[aaavl2821]

Lack of information is certainly a problem but food insecurity and habits are also very important. A lot of people would have a really hard time, logistically, maintaining a ketogenic diet [0]

I'm also somewhat skeptical of the evidence that the ketogenic diet can cure diabetes (or cancer / autism etc). I haven't looked into it in depth, so may be wrong, but all I've seen in the way of evidence are 1) anecdotal cases 2) hypotheses about a supposed biological mechanism (haven't seen any good studies validating this mechanism) and 3) appeals to evolution, i.e. "People ate low carb for most of human history etc", again with no rigorous science (that I've seen) to support this, just logical sounding claims

You'd need large randomized controlled trials to really test 1) whether it works, 2) whether it's safe and 3) whether the benefit is attributable to a low carb diet or to people just being on a diet in general. Unfortunately those are expensive so will probably never be done because no one requires them (like FDA for drugs)

Proponents of keto diet also cite the entrenched corporate financial interests that led the low-fat wave based on shoddy science. The same dynamic is at play with low carb. I asked a very well funded company marketing keto diet products about their clinical research efforts, and they said they don't have a clinical research arm -- all the clinical studies fall under the marketing department

I'm not saying it's pseudoscience, but based on the limited data I've seen I don't think we can rule that out

[0] https://www.google.com/amp/s/www.citylab.com/amp/article/560...

[virtuallynathan]

There are a ton of peer reviewed papers on Keto diets available on PubMed. Here's a collection and summary as a spreadsheet: https://docs.google.com/spreadsheets/d/1Ucfpvs2CmKFnae9a8zTZ...

[aaavl2821]

Thanks, that's helpful

Based on skimming that it looks like low carb diet can be as effective or more effective than low fat diet at reducing triglycerides, blood glucose and other metabolic markers, may not be as good at reducing LDL as low fat, and may pose additional safety risks compared to low fat. Some articles say no difference in blood glucose between low fat and high carb. Some say Mediterranean diet is better at glucose control than low carb diet.

Of the studies that show low carb has better a1c reduction than low fat, the reduction is ~0.5%. Clinically meaningful but certainly not a reversal of diabetes

So low carb may be better than low fat diet at reducing blood glucsoe. However that isn't conclusive. Also the Mediterranean diet may be better than both at improving glucose. And some evidence suggests low carb is worse than low fat for LDL levels and heart disease

However i didn't see any studies that showed reversal of diabetes, cancer or autism or any other disease. I don't doubt that a low carb diet can help people lose weight or better control their diabetes. I do doubt whether it can "reverse diabetes at scale", cure cancer etc. using preliminary findings that low carb is better than other diets at a1c reduction to claim this can "reverse diabetes at scale" seems not far from snake oil to me

[virtuallynathan]

I think you then have to ask the question of "Is LDL cholesterol level a good measure of risk?" -- it seems like it is not. That spreadsheet is pretty focused on diabetes and weight, searching pubmed for Ketosis, or Ketogenic will yield many papers about the benefits for neurodegenerative diseases, cancer, etc. There's still a ton of research to be done, but it looks promising.

[nradov]

Virta Health has been doing that controlled trial, although it's not randomized.

https://clinicaltrials.gov/ct2/show/NCT02519309?term=virta&r...

[aaavl2821]

There are several issues with that study design that leave it open to experimental bias:

* not randomized, as you mention

* the control is not great: "treatment as usual" is not a very good control in general and is a particular issue in psychiatric and behavioral research. with this design you cannot attribute any improvement specifically to the diet. improvement could be driven by better coaching, more frequent contact with health professionals, being part of a group, a psychological / placebo benefit, etc. a better control would be an active control where subjects get the exact same thing as the Virta patients, but are on a low-fat diet, or all-plant diet, etc instead of a low carb diet

* different endpoints for active vs control arm: only the virta arm's primary outcomes are measured at 3 months, while the control and virta arms are measured at 12 and 24 months. there are differences for other endpoints as well. this is not necessarily that big of an issue, and they may just be wanting to measure exploratory endpoints and dont want to spend the extra money following control patients. however for a primary endpoint it seems odd. a cynic could say that virta could claim success on a primary endpoint if the virta arm improves at 3 months even if it does not differ from control at 12 and 24 months. this study is just done by virta prob for marketing and no one is really overseeing this so wouldnt really call them out on it

* different inclusion criteria for active arm: only the active arm can enroll pre-diabetic subjects. the control arm cannot. if they don't pool these pts with others when analyzing results, maybe this is less concerning, otherwise its a pretty big deal in my opinion