BITESIZE: Keto Outperformed Mediterranean and Low-Fat Diets in New RCT for Fatty Liver and Prediabetes

Does reducing carbohydrates improve metabolic health beyond what can be explained by weight loss alone?

Dr. Bret Scher breaks down a new randomized controlled trial published in Cell Metabolism that compared three diets in people with prediabetes and fatty liver disease: a ketogenic diet, a higher-carbohydrate Mediterranean diet, and a very low-fat, plant-forward diet.

One challenge with ketogenic diet research is that participants often lose more weight than those in comparison groups, making it difficult to separate the effects of carbohydrate reduction from those of weight loss itself.

In this trial, researchers provided all of the meals, and participants achieved greater than 95% dietary compliance. Importantly, all three groups ultimately lost the same 10% of their body weight. That gave researchers an unusual opportunity to compare metabolic outcomes across the three diets without differences in weight loss muddying the picture.

And even with weight loss held constant, the outcomes differed.

The ketogenic group reduced liver fat by 67%, compared with 45% in the Mediterranean and plant-forward groups, and saw larger improvements in liver insulin sensitivity. Prediabetes remission also occurred in 50% of the ketogenic group, compared with 29% of the Mediterranean group and 7% of the low-fat, plant-forward group.

Dr. Scher covers:

• Why similar weight loss across the three groups makes this trial especially informative
• How all three diets affected skeletal muscle insulin sensitivity
• Why liver insulin sensitivity improved more with the ketogenic diet
• The differences in liver fat reduction between the three groups
• Prediabetes remission rates across each dietary approach
• How carbohydrate reduction may suppress liver fat production
• Changes in the glucagon-to-insulin ratio on ketogenic therapy
• What the study found about saturated fat, LDL cholesterol, and ApoB
• Improvements in triglycerides, VLDL, and lipoprotein insulin resistance
• The study’s limitations, including its small size and 4- to 5-month duration

For people with fatty liver disease or prediabetes, this study adds evidence that carbohydrate reduction may produce metabolic benefits beyond those achieved through weight loss alone.

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Expert Featured:

Bret Scher, MD - Baszucki Group Medical Director & Host of the Metabolic Mind Podcast

• https://www.linkedin.com/in/bret-scher-08baaa102/
• https://www.instagram.com/drscher858/?hl=en
• https://x.com/bschermd

Resources Mentioned:

Effect of diet macronutrient content on the cardiometabolic response to weight loss: A randomized clinical trial

linkinghub.elsevier.com/retrieve/pii/S1550413126002937

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About us:

Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.

Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice or establishing a provider-patient relationship. Many of the interventions we discuss can have potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications. In addition, it is important to note that people may respond differently to ketosis, and there isn't one recognized universal response.