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J Clin Lipidol. 2019 Sep 13. pii: S1933-2874(19)30267-3. doi: 10.1016/j.jacl.2019.08.003. [Epub ahead of print]

Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force.

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Wellness Center, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA. Electronic address:
Dietitian Nutritionist Specialist II and Clinical Lipid Specialist, Intermountain Health Care, Live Well Center, Salt Lake City, UT, USA.
Distinguished Professor of Nutrition, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA.
Associate Clinical Professor of Medicine (Cardiology Division) and Director of Nutrition, University of California Irvine Preventive Cardiology Program, Irvine, CA, USA.
Brown University Alpert Medical School, Lipid and Prevention Program, Lifespan Cardiovascular Institute, East Greenwich, RI, USA.
University of Pennsylvania, Preventive Cardiology Heart and Vascular Center, Philadelphia, PA, USA.
Physician Advisor for Patient Quality and Safety, Ascension Wisconsin All Saints, Racine, WI, USA.
Midwest Biomedical Research, Center for Metabolic & Cardiovascular Health, Addison, IL, USA.


Historically, low-carbohydrate (CHO) and very-low-CHO diets have been used for weight loss. Recently, these diets have been promoted for type 2 diabetes (T2D) management. This scientific statement provides a comprehensive review of the current evidence base available from recent systematic reviews and meta-analyses on the effects of low-CHO and very-low-CHO diets on body weight, lipoprotein lipids, glycemic control, and other cardiometabolic risk factors. In addition, evidence on emerging risk factors and potential safety concerns of low-CHO and very-low-CHO diets, especially for high-risk individuals, such as those with genetic lipid disorders, was reviewed. Based on the evidence reviewed, low-CHO and very-low-CHO diets are not superior to other dietary approaches for weight loss. These diets may have advantages related to appetite control, triglyceride reduction, and reduction in the use of medication in T2D management. The evidence reviewed showed mixed effects on low-density lipoprotein cholesterol levels with some studies showing an increase. There was no clear evidence for advantages regarding effects on other cardiometabolic risk markers. Minimal data are available regarding long-term (>2 years) efficacy and safety. Clinicians are encouraged to consider the evidence discussed in this scientific statement when counseling patients on the use of low-CHO and very-low-CHO diets.


Cardiometabolic risk factors; Glycemic control; Ketogenic diet; Lipoproteins; Low-carbohydrate diet; Medical nutrition therapy; Obesity; Triglycerides; Very-low-carbohydrate diet; Weight loss

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