Low-carbohydrate (low-carb) diets are supported by a strong and long-standing body of clinical evidence. With research showing consistent benefits to key markers of metabolic health, including glycemic control, insulin sensitivity, lipid profiles, and body composition, low-carb dietary patterns are a relevant and useful strategy for managing conditions, such as type 2 diabetes, prediabetes, and obesity. (1)
While more clinicians and their patients consider the benefits of low-carbohydrate eating patterns for metabolic health, some may still have questions about the efficacy of this approach. It’s important for practitioners to distinguish myths and misconceptions from evidence-based facts to help guide patients on their healthy eating journey.
Fact 1: Low-Carbohydrate Diets Are Nutritionally Adequate
Concerns about nutrient deficiencies in low-carbohydrate diets can be common. However, research shows low-carbohydrate eating patterns can meet and even exceed essential daily nutrient needs when based on whole, nutrient-dense foods. For example, eggs, leafy greens, meat, fish, and full-fat dairy contribute iron, choline, and vitamins D and B12—essential nutrients that many Americans are falling short on to meet recommended intakes. (2)
In fact, a study* published in Frontiers in Nutrition demonstrated that three different low-carbohydrate meal plans safely exceeded nutrient needs for vitamins A, C, D, E, K, thiamin, riboflavin, niacin, folate, and vitamins B6 and B12 in both men and women aged 31–70. (3)
When thoughtfully constructed, low-carbohydrate diets can offer a nutrient-rich foundation that supports overall health and helps close common nutrient gaps.
Fact 2: Low-Carb Diets Can Support Heart Health
A low-carbohydrate eating pattern is naturally higher in fat, which may lead to questions about what this approach means for heart health, particularly if saturated fat intake increases. While dietary guidance has historically cautioned against saturated fat due to its association with increased low-density lipoprotein (LDL) cholesterol and cardiovascular disease, recent evidence challenges this view. A 2020 review in the Journal of the American College of Cardiology found no significant benefit in reducing saturated fat intake for cardiovascular disease prevention. (4) Research also demonstrates that lipid metabolism is more efficient when following a low-carbohydrate eating pattern, resulting in lower levels of plasma saturated fatty acids despite higher levels of saturated fat in the diet. (5)
While some individuals on low-carb diets may experience an increase in LDL cholesterol, this is often accompanied by improvements in other cardiovascular risk markers, such as triglycerides, high-density lipoprotein (HDL) cholesterol, and blood pressure. (6) In a one-year clinical trial, 17 out of 20 cardiovascular risk factors improved significantly on a ketogenic diet, with only LDL cholesterol increasing modestly. Importantly, this LDL increase did not correspond with increased arterial plaque buildup over time. (6)
Cardiovascular outcomes are shaped by the overall quality and balance of the diet, not just individual nutrients like saturated fat. While the research around saturated fat and heart health evolves, there are ways to help guide patients in creating heart-healthy habits.
For example, consider a Mediterranean-style low-carb approach that includes unsaturated fats, fatty fish, lean meats, and nutrient-dense plant foods. Following this dietary pattern with additional fats of either nuts or olive oil has been linked to lower risk of cardiovascular events. (7)
Fact 3: Low-Carbohydrate Diets Effectively Improve Glycemic Control in Type 2 Diabetes
The American Diabetes Association acknowledges that low-carbohydrate eating patterns have the most evidence for improving glycemia. (8)
In a clinical trial involving 238 participants with type 2 diabetes, over 50% achieved disease remission on a ketogenic diet, with most reducing or eliminating medications within 10 weeks. These results were sustained over a two-year period. (9) Additionally, a primary-care audit in England found similar remission rates among patients following a ketogenic diet. (10)
Fact 4: Low-Carbohydrate Diets Are Sustainable and Affordable
Sustainability and cost are important considerations for any dietary approach. Research suggests that low-carbohydrate diets can be both practical and affordable over the long term.
In a survey of more than 1,500 individuals following a low-carbohydrate diet (<100 grams (g) of carbohydrates per day), over 50% reported maintaining the diet for more than one year, and 34% sustained it for more than two years.Participants cited improved health outcomes and greater satiety as key motivators for adherence. (11)
Concerns about cost may also be overstated. A 2019 cost analysis from New Zealand found that a healthy low-carbohydrate diet was $1.27 (NZ$2.06) more per person per day compared to the standard dietary guidelines. (12)
Practical strategies can make low-carbohydrate eating more accessible—even on a budget.:
- Create a weekly menu and shop based on what’s already in your fridge and on sale.
- Buy in bulk—especially for staples like eggs, frozen vegetables, meat, and nuts.
- Prep meals and snacks in advance, like hard-boiled eggs or roasted veggies, to save time and money.
- Choose frozen or canned produce to reduce waste and cost without compromising nutrition.
With thoughtful planning and flexible food choices, low-carbohydrate diets can offer a sustainable, affordable option for a wide range of patient needs.
Fact 5: Low-Carbohydrate Diets Can Be Personalized to Individual Needs
Personalization is a key factor in the success of any dietary intervention. Low-carbohydrate approaches can be adapted to meet a variety of health goals, preferences, and lifestyles. Different levels of carbohydrate intake allow for flexibility depending on a patient’s individual metabolic health, weight management needs, and long-term maintenance goals.
For example, the Atkins framework offers three evidence-based approaches:
- Atkins 20®: Starts at 20 g of net carbs per day and is ideal for patients who need more structure, have type 2 diabetes or prediabetes, or are aiming to lose 40 pounds or more.
- Atkins 40®: Begins at 40 g of net carbs per day, offering more flexibility and variety. It’s a great fit for those with moderate weight loss goals, including those who are breastfeeding and aiming to lose weight.
- Atkins 100™: Allows up to 100 g of net carbs daily and is best for patients looking to maintain weight, adopt healthier habits, or who are pregnant or breastfeeding with weight maintenance goals.
These plans provide flexible starting points for patients at any stage of their health journey. Healthcare professionals can work together with each patient to determine the right starting point and the right progression based on each individual’s unique health goals, lifestyle, needs, and preferences. More information on each plan is available at https://atkins-hcp.com/about-atkins/
Putting it Into Practice
There is substantial clinical evidence showing low-carbohydrate diets can be safe, nutritionally sufficient, and beneficial for enhancing metabolic health. When personalized and well-planned, a low-carbohydrate dietary approach offers a flexible, sustainable option for patients seeking to improve metabolic health.
*This research was funded by Simply Good Foods USA, Inc.