Neither of these papers are keto diets specifically. It looks like these patients just had way more personal one on one time with their doctors, dedicated group sessions, and carb information. Without actual carb counts there’s no way to know if this is actually keto. Importantly, neither paper specified the high fat part of the keto diet, which makes me think neither paper actually supports keto.

Btw I’m not personally an anti-keto guy I just dislike mindless paper citations.

You linked two papers about reducing carbohydrate intake, which is not a ketogenic diet.

A ketogenic diet involves severe carbohydrate restriction and even major protein restriction. The research you shared isn’t applicable.

This is a huge problem in online keto discourse: People share a lot of “research” that isn’t applicable, such as these low-carb papers or other research about treating epilepsy with keto diets.

You can’t just look for studies about lower carb with positive conclusions and assume that this implies the keto diet is good.

I was with my wife during her gestational diabetes nutrition session. The diet they recommended was for all intents and purposes a ketogenic diet. The only carbs were from natural sugars in fruits and veggies. They just didn’t push the fat and squeeze the carbs as much as you see in keto enthusiast literature. I have a hypothesis though: the keto community does this as a “failsafe” way to instruct curious people how to experience ketosis for the first time. People practicing keto long term (once they’ve experienced the acute benefits and/or initial weight loss) are almost always landing on their own personal watermark which very likely looks like taking in 60+g of carbs a day in a state of “nutritional” ketosis where there are only slightly elevated levels of keytones (~0.4-1.0 mmol/l) in the blood compared to the level of “therapeutic” ketosis used to treat epilepsy (3.0-5.0 mmol/l).

The definition of nutritional ketosis is just a restriction in carbohydrate intake to accelerate the production of ketones by the body:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6472268/

There is no specific ketone cutoff level specified, and of course the impact of X g of carbohydrate will vary per individual, during the day and between days.

The paper I cited are the end stage validation that a treatment works: using it on patient in their normal everyday life (instead of being in clinic/laboratory) - note that they see the doctor 3 times 10 minutes per year.

Of course no one knows how much carbohydrate they take but the guidelines (as presented in the paper) are clearly steering them to nutritional ketosis.

As or clinical studies there are many of them done in the past decades, for a ten years ago summary for example:

https://web.archive.org/web/20150702005325/http://www.omega3...

Dr Westman (the main author, Past-President and Master Fellow of the Obesity Medicine Association and Fellow of The Obesity Society, he also has a youtube channel) uses 20g/day carbohydrate guideline and does not recommand the use of a ketone meter for his patients.

I don’t need 20 peer reviewed papers to call out something being a fad - when I get loads of replies calling out it is not a fad on a small comment and YouTubers advertising it on almost all videos.