The popularity of  low carbohydrate diets  has waxed and waned in the U.S. over the last two centuries.  From the Banting diet in the 1860’s to the Atkins plan 100 years later to the Paleo/Primal way of eating that is currently in vogue, some form of carbohydrate restriction has always existed as an alternative to more conventional nutrition recommendations.  Today it is the low-fat, high-complex-carbohydrate diet that is promoted by the United States Department of Agriculture, American Dietetic Association, American Heart Association, and other organizations. While this diet may be healthy for some, I believe low carbohydrate diets can be very beneficial for others. Criticisms of low carbohydrate plans include that they are too difficult to follow long term, ineffective at sustaining weight loss, and potentially harmful to health.  However, there has been abundant research conducted over the last 20 years which disputes these claims and in fact presents a strong argument for why carbohydrate restriction is preferable for managing diabetes, overweight and obesity, and other conditions of carbohydrate intolerance.

The Reference Daily Intake ,  or RDI,  (formerly called the Recommended Dietary Allowance, or RDA)   for nutrient intake  is established by the Food and Nutrition Board (formerly called the U.S. National Academy of Sciences).  This value is used to establish the Daily  Values  seen on food labels.  The Daily Value  for carbohydrate  is currently set at  300 grams  for an individual consuming 2000 calories per day.  Research and anecdotal evidence suggest that reducing this level to 30-100 grams daily decreases postprandial glucose response, modulates hyperinsulinemia, reduces serum triglyceride synthesis,  increases high-density lipoprotein (HDL) levels,  promotes satiety, and has other favorable metabolic effects.

Below are links to several studies which provide evidence that carbohydrate restriction is not only safe but effective for weight loss and blood sugar control.

2024

Nutritional considerations during major weight loss therapy: Focus on optimal protein and a low-carbohydrate dietary pattern

Low-carbohydrate and ketogenic dietary patterns for type 2 diabetes management

Effects of ketogenic diet on weight loss parameters among obese or overweight patients with polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials

The effect of a ketogenic diet versus Mediterranean diet on clinical and biochemical markers of inflammation in patients with obesity and psoriatic arthritis: a randomized crossover trial

Clinical effectiveness and cost-impact after 2 years of a ketogenic diet and virtual coaching intervention for patients with diabetes

Potential therapeutic effect of a ketogenic diet for the treatment of lymphoedema: Results of an exploratory study

2023

Effect of dietary approaches on glycemic control in patients with type 2 diabetes: a systematic review with network meta-analysis of randomized trials

Evidence for the carbohydrate-insulin model in a reanalysis of the Diet Intervention Examining The Factors Interacting with Treatment Success (DIETFITS) trial

Clinical evidence of low-carbohydrate diets against obesity and diabetes mellitus

Low-carbohydrate high-fat diet in real life assessed by diet history interviews

Impact of a low-carbohydrate compared with low-fat breakfast on blood glucose control in type 2 diabetes: a randomized trial

Effects of lifestyle intervention on adults with metabolic associated fatty liver disease: A systematic review and meta-analysis

Effect of ketogenic diets on cardio-metabolic outcomes in cancer patients: A systematic review and meta-analysis of controlled clinical trials

Acute insulin secretory effects of a classic ketogenic meal in healthy subjects: A randomized cross-over study

2022

Dietary carbohydrate restriction augments weight loss-induced improvements in glycaemic control and liver fat in individuals with type 2 diabetes: A randomised controlled trial

Effects of a 6-month, low-carbohydrate diet on glycaemic control, body composition, and cardiovascular risk factors in patients with type 2 diabetes: An open-label randomized controlled trial

Effects of a low-carbohydrate dietary intervention on hemoglobin A1c: A randomized clinical trial
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Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction

Continuous care intervention with carbohydrate restriction improves physical function of the knees among patients with type 2 diabetes: A non-randomized study

Effects of a low-carbohydrate diet on insulin-resistant dyslipoproteinemia-a randomized controlled feeding trial

2021 

Type 2 diabetes prevention focused on normalization of glycemia: A two-year pilot study

A randomized controlled trial of pharmacist-led therapeutic carbohydrate and energy restriction in type 2 diabetes

The beneficial short-term effects of a high-protein/low-carbohydrate diet on glycaemic control assessed by continuous glucose monitoring in patients with type 1 diabetes
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​Safety and efficacy of very low carbohydrate diet in patients with diabetic kidney disease: A randomized controlled trial

Effects of two months of very low carbohydrate ketogenic diet on body composition, muscle strength, muscle area, and blood parameters in competitive natural body builders

Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: A randomized clinical trial

Effects of a self-prepared carbohydrate-reduced high-protein diet on cardiovascular disease risk markers in patients with type 2 diabetes
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Effects of low-carbohydrate versus Mediterranean diets on weight loss, glucose metabolism, insulin kinetics and β-cell function in morbidly obese individuals

Effects of a low-carbohydrate ketogenic diet on health parameters in resistance-trained women

Effects of calorie restricted low carbohydrate high fat ketogenic vs. non-ketogenic diet on strength, body-composition, hormonal and lipid profile in trained middle-aged men

2020 
The effects of a low-calorie ketogenic diet on glycaemic control variables in hyperinsulinemic overweight/obese females

​The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis

Effects of the low carbohydrate, high fat diet on glycemic control and body weight in patients with type 2 diabetes: Experience from a community-based cohort

​Low-carbohydrate diets in the management of obesity and type 2 diabetes: A review from clinicians using the approach in practice

The effects of mobile-app-based low-carbohydrate dietary guidance on postprandial hyperglycemia in adults with prediabetes
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Effects of a ketogenic diet on body composition and strength in trained women

Efficacy and safety of very low calorie ketogenic diet (VLCKD) in patients with overweight and obesity: A systematic review and meta-analysis

Effects of a ketogenic diet in overweight women with polycystic ovary syndrome

Application of nutrient essentiality criteria to dietary carbohydrates

The effect of low-carbohydrate and low-fat diets on pain in individuals with knee osteoarthritis

Effect of low-fat vs low-carbohydrate diet on 12-month weight loss in overweight adults and the association with genotype pattern or insulin secretion
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Very low-calorie ketogenic diet: A safe and effective tool for weight loss in patients with obesity and mild kidney failure

The effects of low-carbohydrate diets on cardiovascular risk factors: A meta-analysis​

Treating binge eating and food addiction symptoms with low-carbohydrate ketogenic diets: A case series

2019
The effect of differing levels of carbohydrate restriction on the achievement of nutritional ketosis, mood, and symptoms of carbohydrate withdrawal in healthy adults: A randomised clinical trial

Comparison of group medical visits combined with intensive weight management vs group medical visits alone for glycemia in patients with type 2 diabetes

Diet, diabetes status, and personal experiences of individuals with type 2 diabetes who self-selected and followed a low carbohydrate high fat diet
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An evidence-based approach to developing low-carbohydrate diets for type 2 diabetes management: A systematic review of interventions and methods

Long-term effects of a novel continuous remote care intervention including nutritional ketosis for the management of type 2 diabetes: A 2-year non-randomized clinical trial

The beneficial effects of Mediterranean diet over low-fat diet may be mediated by decreasing hepatic fat content

​Carbohydrate restriction in type 1 diabetes: A realistic therapy for improved glycemic control and athletic performance?

Reversing type 2 diabetes: A narrative review of the evidence

Low versus high carbohydrate diet in type 1 diabetes: A 12-week randomized open-label crossover study
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Low-carbohydrate diets differing in carbohydrate restriction improve cardiometabolic and anthropometric markers in healthy adults: A randomised clinical trial

An experimental ketogenic diet for Alzheimer disease was nutritionally dense and rich in vegetables and avocado

Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis

Extended ketogenic diet and physical training intervention in military personnel

The effect of low-carbohydrate and low-fat diets on pain in individuals with knee osteoarthritis

A clinician’s guide to inpatient low carbohydrate diets for remission of type 2 diabetes: Toward a standard of care protocol
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2018
The ketogenic diet and its clinical applications in type 1 and type 2 diabetes

Nutritional ketosis and mitohormesis: potential implications for mitochondrial function and human health

The effect of low-carbohydrate diet on glycemic control in patients with type 2 diabetes mellitus
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Effects of carbohydrate-restricted diets on low-density lipoprotein cholesterol levels in overweight and obese adults: A systematic review and meta-analysis

A low-carbohydrate ketogenic diet reduces body mass without compromising performance in powerlifting and olympic weightlifting athletes

Acute effects of dietary carbohydrate restriction on glycemia, lipemia and appetite regulating hormones in normal-weight to obese subjects

Effect of a very low-calorie ketogenic diet on food and alcohol cravings, physical and sexual activity, sleep disturbances, and quality of life in obese patients
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Management of type 1 diabetes with a very low-carbohydrate diet

Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus

Effect of dietary carbohydrate restriction on glycemic control in adults with diabetes: A systematic review and meta-analysis.
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Low carbohydrate diet and improved glycaemic control in a patient with type one diabetes
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Low-carbohydrate diets for type 1 diabetes mellitus: A systematic review

Effect of low-carbohydrate diet on markers of renal function in patients with type 2 diabetes: A meta-analysis
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Effects of an energy-restricted low-carbohydrate, high unsaturated fat/low saturated fat diet versus a high-carbohydrate, low-fat diet in type 2 diabetes: A 2-year randomized clinical trial

Efficacy of a moderately low carbohydrate diet in a 36-month observational study of Japanese patients with type 2 diabetes
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Effectiveness and safety of a novel care model for the management of type 2 diabetes at 1 year: An open-label, non-randomized, controlled study

Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: An open label, non-randomized, controlled study

Assessing the nutrient intake of a low-carbohydrate, high-fat (LCHF) diet: a hypothetical case study design
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2017
Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes

​A novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes

Short-term effects of a low carbohydrate diet on glycaemic variables and cardiovascular risk markers in patients with type 1 diabetes: A randomized open-label crossover trial

Acid-base safety during the course of a very low-calorie-ketogenic diet
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The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: A systematic review
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​Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies

Efficacy of low carbohydrate diet for type 2 diabetes mellitus management: A systematic review and meta-analysis of randomized controlled trials

A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a randomised controlled trial with overweight defence force personnel
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Ketogenic diet benefits body composition and well-being but not performance in a pilot case study of New Zealand endurance athletes

Dynamics of intrapericardial and extrapericardial fat tissues during long-term, dietary-induced, moderate weight loss

Prop nontaster women lose more weight following a low-carbohydrate versus a low-fat diet in a randomized controlled trial

Hepatic, adipocyte, enteric and pancreatic hormones: Response to dietary macronutrient composition and relationship with metabolism

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Body composition changes after very-low-calorie ketogenic diet in obesity evaluated by 3 standardized methods
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Should a low-carbohydrate diet be recommended for diabetes management?

An online intervention comparing a very low-carbohydrate ketogenic diet and lifestyle recommendations versus a plate method diet in overweight individuals with type 2 diabetes: A randomized controlled trial

2016
Impact of low-carbohydrate diet on body composition: Meta-analysis of randomized controlled studies
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Very-low-carbohydrate diets in the management of diabetes revisited 

Long-term effects of a very-low-carbohydrate weight-loss diet and an isocaloric low-fat diet on bone health in obese adults
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Obesity treatment by very low-calorie-ketogenic diet at two years: Reduction in visceral fat and on the burden of disease

Short-term safety, tolerability and efficacy of a very low-calorie-ketogenic diet interventional weight loss program versus hypocaloric diet in patients with type 2 diabetes mellitus

Effects of low-carbohydrate diets v. low-fat diets on body weight and cardiovascular risk factors: A meta-analysis of randomised controlled trial

The effects of low carbohydrate diets on liver function tests in nonalcoholic fatty liver disease: A systematic review and meta-analysis of clinical trials
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Low carbohydrate diet based intervention for obstructive sleep apnea and primary hypothyroidism in an obese Japanese man

A randomised trial of the feasibility of a low carbohydrate diet vs standard carbohydrate counting in adults with type 1 diabetes taking body weight into account 

2015
Effects of a high-protein/low carbohydrate versus a standard hypocaloric diet on adipocytokine levels and insulin resistance along 9 months 

The effects of a low-carbohydrate diet vs. a low-fat diet on novel cardiovascular risk factors: A randomized controlled trial

The effects of a low-carbohydrate diet on appetite: A randomized controlled trial

Metabolic characteristics of keto-adapted ultra-endurance runners

Long-term effects of a very low carbohydrate compared with a high carbohydrate diet on renal function in individuals with type 2 diabetes: A randomized trial

Dietary intervention for overweight and obese adults: comparison of low-carbohydrate and low-fat diets. A meta-analysis

​Comparison of a carbohydrate-free diet vs. fasting on plasma glucose, insulin and glucagon in type 2 diabetes

Do ketogenic diets really suppress appetite? A systematic review and meta-analysis.

A lower-carbohydrate, higher-fat diet reduces abdominal and intermuscular fat and increases insulin sensitivity in adults at risk of type 2 diabetes

Comparison of low- and high-carbohydrate diets for type 2 diabetes management: A randomized trial.

Low starch/low dairy diet results in successful treatment of obesity and co-morbidities linked to polycystic ovary syndrome (PCOS)

2014
The effects of ketogenic dieting on skeletal muscle and fat mass

Dietary carbohydrate restriction as the first approach in diabetes management. Critical review and evidence base

Effects of a eucaloric reduced-carbohydrate diet on body composition and fat distribution in women with PCOS

Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet

Retrospective study on the efficacy of a low-carbohydrate diet for impaired glucose tolerance
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A very low-carbohydrate, low–saturated fat diet for type 2 diabetes management: A randomized trial

​Randomization to a low-carbohydrate diet advice improves health related quality of life compared with a low-fat diet at similar weight-loss in Type 2 diabetes mellitus

Effects of low-carbohydrate and low-fat diets: A randomized trial
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Low carbohydrate diet to achieve weight loss and improve HbA1c in type 2 diabetes and pre-diabetes: Experience from one general practice

A non-calorie-restricted low-carbohydrate diet is effective as an alternative therapy for patients with type 2 diabetes

A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes

Two diets with different hemoglobin A1c and antiglycemic medication effects despite similar weight loss in type 2 diabetes

2013
Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets

Treatment of diabetes and diabetes complications with a ketogenic diet
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Long term successful weight loss with a combination biphasic ketogenic Mediterranean diet and Mediterranean diet maintenance protocol

Renal function following three distinct weight loss dietary strategies during 2 years of a randomized controlled trial

​Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: A meta-analysis of randomised controlled trials

Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects

2012
Low carbohydrate diet in type 1 diabetes, long-term improvement and adherence: A clinical audit

Effect of low-calorie vs. low-carbohydate ketogenic diet in type 2 diabetes

2011
Short-term carbohydrate-restricted diet for weight loss in severely obese women.

​A carbohydrate-restricted diet during resistance training promotes more favorable changes in body composition and markers of health on obese women with and without insulin resistance.

Reversal of nephropathy by a ketogenic diet

A pilot study of the Spanish ketogenic Mediterranean diet: An effective therapy for the metabolic syndrome

2010
Weight and metabolic outcomes after 2 years on a low-carbohydrate vs. low-fat diet: A randomized trial

A low-carbohydrate Mediterranean diet improves cardiovascular risk factors and diabetes control among overweight patients with type 2 diabetes mellitus: a one-year prospective randomized intervention study

Revealing the molecular relationship between type 2 diabetes and the metabolic changes induced by a very low carbohydrate ketogenic diet

Renal function following long-term weight loss in individuals with abdominal obesity on a very-low-carbohydrate vs. high carbohydrate diet

2008
Restricted-carbohydrate diets in patients with type 2 diabetes: A meta-analysis

Weight Loss with a low-carbohydrate, mediterranean, or low-fat diet

​Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum

The effect of a low carbohydrate, ketogenic diet vs. a low glycemic index diet on glycemic control in type 2 diabetes mellitus

Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet

Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: Time for a critical appraisal

Low-carbohydrate diet in type 2 diabetes: stable improvements of body weight and glycemic control during 44 months follow-up

2007
Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women

Beneficial effects of ketogenic diet in obese diabetic subjects

2006
The metabolic response to a high-protein, low-carbohydrate diet in men with type 2 diabetes mellitus

​Short-term effects of severe dietary carbohydrate-restriction advice in Type 2 diabetes: A randomized controlled trial

2005
Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes

A low carbohydrate, ketogenic diet to treat type 2 diabetes

The effects of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome: A pilot study

A low carbohydrate diet in Type 1 diabetes: clinical experience – A brief report

Perceived hunger is lower and weight loss is greater in overweight premenopausal women consuming a low-carbohydrate/high-protein vs high-carbohydrate/low-fat diet

2004
Comparison of energy -restricted very low carbohydrate and low fat diets on weight loss and body composition on overweight men and women

Effect of a high-protein, low-carbohydrate diet on blood glucose control in people with type 2 diabetes

A low-carbohydrate, ketogenic diet vs. a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial

2003 
A low carbohydrate as compared with a low fat diet in severe obesity

A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women

The effects of a low-carbohydrate regimen on glycemic control and serum lipids in diabetes mellitus
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Effect of a high saturated fat and no-starch diet on serum lipid subfractions in patients with documented atherosclerotic cardiovascular disease.