Weight loss is a key step toward restoring metabolic health, but it has remained unclear whether the type of diet can affect metabolic benefits even when a similar amount of weight loss is achieved.
A new clinical study by researchers from Washington University in St. Louis, published in the journal Cell Metabolism, showed that the macronutrient composition of the diet can influence the metabolic benefits of weight loss, particularly liver health and blood sugar levels.
The study involved 55 people with obesity, prediabetes, and fatty liver disease, of whom 42 completed the course. Participants were randomly assigned to three groups, each following a strictly controlled diet. The first group followed a low-carbohydrate, high-fat ketogenic diet, the second followed a Mediterranean diet, and the third followed a low-fat, plant-based diet. Researchers provided all meals to the participants throughout the five-month study.
The experiment lasted on average about five months, which is the time it took for participants to achieve a loss of about 10% of their initial weight.
In terms of weight loss, the three diets achieved very similar results. However, a detailed analysis of metabolic indicators revealed clear differences in the impact of each diet, particularly on liver health and blood sugar control.
The ketogenic diet showed the best results in improving liver insulin sensitivity, increasing it two to three times compared to the other two diets. Additionally, the amount of fat accumulated in the liver decreased by 67% in those following the ketogenic diet, compared to approximately 45% in the groups following the Mediterranean and low-fat diets.
The effect on blood sugar control was also more pronounced; average 24-hour glucose levels decreased by 20% in the ketogenic group, compared to 8% in the other two diets. Daytime insulin levels also decreased by 74% in the ketogenic group, compared to 44% in the Mediterranean group and 27% in the low-fat diet group.
As for prediabetes, the condition declined to levels that did not meet the diagnostic criteria in half of the participants in the ketogenic group, compared to 29% in the Mediterranean group and 7% in the low-fat, plant-based diet group.
The study showed a significant difference in the composition of the diets; the ketogenic diet provided 73% of calories from fat and only 4% from carbohydrates, compared to 35% fat and 50% carbohydrates in the Mediterranean diet, and 15% fat and 70% carbohydrates in the low-fat, plant-based diet.
Despite this significant difference, no differences were found between the groups in 24-hour blood levels of LDL cholesterol, ApoB cholesterol, or triglycerides. The results suggest that drastically reducing carbohydrate intake may offer additional benefits for liver health and blood sugar control beyond those resulting from weight loss alone.
The researchers confirm that weight loss itself was beneficial for all participants; muscle sensitivity to insulin improved by approximately 50% in all three groups. However, the ketogenic diet showed an additional effect on liver metabolism and blood sugar levels, suggesting that the composition of the diet may be important, in addition to the amount of weight lost, in improving certain aspects of metabolic health.
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