Low-carbohydrate and Ketogenic Diets: Mechanisms for Weight Loss and Diabetes Remission

Abstract

The rising global prevalence of obesity and type 2 diabetes necessitates a deeper understanding of effective dietary interventions beyond conventional paradigms. Low-carbohydrate and ketogenic diets have demonstrated significant clinical efficacy, yet their multifaceted physiological mechanisms are often fragmented in the literature. This paper synthesizes current evidence to provide a cohesive explanation of how these diets drive weight loss and facilitate diabetes remission. This paper details the primary metabolic shift from glucose to ketone body utilization, driven by glycogen depletion and sustained low insulin levels, which enables continuous lipolysis. It further explores the hormonal regulation underpinning fat mobilization, the debate surrounding increased energy expenditure, and the direct mechanisms for glycemic control, including the removal of dietary glucose and restoration of hepatic insulin sensitivity. The discussion extends to favorable alterations in body composition, including the preferential loss of visceral and ectopic fat, and analyzes the complex impact on lipid metabolism and cardiovascular risk factors. Finally, the evidence from clinical trials is contextualized by a comparative analysis with other dietary patterns, highlighting short-term advantages and the critical role of long-term adherence. Future research must prioritize long-term, randomized controlled trials to definitively establish the sustainability and safety of these diets. Further investigation is needed to elucidate the precise role of gut microbiota and bile acid signaling in mediating metabolic benefits. Personalized nutrition approaches will be essential to identify which individuals are most likely to achieve long-term success and optimal health outcomes on a low-carbohydrate or ketogenic diet.