KetoDiet App is free to download, try it now!

Benign Ketosis
Who Benefits the Most on a Ketogenic Diet?

4.3 stars, average of 21 ratings

Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?ShareFollow us 182.0k

People start following a ketogenic diet many different reasons: to lose weight or manage a health condition - eg by reducing severity of seizures in drug-resistant epilepsy. In this article, we examine the role of insulin sensitivity in our diet and look at how it affects weight loss.

The Ketogenic Diet and Insulin-Resistant Patients

That scene in Shameless when the nurse tells Kev his tumor is benign and he says:

“Oh god no … Wait is that good or bad, I can never remember” hahaha

The authors of this manuscript called their dietary intervention “benign dietary ketosis” (+1), which turned out to be a pretty big understatement given the conclusion:

“All variables for the ketogenic group out-performed those of the exercise and non-exercise groups, with five of the seven [pre-specified endpoints] reaching statistical significance” ( Gibas and Gibas, 2017).

They cited the Dashti year-long keto study which showed a significant reduction in antidiabetic meds before significant weight loss ( Dashti et al., 2006). This is keto’s strong suit: obese insulin resistant (IR) subjects.

The #1 Keto Diet App
Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?
Free Download
1,500+ delicious keto recipes
Trialed & tested for best results
Optimized for nutrition
Never feel hungry
Planner & tracker
Track all macros including net carbs
Scan products
Create your own meals
Advanced tracking
Track ketones, blood glucose & lipids
Stay hydrated with water tracking
Track your mood & energy levels
Macro calculator
Calculate your ideal fat, protein & carb intake
Set any goal: weight loss, maintenance or weight gain
Your macros update based on your progress
Monitor your macros, water intake, mood & energy
Body weight, body fat and body measurements
Ketones, blood glucose & lipids
Evidence-based content
Expert articles to help you make informed choices
Guides & free diet plans
New daily content
And so much more...!
Complete Keto Diet guide
Integrated shopping basket
Restaurants & guide to eating out
Free Download

Insulin resistance is carbohydrate intolerance which means that more insulin is needed to metabolize carbs. More insulin then leads to an increased fat storage.

In  Gibas and Gibas, they selected the right population (obese IR) and kept carbs below 30 grams per day. This was confirmed as ketones continued to increase all the way through week 10.

This demonstrates better-than-average adherence to the dietary advice. Usually the opposite happens whereby participants begin with very low carbs, a large energy deficit, and rapid weight loss (all of which are conducive to deep ketosis), and as the study goes on, carb creep, smaller energy deficit, and slowed weight loss (all of which lower ketones). Cool.

The Comparison Groups

  1. Keto diet – participants were eating up to 30 grams of carbs per day for 10 weeks.

  2. No diet intervention which is basically a weight-maintaining control group (commonly overlooked but important control group because just the simple act of being in a diet study usually causes people to lose weight); and

  3. No diet intervention plus exercise (30 minutes of exercise 3-5 times a week).

Strengths of the Study

Data presentation was excellent: individual values and averages were reported. This is important because it is visually easy to see inter-individual variability in the responses. Body weight, body fat, BMI, HbA1c, and triglycerides were all significantly reduced in the keto group compared to the exercise and non-exercise groups.

Another strength of this study is that all diets were to be consumed ad libitum - they could eat as much as they wanted, so it more closely reflected what would happen in real life, outside the setting of a clinical study.

Short-comings of the Study

The main short-coming in this manuscript is the lack of information about the diets (foods, macro’s, calories, etc.). However, we don’t expect too much change in the control groups, which was confirmed by the lack of weight loss, and elevated ketones in the keto group confirms good adherence, at least, to the carbohydrate advice.

Another short-coming is the exercise intervention in the third group which I suspect was quite weak as we know exercise is beneficial although no clinical improvements were seen in this group. Exercise alone doesn’t usually result in significant weight loss because energy intake frequently increases or total energy expenditure declines to compensate.

The fact that exercise alone doesn’t result in significant weight loss was demonstrated in the notorious marathon study, wherein previously sedentary participants trained for a marathon for 18 months and eventually ran a marathon - we know they exercised a lot because a marathon is no small feat ( Janssen et al., 1989)!

But no weight was lost because no dietary advice was given - they simply instinctively ate more. No major changes in body composition occurred because that isn’t usually observed in the absence of resistance training in this context.

The Ketogenic Diet and Insulin-Sensitive Patients

However, the ketogenic diet isn’t for everyone. It’s suited for obese IR adults (most overweight/obese people are insulin resistant) who are looking to reduce body fat. Contrary to that, some studies (eg, see studies by Ebbeling, Gardner, and Pittas and Cornier) show that populations of obese insulin sensitive patients who appear to respond better to diets lower in fat.

Also, in growing children, who need to gain not lose weight (which is two completely different contexts), it has been shown to have detrimental effects on blood lipids and the liver (eg, de Lima et al., 2017 and  Arslan et al., 2016, respectively).

Insulin sensitivity varies for individuals, and describes how sensitive your body is to the effects of insulin. Insulin sensitive individuals will require smaller amounts of insulin to lower blood glucose levels as opposed to someone who is insulin resistant.

Bestselling Keto Books
Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?
Keto Chaffles
Order and get 5 bonus chaffle recipes!
My latest keto cookbook!
75 Delicious Treats for Your Low-Carb Diet
Chaffles are the epitome of simplicity and versatility
Simple Keto
Meal-prepping, planning, and shopping strategies
100+ delicious low-carb recipes
Quick & easy, no stress, no complication
The Beginner's KetoDiet Cookbook
Easy keto guide
100+ delicious low-carb recipes
Whole foods, optimized for nutrition
The Keto All Day Cookbook
My best keto recipes
100+ delicious low-carb recipes
Allergy-free options
Quick Keto Meals in 30 Minutes or Less
Quick and easy meals
100+ delicious low-carb recipes
Allergy-free options
Sweet & Savory Fat Bombs
Sweet treats & savory snacks
100+ delicious keto recipes
Allergy-free options
Keto Slow Cooker & One-Pot Meals
100+ delicious low-carb recipes
Ideal for batch cooking and meal prep
Allergy-free options
The KetoDiet Cookbook
150+ delicious low-carb recipes
Quick guide to keto
Keto food list
Super Low-Carb Snacks
100+ delicious low-carb recipes
Tasty paleo treats and snacks
Ultra low-carb fat bombs
Have any of my books?

Methods used to determine who is insulin sensitive varies by research groups. For example, Ebbeling and Pittas administered a sugar-sweetened beverage, measured insulin levels 30 minutes later, and the top half was labeled insulin resistant while the lower half was insulin sensitive.

Cornier took fasting insulin and deemed highest 50% resistant and lowest 50% sensitive. In all of these studies, the participants were overweight or obese and the goal was weight loss and improved health.

And in each case, the low fat diet worked modestly better for insulin sensitive participants whereas the low carbohydrate diet worked modestly better for insulin resistant participants.

Take Home Message

For obese IR looking to reduce body fat, anti-diabetic medications, and symptoms of Metabolic Syndrome, a low carbohydrate or ketogenic diet is safe and effective.

A low-fat diet seems to be slightly more efficacious in obese insulin sensitive patients, eg, The Hunger-Free Diet(s). Tl;dr: Great health improvements can be seen on a variety of diets by reducing industrial and highly processed foods.

Lastly, some obese insulin resistant people may achieve great success losing weight with a ketogenic diet, but then weight loss stalls. This may be due to increased insulin sensitivity, which means they might need to start watching dietary fat because the context has changed.

  1. Blog
  2. Expert Articles
  3. Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?
  1. Blog
  2. Advice
  3. Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?
  1. Blog
  2. Diet & Nutrition
  3. Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?
  1. Blog
  2. Bill Lagakos, Ph.D.
  3. Benign Ketosis - Who Benefits the Most on a Ketogenic Diet?

Do you like this post? Share it with your friends! 

Bill Lagakos, Ph.D.
Nutritional sciences researcher, consultant and blogger

Bill Lagakos

Hi, I’m Bill. I have a Ph.D. in Nutritional Biochemistry and Physiology from Rutgers University where my dissertation focused on fatty acid-binding proteins and energy metabolism. I studied inflammation and diabetes at UCSD. And most recently, I studied circadian biology at the Mayo Clinic. I have a broad range of knowledge about health, wellness, sickness, and disease... and I’m learning more every day!

Expert Article

This article was written by Bill Lagakos, Ph.D. who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page.

Evidence Based

Evidence-Based articles are based on medical research, and scientific evidence. Our expert authors focus on hard evidence alone and include relevant research references from trusted sources to support their articles. We always aim to deliver relevant, trustworthy and up-to-date information based on trusted evidence and proven research.

Let us know what you think, rate this post!

Leave a comment

Note: Any links to products or affiliate links will not be approved.
Please note that we do not offer personalised advice. For any diet related questions, please join our Facebook community.

Comments (10)

Most of the studies seem to suggest that keto is at the very least safe and as good as other approaches. It may well be better but more research is needed for that conclusion.
But, of course, the studies focus more on averages. Within those studies, there are likely to be some people that do really well on a keto diet and others who fare poorly.


Hi Vince,
Good point, and a lot of studies these days are reporting individual data for each participant. It can be burdensome, but I think helpful overall.


I’m interested in the use of “obese” and “overweight” this article. I’m a 72-year-old woman, I am 5‘5“ tall, and today way about 162 pounds. Depending on who’s making the charts, I find myself always overweight, and either in the obese column or just barely there. I’m interested in the applicability of the data in the studies to my particular case.


Hi Sheryl,
Your BMI of 28 would technically be considered overweight but not obese.


Very interesting article, thank you


Thanks, Kate 😊


My husband has high triglycerides is the ketogenic diet safefor him?  He i
Has been told he is borderline diabetic.


Hello Beverley, for information on blood lipids, have a look at this article: High Cholesterol on a Keto Diet - Should You Be Concerned?


Welcome! I look forward to reading more from you in the future.


Thanks, Bill 😊