When Keto Critics Miss the Bigger Picture

Why Scare Tactics about muscle loss, liver damage, and diabetes don’t hold up

Every so often an influencer warns that keto is dangerous. This week’s version went further: "the diet industry’s biggest scam," claiming keto destroys muscle, wrecks your metabolism, damages your liver, and can even trigger type 1 diabetes. The author leaned heavily on a single mouse study and ignored what we know from human trials and lived experience. It was an alarming post. It was also deeply misleading.

Keto is the diet industry’s biggest scam… it doesn’t cure obesity and it may actually *cause* diabetes.

Lose weight on keto? Sure but mostly water and muscle. What you gain back is fat, liver damage and metabolic retardation.

Let’s unpack.

Weight loss on keto is mostly water… pic.twitter.com/ICCp1uocX6

— Veronica (@celestialbe1ng) October 3, 2025

I read it. Then I thought about my own journey. I lost 120 pounds. Not just water. Not just muscle. On keto I reversed nonalcoholic steatohepatitis (NASH, the inflamed form of nonalcoholic fatty liver disease, NAFLD), insulin-dependent type 2 diabetes, stage 3 chronic kidney disease, GERD, and what used to be called "super obesity." My metabolic rate did not crash. I did not rebound heavier. And I am not an outlier. Many of my clients and thousands of people in published trials have seen similar results.

Claim: "Keto weight loss is mostly water and muscle"

Yes, the first few pounds on keto are water. This happens with any weight loss. More so on keto for two reasons:

• The liver dumps stored glycogen. That’s long chains of glucose. Each gram of stored glycogen binds about 3–4 grams of water. So there, water loss.
• Insulin levels drop, and with this drop the kidneys retain less sodium. Less sodium allows the body to get rid of excess fluid.

Right from the start, fat loss happens. Studies using DEXA scans and multifrequency BIA show that ketogenic diets preserve lean mass as well as, and often better than, calorie-matched low-fat diets when protein and resistance training are included. The idea that keto automatically makes you "skinny-fat" comes from crash diets and inadequate protein, not well-formulated ketogenic nutrition.

Claim: "Keto lowers your metabolic rate so you regain more fat"

This argument is built around the "Biggest Loser" study, but those participants were eating very low calories and training for hours daily, which is what caused a sharp drop in resting metabolic rate. Keto is not calorie-starved. In supervised clinical trials, people eating a low carb diet with adequate protein and calories maintain resting energy expenditure after weight loss. Mild metabolic adaptation happens with any diet because a smaller body burns fewer calories, but keto does not uniquely crash metabolism.

Claim: "Keto causes sarcopenic obesity"

Sarcopenic obesity means low muscle and high fat. That can happen after starvation diets or in aging without enough protein or activity. Well-designed ketogenic diets typically include 1.2–2.0 g protein per kg of reference body weight and resistance training. When people follow that, studies show preserved lean mass and improved strength. Sarcopenia is not a built-in outcome of keto. It’s a risk of poorly executed dieting in general.

Claim: "Low insulin on keto damages lipid metabolism and causes liver fat"

In insulin-resistant people, high fasting insulin drives fat storage in the liver and around organs. Lowering insulin through carbohydrate restriction usually reverses fatty liver. Clinical trials show reductions in liver fat, liver enzymes, and even reversal of NASH. Triglycerides fall sharply, HDL rises, and small dense LDL decreases. Some people see LDL cholesterol go up, but that is not a reason to label keto liver-toxic. LDL is not even a marker of metabolic disease.

Dr. Eric Westman has seen reversal of nonalcoholic fatty liver in some of his patients in under a month. I have reversed NASH, which is an inflamed fatty liver, one step short of cirrhosis. To be clear, nothing in a well formulated ketogenic diet harms the liver.

Claim: "Keto worsens glucose control and leads to beta-cell failure (like type 1 diabetes)"

This is mouse data taken out of context. The study behind the misleading post followed mice on an extreme high-fat formulation for a year and saw poor insulin secretion. Rodents respond to fat and carbohydrate balance vastly differently than humans. In humans with type 2 diabetes, the evidence points the other way: lower HbA1c, less insulin resistance, fewer medications, and often remission/reversal. The two-year Virta Health trial followed over 300 adults with type 2 diabetes. Participants lowered HbA1c, lost significant body fat, reduced or discontinued insulin and other diabetes medications, and maintained resting metabolic rate with no evidence of beta-cell failure. Type 1 diabetes is autoimmune. It is not triggered by eating a ketogenic diet.

My own health journey included the reversal of insulin dependent type 2 Diabetes. I lowered an A1c of 8.5 to 5.2 within 6 months. By month 8 I was off of both insulin and metformin, and have maintained a healthy A1c ever since without diabetes meds. After more than five years in healthy ranges, this meets the definition of prolonged remission, a state some experts say can be operationally regarded as a cure, while acknowledging relapse risk remains higher than in people who never had diabetes.
How Do We Define Cure of Diabetes?

Claim: "Long-term keto harms liver, heart and pancreas"

No high-quality human data supports that sweeping statement. Instead, we see improved liver enzymes, lower triglycerides, better HDL, and reductions in visceral fat. Some people will have an LDL rise which is a discussion for another post, but heart disease risk markers overall often improve. Pancreatic burnout is not reported; in fact, reducing glucose and insulin demand may preserve beta-cell function longer in type 2 diabetes.

Claim: "Low-fat diets outperform keto for fat loss and metabolic health"

Some animal models say that. And once again for those in the back: humans are not mice. In humans with obesity and diabetes, low carb diets match or outperform low fat for fat loss, blood sugar control, triglyceride reduction, and medication reduction. Even the American Diabetes Association lists low carb as an accepted option alongside Mediterranean, DASH and other eating patterns. Granted, they don’t put the keto option front and center, probably not to upset their ‘proud sponsors.’
Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes

Takeaways

• If you choose keto, do it well: adequate protein, whole-food fats, non-starchy vegetables, and electrolytes.
• Work with a clinician if you have diabetes or advanced metabolic disease. Medications often need to be reduced quickly when carbs drop.
• Monitor lipids and liver markers. Most see improvement, but individual responses vary.
• Keto is not a fad. It is the proper human diet. There is strong human evidence when applied correctly.

Dismissing keto as a "scam" ignores both clinical evidence and lived experience. It also discourages people with metabolic syndrome or fatty liver who could benefit from trying carbohydrate restriction with professional guidance.

Final thoughts:

I reversed severe disease on keto. Thousands of patients in peer-reviewed studies have done the same. The story is far bigger, and far more hopeful, than a mouse study and a misleading tweet would have you believe.

Eat like it matters,
–Coach Roxana

Written by Roxana Soetebeer, MPHC, NNP, MHP, PFC
Published October 5th, 2025

---

---

Social Media:
Facebook
YouTube
X Roxana
X Joy
Coaching: Are you stuck on your weight loss journey? Check out our coaching programs. Book a free discovery call to find out if we are a good fit.
Patreon with weekly interactive Zooms.

Recommended Books: