OBESITY AND NUTRITION: Edited by Eric C. WestmanThe biochemistry of low-carbohydrate and ketogenic dietsFeinman, Richard D. Author Information State University of New York Downstate Health Sciences University, Brooklyn, New York, USA Correspondence to Richard D. Feinman, State University of New York Downstate Health Sciences University, 450 Clarkson Avenue, Brooklyn, NY 11203, USA. Tel: +1 718 270 2252; fax: +1 917 554 7794; e-mail: [email protected] Current Opinion in Endocrinology & Diabetes and Obesity 27(5):p 261-268, October 2020. | DOI: 10.1097/MED.0000000000000575 Buy Metrics Abstract Purpose of review To summarize the underlying biochemical basis for low-carbohydrate and ketogenic diets (LC/KD) and provide mechanisms to account for demonstrated effectiveness. Recent findings LC/KD continue to have success, to outperform other diets as well as most drugs for weight loss and diabetes treatment. In many cases, LC/KD can effect remission (absence of drugs) or reversal (only metformin or nondiabetes drugs) of type 2 diabetes and can provide a significant adjunct to pharmacology in type 1. Medication is reduced or eliminated in most cases. The results are consistent with the biochemical rationale which stresses the global effects of the glucose–insulin axis. Summary Evidence for the superior effectiveness of LC/KD for metabolic disease is now overwhelming. At the same time, the approach has received only limited support, and in many cases, persistence of the traditional opposition. Clinical practice or research must confront this crisis in order to bring practice in line with current science and to avoid continued harm to medicine and ultimately, the patient. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.