affecting their real-world effectiveness. The set point theory suggests that the body has a natural weight range, or "set point," that it tends to maintain, making it difficult to sustain weight loss or gain outside of this range. This is why maintaining weight loss can be challenging, and the more drastically a diet is altered to achieve weight loss, the easier it may be to regain weight once the diet is stopped.

The energy in vs energy out theory is further complicated by the insulin response to the foods we consume. Insulin modulates weight regulation by directing how the body handles energy: foods that trigger strong insulin responses promote fat storage and suppress fat breakdown, while those with gentler effects support satiety and allow fat mobilisation between meals. Thus, weight change is not determined by energy balance alone but also by the hormonal context, food quality, timing of intake and individual insulin sensitivity.

One effective way to lower insulin responses is to follow a low-carbohydrate diet, which reduces the amount of glucose entering the bloodstream and therefore minimises insulin release. However, it is not just the quantity (% contribution to total energy intake) but also the quality (type and nature) of the carbohydrates that are critical in weight loss diets (7) and these profoundly affects health outcomes of dieters. Complex carbohydrates are digested more slowly, producing a gentler rise in blood glucose and insulin, supporting satiety and reducing fat storage. Substituting refined carbohydrates, such as sugary snacks and white bread, with high-quality alternatives—such as whole grains, legumes, vegetables and fruit, which provide more fibre, nutrients and slow-releasing energy with a low insulin response—is always a smart strategy.

While any diet that restricts energy intake and consider insulin response can lead to weight loss, it is essential to consider the associated disease risks, whether the diet meets nutritional needs and its sustainability for long-term success. In the nutrition community, low-carbohydrate diets—which limit carbohydrate intake in favour of increased protein, fat or both (such as Atkins or Keto diets)—along with low-fat and balanced diets, are debated due to their potential impact on health and disease (2). Normally, the body uses glucose (derived from carbohydrates) as its primary energy source. However, when carbohydrates are restricted, the body shifts to using fatty acids and ketones for fuel (3). This metabolic state, known as ketosis, occurs because the lack of glucose forces the body to break down stored fat into fatty acids, which are then converted into ketones for energy. This shift is one reason why low-carbohydrate diets are heavily debated in terms of their long-term health effects.

Here, I present evidence supporting the effectiveness of low-carbohydrate diets for weight loss, while also discussing the potential health consequences that dieters should consider.

Effectiveness of low-carbohydrate diets on weight loss: Evidence from studies summarising weight loss trials🏋️‍♀️

When interpreting results from low-carbohydrate diets (Keto) diet trials one must consider the significant water weight loss due to glycogen depletion, which can affect body weight results and that must be properly accounted for. In their meta-analysis Nordmann and other researchers (4) compared the effects of low-carbohydrate diets followed for 6 months without energy restriction vs energy-restricted low-fat diets on weight loss. They concluded that low-carbohydrate, non–energy-restricted diets are at least as effective as low-fat, energy-restricted diets in inducing weight loss.

Similarly, Bueno et al. (5) summarised 13 studies that compared the long-term effects of very-low-carbohydrate ketogenic diets (with no more than 50 g of carbohydrates per day) and low-fat diets. Their findings showed that individuals on very-low-carbohydrate ketogenic diets experienced greater weight loss than those on low-fat diets.

In another meta-analysis (6) low-carbohydrate diets, were shown to be effective for weight loss, with significant reductions in body weight at both 6-month (8.73 kg) and 12-month (7.25 kg) follow-ups. However, the differences in weight loss between low-carbohydrate and low-fat diets were minimal, reinforcing the idea that adherence to the chosen diet plays a more crucial role in achieving weight loss than the specific macronutrient composition. Similarly, Naude and colleagues (7) summarised 19 good quality randomised controlled trails and concluded that weight loss could be achieved irrespective of whether the diet is low in carbohydrates or balanced.

A one-month very-low-energy ketogenic diet in women with obesity led to weight loss, including reductions in both fat mass and lean soft tissue, alongside a metabolic shift toward increased fat and protein oxidation with reduced carbohydrate use (8). However, energy expenditure decreased by about 10%, highlighting both the effectiveness of very-low-energy ketogenic diet for short-term weight loss and the potential metabolic adaptations that may limit long-term sustainability (8).

Although not a systematic review or meta-analysis a 12-month randomised controlled trial (DIETFITS) compared the effects of a healthy low-carbohydrate diet and a healthy low-fat  diet on visceral adipose tissue (VAT; VAT conveys a high risk for disease development) in 449 adults using dual-energy X-ray absorptiometry (9). Participants following the healthy low-carbohydrate diet experienced greater reductions in VAT than those on the healthy low-fat diet at both 6 months and 12 months, with the difference particularly evident at 6 months (9). The preferential loss of metabolically harmful visceral fat relative to subcutaneous fat was observed mainly at 6 months, and men showed greater VAT reductions than women, while insulin secretion status did not influence the response (9). The findings highlight the importance for researchers conducting meta-analyses in the future to consider not only overall weight loss but also the specific type of adipose tissue lost.

Tailoring diets based on insulin sensitivity and genetics: Personalised weight loss strategies🧬

The table below summarises findings from various studies on the relationship between diet, insulin sensitivity and genetics. The key takeaway is that insulin sensitivity and genetic factors i.e. the insulin receptor substrate 1 (IRS1) genotype can influence how effective certain diets are for weight loss and insulin resistance improvement. Tailoring diets based on these factors may lead to better outcomes, particularly with low-carbohydrate diets being more beneficial for insulin-resistant individuals. However, in some cases (10), genetics and insulin secretion were found to have no effect on weight loss between different diets.

Table: Summary of studies on diet, insulin sensitivity and genetic factors

Health implications of low-carbohydrate diets❤️

When selecting a weight loss strategy, it is crucial to consider not only the effects on body weight but also the broader health impacts. Different diets, particularly those with low-carbohydrate approaches, can influence various aspects of health, including cardiovascular risk factors, metabolic health and even long-term mortality. Therefore, dieters must balance weight loss goals with the potential long-term health consequences of their chosen dietary approach.

Cholesterol changes and cardiovascular health

There are health aspects to consider when choosing a weight loss strategy. Nordmann and colleagues (4) warned against the unfavourable changes in low-density lipoprotein cholesterol (the bad cholesterol) values when consuming a low-carbohydrate diets to induce weight loss. Bueno et al. (5) found that the very low carbohydrate diet decreased triglycerides (triacylglycerol) and diastolic blood pressure, but increased both the good (high-density lipoprotein, HDL) and bad (low-density lipoprotein, LDL) cholesterol. A meta-analysis of 174 randomised trials with 11,481 adults found that carbohydrate-restricted diets improved cardiovascular markers (lower triglycerides, blood pressure and inflammation, with higher HDL cholesterol) and reduced body fat. However, ketogenic diets increased LDL cholesterol and total cholesterol, and potential adverse effects such as lean mass loss highlight the need for careful clinical monitoring (16).

Low-carbohydrate diets improve cardiometabolic risk factors—including blood pressure, glycaemic control, lipid profiles and body composition—in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), especially when carbohydrate intake is strictly limited and interventions are short-term (17). Similarly a cross-sectional study of 3,685 adults with type 2 diabetes found an inverse association between low-carbohydrate diet score and 10-year atherosclerotic cardiovascular disease risk, meaning higher low-carbohydrate diet scores were linked to lower cardiovascular risk (18). Individuals in the highest low-carbohydrate diet tertile had reduced atherosclerotic cardiovascular disease risk compared to those in the lowest tertile, with stronger protective effects observed in those with obesity, hypertension, dyslipidaemia or chronic kidney disease (18). While these findings suggest low-carbohydrate diet patterns may benefit cardiovascular health in type 2 diabetes, the cross-sectional design and reliance on self-reported diet limit causal interpretation (18).

Animal vs plant protein in low-carbohydrate diets

Song et al. (19) showed that high animal protein intake was positively associated with cardiovascular mortality and high plant protein intake was inversely with all-cause and cardiovascular mortality. Therefore, dieters considering following a high protein diet could substitute animal protein especially that from processed meat and red meat with plant protein because they are linked to increased cancer, cardiovascular and type 2 diabetes risk (20-22).

Low-carbohydrate diets: Metabolic health and type 2 diabetes risk

Recent evidence presents a nuanced view of low-carbohydrate diets in relation to metabolic health and type 2 diabetes. A large Australian cohort study found that a higher low-carbohydrate diet score was associated with an increased risk of developing type 2 diabetes, primarily mediated by obesity—suggesting that low-carbohydrate diets may elevate diabetes risk, particularly in individuals predisposed to excess weight (23). A weight-maintaining ketogenic diet, even with increased ketone levels, did not improve glucose tolerance, insulin sensitivity or other metabolic parameters in obese individuals with type 2 diabetes (24). A systematic review and meta-analysis (12 randomised control trials, 805 participants) examined whether a low-carbohydrate diet combined with exercise (LCD+EX) improves glycaemic control and metabolic health compared to non-restricted diets with exercise (NRD+EX) in adults with type 2 diabetes (25). A low-carbohydrate diet combined with exercise did not show overall improvements in glycaemic control compared to non-restricted diets with exercise in adults with type 2 diabetes (25).

In contrast, an umbrella meta-analysis found that low-carbohydrate diets improved short-term glycaemic control in type 2 diabetes, with reductions in glycated haemoglobin (HbA1c) observed in most studies and temporary gains in insulin sensitivity (26). Another systematic review and meta-analysis of 41 randomised controlled trials assessed the effects of low-carbohydrate diets interventions in adults with metabolic syndrome. The findings demonstrated improvements in key metabolic biomarkers, including glycated haemoglobin (HbA1c) (27).

Low-carbohydrate diets show mixed effects on metabolic health and type 2 diabetes risk. Some studies report short-term improvements in glycaemic control, while others suggest long-term risks. Contrasting results may stem from not distinguishing between complex, high-quality carbohydrates and refined carbohydrates in studies.

Mortality risk and macronutrient balance

In a summary of observational studies low-carbohydrate diets were associated with a higher risk of all-cause mortality but not with cardiovascular mortality (28). Likewise, Seidelmann et al. (29) found that both high and low percentages of carbohydrate diets were associated with increased mortality, with minimal risk observed at 50–55% of total energy provided by carbohydrates. Similar to Noto and colleagues (28), Seidelmann et al. (29) observed that low carbohydrate dietary patterns favouring animal-derived protein and fat sources (lamb, beef, pork and chicken), were associated with higher mortality, whereas those that favoured plant-derived protein and fat intake (from sources such as vegetables, nuts, peanut butter and whole-grain breads) were associated with lower mortality.

Cognitive effects of very low-carbohydrate diets

A study by Wing et al. (30) showed that a very low carbohydrate ketogenic diet reduced weight, but worsened higher order mental processing and flexibility impairing problem solving. A large prospective cohort study examined the relationship between long-term red meat intake and cognitive outcomes in 133,771 participants (31). Higher consumption of processed red meat (≥0.25 servings/day) was linked to a 13% increased risk of dementia and 14% higher risk of subjective cognitive decline (31). Additionally, processed red meat intake was associated with accelerated cognitive aging, particularly in global cognition and verbal memory. Higher unprocessed red meat intake (≥1 serving/day) was also linked to a 16% higher risk of subjective cognitive decline (31). Notably, replacing one daily serving of processed red meat with nuts and legumes was associated with a 19% lower risk of dementia and 21% lower risk of subjective cognitive decline (31). This has important implications for individuals following a low-carbohydrate diet for weight loss, as such diets often emphasise protein sources, including red meat and not plant derived sources.

Kidney health

A cohort study of 1,797 Tehranian adults found that a low-carbohydrate, high-protein (LCHP) diet score was associated with an increased risk of chronic kidney disease over 6.1 years—independent of major risk factors (32). A systematic review and meta-analysis of 30 studies (n = 2,160) reported that high-protein diets increased glomerular filtration rate, serum urea, urinary calcium and uric acid levels compared to normal/low-protein diets, raising concerns about renal strain, particularly in obese individuals consuming high levels of animal protein (33).

In contrast, a meta-analysis of 9 randomised controlled trials involving 1,687 overweight and obese individuals without chronic kidney disease found that low-carbohydrate diets led to a greater increase in estimated glomerular filtration rate than control diets, suggesting no adverse impact on renal function in this population (34). Similarly, a one-year randomised controlled trial in 68 adults with abdominal obesity showed no differences in serum creatinine, estimated glomerular filtration rate or urinary albumin excretion between very-low-carbohydrate and high-carbohydrate diets, indicating that long-term low-carbohydrate diets are safe for individuals with normal kidney function (35).

In summary, while high-protein diets may pose risks for kidney health—especially in vulnerable groups consuming high animal derived proteins—low-carbohydrate diets appear safe and potentially beneficial for renal function in individuals without pre-existing kidney disease.

Binge eating after low-carbohydrate diet

Adherence to an unsupervised low-carbohydrate diet among Brazilian university students was associated with worsening binge eating and heightened food cravings over a three-month period, particularly when culturally important foods such as rice were restricted (36).

Cancer patients

Cancer patients often face challenges including dietary. A ketogenic diet—high in fat and low in carbohydrates—improved metabolic, emotional and functional outcomes in cancer patients compared to standard diets, especially when followed for over 12 weeks (37).

Modest benefits for depression, inconclusive evidence for anxiety

In a meta-analysis involving 50 studies and 41 718 participants, ketogenic diets were linked to modest improvements in depressive symptoms, especially in studies verifying ketosis, while evidence for anxiety outcomes was inconsistent (38). Larger, high-quality trials with standardised protocols are needed to confirm their effectiveness and long-term impact.

Ketogenic diet and liver health

A systematic review and meta-analysis of 20 randomised controlled trials found that ketogenic diets lower liver enzyme levels (alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT)), particularly in individuals with a body mass index under 30 and when followed for less than 12 weeks (39). However, the diet showed no meaningful effect on liver stiffness, indicating limited impact on fibrosis progression.

Oxytocin levels

An exploratory study found that a very‑low‑calorie ketogenic diet reduced plasma oxytocin levels in individuals with overweight or obesity (40). Baseline oxytocin correlated with body mass index, fat mass and ketone levels, and served as an independent predictor of both weight loss and ketosis during the intervention (40). In the context of weight loss, a drop in oxytocin may reflect improved metabolic balance rather than impaired function, but it could also indicate shifts in how the body regulates hunger, fat storage and emotional eating behaviours.

Sleep quantity and quality

A systematic review and meta-analysis evaluated the effects of carbohydrate intake on sleep across 11 articles comprising 27 nutrition trials, resulting in 16 comparison datasets (sleep quantity n = 11; sleep quality n = 5)(41). Using a random-effects meta-analysis, low carbohydrate intake moderately increased both duration and proportion of deep (N3) sleep compared to high carbohydrate intake (41). Conversely, high carbohydrate intake prolonged rapid eye movement (REM) sleep duration and proportion. REM sleep is the stage of sleep most strongly linked to vivid dreaming, memory consolidation and emotional regulation. It occurs multiple times per night, with longer episodes toward the morning. Meta-regression showed that changes in carbohydrate quantity (% of daily energy) influenced sleep onset latency, highlighting that reducing carbohydrates may improve sleep depth without affecting sleep quality measures related to REM. These results suggest that low-carbohydrate dietary patterns could support deeper restorative sleep (41).

Conclusion📝

Low-carbohydrate diets have demonstrated effectiveness in promoting weight loss, particularly in the short term, however, their long-term health implications and sustainability must be further explored. Evidence supports that weight loss can be achieved with various dietary approaches—whether low-carbohydrate, low-fat or balanced—provided there is adherence to the chosen regimen. However, individual factors such as insulin sensitivity and genetics can influence the effectiveness of these diets, particularly for insulin-resistant individuals who may benefit more from low-carbohydrate approaches.

Importantly, beyond weight loss, the quality of macronutrients plays a critical role in determining long-term health outcomes. Substituting refined carbohydrates with nutrient-dense, high-fibre alternatives and replacing unhealthy fats with healthier options can contribute to better cardiovascular health and overall well-being.

For those without insulin resistance, a balanced diet that meets the body’s micronutrient needs—providing 50–55% of total energy from high-quality carbohydrates (complex carbohydrates with low glycaemic indexes), protein primarily from plant sources and healthy fats such as mono-unsaturated fatty acids (MUFAs) and poly-unsaturated fatty acids (PUFAs)—appears to be the most effective for long-term health. Adopting balanced dietary changes and increasing physical activity levels are recommended both for achieving weight loss and for keeping the weight off long-term (42).

Reflection Exercises🤔

·        Reflect on how much you know about the importance of macronutrients. How has your understanding of carbohydrates, proteins and fats changed after reading about their role in both weight loss and overall health?

·        Reflect on your current diet. How much of it is composed of carbohydrates, proteins and fats?

·        Consider your own or someone else's weight loss journey. Were specific diets such as low-carbohydrate or low-fat used? Reflect on how successful these diets were in terms of both weight loss and long-term maintenance.

·        Reflect on the association between high animal protein intake and cancer and cardiovascular risks. How could substituting plant-based proteins in your diet impact your long-term health?

·        Reflect on how a very low-carbohydrate diet could affect cognitive functions, such as problem-solving and flexibility. Have you ever noticed a change in mental performance when following a specific diet?

·        Reflect on the idea of balance in a diet. How do you currently balance your carbohydrate, protein and fat intake? What changes could you make to ensure you are meeting your micronutrient requirements?

·        Consider the challenges of maintaining weight loss after dieting. Have you or someone you know experienced weight regain after a restrictive diet? Reflect on why balanced diets may be more sustainable.

Always seek guidance from dietitians for personalised diets and weight management plans.

Love what you’re reading? Share the knowledge! 📨 Forward this link to a friend who might also enjoy it.

References 📝

1.         Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. New England Journal of Medicine. 2009;360(9):859-73.

2.         Ornish D. Was Dr Atkins right? Journal of the American Dietetic Association. 2004;4(104):537-42.

3.         Westman EC, Feinman RD, Mavropoulos JC, Vernon MC, Volek JS, Wortman JA, et al. Low-carbohydrate nutrition and metabolism. The American journal of clinical nutrition. 2007;86(2):276-84.

4.         Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Brehm BJ, et al. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Archives of internal medicine. 2006;166(3):285-93.

5.         Bueno NB, de Melo ISV, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British journal of nutrition. 2013;110(7):1178-87.

6.         Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, et al. Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. Jama. 2014;312(9):923-33.

7.         Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PloS one. 2014;9(7):e100652.

8.         Basolo A, Piaggi P, Angeli V, Fierabracci P, Bologna C, Vignali E, et al. Effects of 1-Month Very-Low-Calorie Ketogenic Diet on 24-Hour Energy Metabolism and Body Composition in Women With Obesity. The Journal of Clinical Endocrinology & Metabolism. 2025;110(12):e4158-e68.

9.         Follis S, Landry MJ, Cunanan KM, Stefanick ML, Ward CP, Gardner CD. Effect of low-carbohydrate vs low-fat diet intervention on visceral fat estimated from dual energy X-ray absorptiometry in a 12-month randomized controlled trial. International journal of obesity (2005). 2025.

10.       Gardner CD, Trepanowski JF, Del Gobbo LC, Hauser ME, Rigdon J, Ioannidis JP, et al. Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion: the DIETFITS randomized clinical trial. Jama. 2018;319(7):667-79.

11.       Cornier MA, Donahoo WT, Pereira R, Gurevich I, Westergren R, Enerback S, et al. Insulin sensitivity determines the effectiveness of dietary macronutrient composition on weight loss in obese women. Obesity research. 2005;13(4):703-9.

12.       Ebbeling CB, Feldman HA, Klein GL, Wong JM, Bielak L, Steltz SK, et al. Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. bmj. 2018;363.

13.       McClain AD, Otten JJ, Hekler EB, Gardner CD. Adherence to a low‐fat vs. low‐carbohydrate diet differs by insulin resistance status. Diabetes, Obesity and Metabolism. 2013;15(1):87-90.

14.       Pittas AG, Das SK, Hajduk CL, Golden J, Saltzman E, Stark PC, et al. A low-glycemic load diet facilitates greater weight loss in overweight adults with high insulin secretion but not in overweight adults with low insulin secretion in the CALERIE Trial. Diabetes care. 2005;28(12):2939-41.

15.       Qi Q, Bray GA, Smith SR, Hu FB, Sacks FM, Qi L. Insulin receptor substrate 1 gene variation modifies insulin resistance response to weight-loss diets in a 2-year randomized trial: the Preventing Overweight Using Novel Dietary Strategies (POUNDS LOST) trial. Circulation. 2011;124(5):563-71.

16.       Feng S, Liu R, Thompson C, Colwell B, Chung S, Barry A, et al. Effects of carbohydrate-restricted diets and macronutrient replacements on cardiovascular health and body composition in adults: a meta-analysis of randomized trials. Am J Clin Nutr. 2025;122(5):1461-78.

17.       Pi S, Zhang S, Zhang J, Guo Y, Li Y, Deng J, et al. Low-carbohydrate diets reduce cardiovascular risk factor levels in patients with metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Nutrition. 2025;12:1626352.

18.       Du Y, Ouyang H, Wang H, Shi J, Li Y, Long H, et al. Association between Low-carbohydrate Diets and 10-year Atherosclerosis Cardiovascular Disease Risk: Data from the National Health and Nutrition Examination Survey. Current diabetes reviews.

19.       Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA internal medicine. 2016;176(10):1453-63.

20.       Farvid MS, Sidahmed E, Spence ND, Mante Angua K, Rosner BA, Barnett JB. Consumption of red meat and processed meat and cancer incidence: a systematic review and meta-analysis of prospective studies. European journal of epidemiology. 2021;36:937-51.

21.       Kennedy J, Alexander P, Taillie LS, Jaacks LM. Estimated effects of reductions in processed meat consumption and unprocessed red meat consumption on occurrences of type 2 diabetes, cardiovascular disease, colorectal cancer, and mortality in the USA: a microsimulation study. The Lancet Planetary Health. 2024;8(7):e441-e51.

22.       Wang DD, Li Y, Nguyen X-M, Ho Y-L, Hu FB, Willett WC, et al. Red Meat Intake and the Risk of Cardiovascular Diseases: A Prospective Cohort Study in the Million Veteran Program. The Journal of Nutrition. 2024;154(3):886-95.

23.       Kabthymer RH, Karim MN, Itsiopoulos C, Hodge AM, De Courten B. Association of low carbohydrate diet score with the risk of type 2 diabetes in an Australian population: A longitudinal study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2024:103049.

24.       Merovci A, Finley B, Hansis-Diarte A, Neppala S, Abdul-Ghani MA, Cersosimo E, et al. Effect of weight-maintaining ketogenic diet on glycemic control and insulin sensitivity in obese T2D subjects. BMJ Open Diabetes Res Care. 2024;12(5).

25.       He Y, Dai Z, Yu AP-h, Wong SH-s, Poon ET-c. Efficacy of a low-carbohydrate diet combined with exercise on glycemic control and metabolic health in type 2 diabetes mellitus: A systematic review and meta-analysis. Diabetes, Obesity and Metabolism.n/a(n/a).

26.       Yan Y, Asemani S, Jamilian P, Yang C. The efficacy of low-carbohydrate diets on glycemic control in type 2 diabetes: a comprehensive overview of meta-analyses of controlled clinical trials. Diabetol Metab Syndr. 2025;17(1):341.

27.       Zheng Q, Gao X, Ruan X, Chen S, Pan X, Wang R, et al. Are low carbohydrate diet interventions beneficial for metabolic syndrome and its components? A systematic review and meta-analysis of randomized controlled trials. International Journal of Obesity. 2025;49(7):1252-63.

28.       Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PloS one. 2013;8(1):e55030.

29.       Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018;3(9):e419-e28.

30.       Wing R, Vazquez J, Ryan C. Cognitive effects of ketogenic weight-reducing diets. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity. 1995;19(11):811-6.

31.       Li Y, Li Y, Gu X, Liu Y, Dong D, Kang JH, et al. Long-Term Intake of Red Meat in Relation to Dementia Risk and Cognitive Function in US Adults. Neurology. 2025;104(3):e210286.

32.       Farhadnejad H, Asghari G, Emamat H, Mirmiran P, Azizi F. Low-Carbohydrate High-Protein Diet is Associated With Increased Risk of Incident Chronic Kidney Diseases Among Tehranian Adults. Journal of Renal Nutrition. 2019;29(4):343-9.

33.       Schwingshackl L, Hoffmann G. Comparison of high vs. normal/low protein diets on renal function in subjects without chronic kidney disease: a systematic review and meta-analysis. PloS one. 2014;9(5):e97656.

34.       Oyabu C, Hashimoto Y, Fukuda T, Tanaka M, Asano M, Yamazaki M, et al. Impact of low-carbohydrate diet on renal function: a meta-analysis of over 1000 individuals from nine randomised controlled trials. British journal of nutrition. 2016;116(4):632-8.

35.       Brinkworth GD, Buckley JD, Noakes M, Clifton PM. Renal Function Following Long-Term Weight Loss in Individuals with Abdominal Obesity on a Very-Low-Carbohydrate Diet vs High-Carbohydrate Diet. Journal of the American Dietetic Association. 2010;110(4):633-8.

36.       de Oliveira J, de Paula ACP, dos Santos TDSM, Smaira FI, Caruso BM, Guimarães VHD. Worsening Binge eating over time following an unsupervised Low-carbohydrate diet. Nutrition. 2025:112906.

37.       Zhang M, Zhang Q, Huang S, Lu Y, Peng M. Impact of the Ketogenic Diets on Cancer Patient Outcomes: A Systematic review and Meta-analysis. Frontiers in Nutrition. 2025;12:1535921.

38.       Janssen-Aguilar R, la Portilla JG, Martínez-Juárez IE, Mimiaga-Hernandez C, Alvarado-Luis G, Aguilar-Hernandez A, et al. The impact of ketogenic diet on the frequency of psychogenic non-epileptic seizures (PNES): A feasibility randomized pilot study. Epilepsia Open. 2025.

39.       Qu Y, Sohouli MH, Rohani P, Cerqueira HS, Gomes GK, Santos HO. The Effect of a Ketogenic Diet on Liver Health: A Systematic Review and Meta-Analysis. Nutrition Reviews. 2025.

40.       Gangitano E, Rossetti R, Tozzi R, Nevi P, Masi D, Basciani S, et al. Oxytocin, Weight Loss and Ketosis in Response to a Very-Low-Calorie Ketogenic Diet: An Exploratory Study. Nutrients. 2026;18(3):485.

41.       Vlahoyiannis A, Giannaki CD, Sakkas GK, Aphamis G, Andreou E. A Systematic Review, Meta-Analysis and Meta-Regression on the Effects of Carbohydrates on Sleep. Nutrients. 2021;13(4).

42.       Macedo RC, Santos HO, Tinsley GM, Reischak-Oliveira A. Low-carbohydrate diets: Effects on metabolism and exercise–A comprehensive literature review. Clinical nutrition ESPEN. 2020;40:17-26.

In developing this work, the author utilised ChatGPT-4 to assist with language editing, not for content generation.