Keto Diet for Weight Loss: Does It Work Better Than Other Diets?

Keto has been around for a century — it was first used to treat epilepsy in children — but it became a weight-loss trend through social media, books and before-and-after photos. The promise is that cutting carbohydrates 'flips a switch' so the body burns fat instead of sugar. Something real does happen in the body. The question is whether it makes you lose more fat than a sensible diet with the same calories.

What is the keto diet?

A ketogenic diet keeps carbohydrate very low — usually under 20–50 g a day — with most calories coming from fat (often 70–75 percent) and moderate protein. After a few days the liver makes ketones from fat, and the brain and muscles use them for fuel. For scale: one medium roti has about 22 g of carbohydrate and a cup of cooked rice about 45 g, so a single roti uses up most of a strict keto day.

Does keto work better than other diets for weight loss?

The differences are small and point the same way: when calories are matched, keto has no special fat-burning effect, and when people eat freely, any advantage comes from eating less, not from ketones. DIETFITS also tested whether genes or how much insulin a person makes predicted who did better on low-carb or low-fat. They did not. The best diet was the one each person stuck to.

Why do people lose weight so fast in the first week of keto?

The body stores carbohydrate as glycogen in the liver and muscles, and each gram of glycogen is stored with water. When you stop eating carbohydrate, the glycogen is used up and the water goes with it, so the scale can drop a kilogram or two in the first week. That is real weight, but it is not fat, and it comes back within days of eating roti or rice again. This is why people who 'fall off' keto often feel they have regained everything overnight.

What does keto look like with Pakistani food?

A desi keto day ends up as eggs and paneer for breakfast, karahi or tikka with salad for lunch and dinner, and nuts for snacks. It can work for a few weeks. It is much harder at family meals, weddings, Ramadan iftar and dawats, where roti, rice and sweets are the centre of the table — and it tends to push people towards more ghee, butter and fatty meat. If you do keto, be careful with saturated fat; our guide on desi ghee vs oil explains why.

Is keto bad for your cholesterol?

On average, keto lowers triglycerides and raises HDL ('good') cholesterol, which looks good on a report. But it also raises LDL cholesterol, the main driver of heart disease — by 0.12 mmol/L in the 2013 meta-analysis and 0.16 mmol/L in the 2016 one. Averages hide a range: some people see little change, others see large rises. If you try keto for more than a few weeks, get a lipid profile before you start and again after about 3 months, and stop if LDL climbs.

Does keto help type 2 diabetes?

Low-carbohydrate diets do lower blood sugar, because there is less sugar coming in. A 2021 BMJ meta-analysis of 23 trials (1,357 people) found that at 6 months, 57 percent of people on low-carb diets reached diabetes remission (HbA1c under 6.5 percent) compared with 31 percent on control diets. The effect was smaller and not statistically significant when remission meant HbA1c under 6.5 percent without diabetes medicines, and data at 12 months were sparse. It can help, but it must be done with your doctor, because medicines often need lowering on day one.

Who should not do keto?

• People taking SGLT2 inhibitor diabetes medicines (such as empagliflozin or dapagliflozin): keto raises the risk of ketoacidosis, which can happen even when blood sugar looks normal.
• People on insulin or sulfonylureas (such as glimepiride or gliclazide): blood sugar can fall dangerously low unless the dose is changed by a doctor.
• Anyone with type 1 diabetes, kidney disease, kidney stones, liver disease or a history of pancreatitis.
• Anyone with a history of an eating disorder.
• Teenagers who are still growing, unless a doctor prescribes it.

What works better for most people?

Keep the useful part of keto — cutting sugar, sweet drinks, mithai, biscuits and refined snacks — without banning roti and daal. Eat protein at every meal (eggs, chicken, fish, daal, dahi, paneer), fill half the plate with salad or sabzi, and cut portions of roti and rice rather than removing them: one roti instead of three, half a plate of rice instead of a full one. Our guide to calories for weight loss shows how to set the target. Over a year this loses about as much as keto, and it is something you can do at a family dinner.

This article is general information, not medical advice. If you have diabetes, take any regular medicine, or have kidney, liver or heart disease, talk to your doctor before starting a ketogenic or very-low-carbohydrate diet.