Reacción a "The ketogenic diet may be more beneficial in the short term than other diets for people with obesity, according to a small clinical trial"

It is a small but well-controlled and high-quality trial: participants were randomly assigned, received all meals, and all three groups lost approximately the same amount of weight. This allows for a fairly robust conclusion that, in people with obesity, prediabetes, and fatty liver, the ketogenic diet may reduce liver fat more effectively and improve some indicators of glucose control during weight loss. However, it was not superior in every respect: all three diets similarly improved muscle response to insulin, and there were no clear differences in blood pressure, LDL cholesterol, or apolipoprotein B. Therefore, claiming that the ketogenic diet is overall healthier or better than the Mediterranean diet exaggerates the results.

The main limitation is that only 42 people completed the study, 14 per diet, and the follow-up lasted about five months. Furthermore, receiving all meals free of charge, pre-prepared, and meeting weekly with a dietitian is far from typical conditions and does not allow us to know if the diet can be maintained long-term. Frozen meals and prepared snacks were used, some potentially ultra-processed, but insufficient information was provided on their ingredients and additives to classify them or to separate the effect of macronutrients from the effect of food quality and processing. Finally, the fact that a diet with 23% of calories from saturated fat did not worsen cholesterol levels during a few months of active weight loss is interesting, but it does not demonstrate that it is safe or beneficial over years. The Mediterranean diet continues to have much stronger evidence regarding long-term cardiovascular health.