Is the ketogenic diet more beneficial than a regular American diet combined with exercise for persons with metabolic syndrome?
Bethel University in Minnesota researchers believe so.
However, nutritionists believe it may be more complex.
The researchers wanted to see if a prolonged, regulated ketogenic diet might minimize the impact of metabolic syndrome and study participants’ weight, body mass index (BMI), and body fat mass.
They gathered 30 people who had been diagnosed with metabolic syndrome, a set of illnesses that occur at the same time.
Excessive blood pressure, excessive blood sugar, extra body fat around the midsection, and abnormal cholesterol levels are examples of the disorders.
People with metabolic syndrome are more likely to have a heart attack or a stroke.
The individuals were divided into three groups at random by the researchers.
One group maintained a ketogenic diet with no activity.
Another had a typical American diet with little activity.
The third group maintained a regular American diet and exercised for 30 minutes three to five days weekly.
The ketogenic group had the most significant outcomes for weight loss, body fat percentage, and BMI decrease after 10 weeks.
“All variables for the ketogenic group outperformed those for the exercise and non-exercise groups, with five of the seven demonstrating statistical significance,” said the scientists.
The Theory behind the keto diet
The ketogenic diet (sometimes known as “keto”) is a low-carb, high-fat diet that substantially lowers carbs and replaces them with fats.
The body responds to this decrease by entering a condition known as ketosis.
“Carbohydrates are the primary fuel our bodies were designed to use, as well as the only fuel used by the brain and heart muscles.” When we don’t eat enough carbs, our bodies turn to other energy sources to fill that need.
When we don’t eat carbohydrates, our insulin levels drop, and fat is liberated from our cells. “The liver converts fat into ketones, our body’s second choice for energy,” says Lauri Wright, PhD, an assistant professor of public health at the University of South Florida.
In medicine, the keto diet has been combined with other therapies to benefit children with epilepsy. This is done under the supervision of a medical practitioner.
However, whether the diet can be utilized safely for weight loss must be established.
“In the short term (as in this 10-week study), the ketogenic diet appears safe.” “However, we don’t have much evidence that it’s safe or sustainable in the long term,” Jennifer McDaniel, a registered dietician and Academy of Nutrition and Dietetics representative, told Eathealthyisgood.
Wright expresses fear that a long-term keto diet might be harmful.
“Because ketone excretion can raise kidney pressure, there is concern about the effects on renal function.” “There is also concern about muscle mass loss due to relying on ketones for fuel,” she added.
Keto vs Regular Diet Weight Loss — What the 10-Week Study Showed
A randomized 10-week trial of adults diagnosed with metabolic syndrome found that participants assigned to a well-formulated ketogenic diet lost more weight, reduced BMI, and lowered body fat percentage than those following a standard American diet — even when the latter group added 30 minutes of exercise 3–5 times per week. The ketogenic arm also showed greater short-term improvements in HbA1c and blood ketone levels, signaling metabolic shifts consistent with nutritional ketosis.
How should you read those results? First, the focus keyword keto vs regular diet weight loss explains the direct comparison: keto outperformed the typical U.S. diet in this short trial. But the study size was small and lasted only 10 weeks, so its best value is as proof that a ketogenic approach can produce meaningful short-term changes in people with metabolic syndrome, not as definitive evidence of superior long-term outcomes. Larger and longer trials (6–12 months and beyond) often narrow the gap when diets are calorie-matched or when high-quality low-fat/balanced diets are used.
Practical takeaway: for people with metabolic syndrome who need quick improvements in weight and glycemic markers, a medically supervised ketogenic protocol can work — but results should be framed as short-term, monitored, and paired with a plan for sustainable maintenance.
Mechanisms Behind Keto vs Regular Diet Weight Loss: Ketosis, Water Loss, and Fat Loss
The mechanisms that produce the weight loss advantage in keto vs regular diet weight loss comparisons are multifaceted. First, ketogenic diets drastically reduce carbohydrate intake, lowering insulin levels and prompting the body to mobilize stored fat. The liver converts fatty acids into ketone bodies, which become an alternative fuel for the brain and muscles and help suppress appetite for many people — a behaviorally useful effect for calorie reduction.
Second, an early and substantial portion of the “weight loss” after switching to keto is water. Glycogen (the stored form of carbohydrate) binds water; when glycogen is depleted, that water is released, producing rapid initial drops on the scale. Experts caution that this water loss can partly explain large short-term differences versus higher-carb diets and may quickly rebound if carbohydrates are reintroduced.
Third, true fat loss occurs when calorie intake remains below energy needs for an extended period. Keto may facilitate this by reducing hunger and improving insulin sensitivity, which helps mobilize fat stores. Some studies also report favorable changes in triglycerides, HDL, and glucose control during short-term ketogenic interventions — benefits especially relevant for metabolic syndrome.
Caveats and clinical context: the metabolic improvements seen in short trials don’t automatically translate to long-term cardiovascular or renal benefits, and adherence is the major limiter — diets that people can sustain tend to produce the best long-term outcomes. Clinicians often recommend careful monitoring (electrolytes, kidney function, lipid profile) and a transition plan toward a heart-healthy maintenance diet once initial goals are met.
Keto vs Regular Diet Weight Loss — Short-Term Gains vs Long-Term Sustainability
Short-term trials — including a controlled 10-week study of people with metabolic syndrome — show that a well-formulated ketogenic diet can produce faster and larger reductions in body weight, BMI, and some metabolic markers than a standard American diet, even when the latter includes moderate exercise.
However, those short-term wins don’t automatically predict long-term superiority: larger and longer randomized trials and systematic reviews generally find the gap narrows at 6–12 months when diets are calorie-matched or when high-quality balanced diets are compared.
Sustainability is the central issue. Adherence to very-low-carbohydrate regimens tends to fall over time because of food restrictions, social eating challenges, and taste preferences. When people stop strict carbohydrate restriction, much of the rapid initial weight loss (often driven by glycogen/water changes) can partially return. For clinicians and readers, the practical takeaway is to treat keto as an effective short-term tool for targeted metabolic improvements — particularly in people with insulin resistance or metabolic syndrome — but to plan a transition toward a long-term, nutritionally complete maintenance diet.
Effects on BMI and Body Fat
The keto vs regular diet weight loss comparison repeatedly shows larger early drops in body weight and BMI on ketogenic programs; several trials and reviews also report favorable reductions in fat mass and improvements in triglycerides and glycemic measures during short interventions.
That said, lean mass preservation depends on protein intake and whether exercise (especially resistance training) is included — without it, some keto programs can lead to greater lean-mass loss versus combined diet-plus-exercise strategies.
How Exercise Changes the Picture
Exercise amplifies many benefits of any weight-loss plan. When exercise is added to dietary interventions, studies indicate better preservation of lean mass, greater improvements in cardiorespiratory fitness, and often larger reductions in central adiposity than diet alone. In head-to-head comparisons, calorie restriction plus structured exercise sometimes outperforms diet-only approaches for long-term body-composition outcomes, meaning the advantage of keto observed at 10 weeks may shrink if the alternative diet is paired with consistent aerobic and resistance training.
Risks, Side Effects, and Who Should Be Cautious
Keto is not risk-free. Short-term adverse effects can include “keto flu,” constipation, electrolyte imbalance, and dehydration; some people experience rises in LDL cholesterol. People with type 1 diabetes, chronic kidney disease, pregnant or breastfeeding women, and those on certain medications should avoid or only use keto under close medical supervision. Regular monitoring — lipids, kidney function, electrolytes, and medication adjustments — is recommended when pursuing a strict ketogenic protocol.
Practical Tips for Tracking Keto vs Regular Diet Weight Loss
- Track body composition (scale + weekly waist and at least one body-fat estimate) rather than scale weight alone.
- Log ketone measurements (blood or breath) during the induction phase to confirm ketosis.
- Pair keto with resistance training to protect lean mass.
- Monitor labs (lipids, HbA1c, electrolytes, creatinine) at baseline and during follow-up.
- Build a staged plan: short-term ketogenic induction (4–12 weeks) → reintroduction of higher-quality carbs + maintenance plan focused on whole foods and sustainability.
What do the results mean?
Although the study’s findings revealed that individuals in the ketogenic group had the best weight reduction outcomes, Wright quickly points out that this does not necessarily imply that this is a more effective weight loss approach for this group.
“The greater weight loss was due to water loss rather than fat loss.” According to studies, water weight returns fast, and many people experience rebound weight gain due to nutritional restriction and changes in metabolic rate. “Body fat contributes to health problems,” she explained.
According to a 2015 study, metabolic syndrome affects around 35% of all individuals in the United States. This rises to 50% for individuals aged 60 and over.
Weight reduction is one of the most critical measures in avoiding and treating metabolic syndrome.
A balanced diet paired with exercise can help. According to experts, metabolic syndrome is less common among those who frequently engage in some physical activity.
The American Academy of Nutrition and Dietetics suggests a heart-healthy diet rich in fruits and vegetables, low-fat or fat-free dairy, whole grains, seafood, and moderate portions of lean meat, poultry, and oils for patients with metabolic syndrome.
McDaniel believes reducing carbs benefits weight loss, but it does not have to be as drastic as the ketogenic group in the Bethel research.
“Low-carb diets, in general, are more effective for weight loss than the standard American diet.”
Low-carb diets can aid in weight loss, but they don’t have to be this drastic. “We have strong evidence that high-quality carbs with fiber and resistant starches, such as vegetables, beans, and whole grains, support weight loss and reduce metabolic syndrome risk factors,” she added.
According to Dana Hunnes, PhD, a senior dietitian at the Ronald Reagan UCLA Medical Center in Los Angeles, while the ketogenic group appears to have had superior outcomes, this may be owing to the shortcomings of the conventional American diet.
“Almost any diet other than the standard American diet could produce similar (perhaps attenuated) results.” A typical American diet is not a healthy one. It typically contains 30% fat, is frequently high in saturated fat, and has 50% or more carbohydrates, mainly processed carbs rich in sugar. “It’s a diet high in salt and low in fiber and other beneficial nutrients,” she explained.
“I’m not sure that comparing this diet (keto) to the standard American diet is really a fair analysis when they could have also compared it to other diets known in the literature to reduce the risks for metabolic syndrome,” Hunnes said.
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