Downloaded more than 56,000 times, this ketogenic diet article gives clinicians and patients a practical, evidence-based starting point
When Sarah Rice, BSc. (Hons), MCOptom (UK), MHP, began working with LowCarbUSA founder Doug Reynolds, BSc (Elec Eng), MHP, on what would become one of the most widely downloaded ketogenic diet resources, the goal was not to create another piece of promotional content.
It was to create something useful.
The result was “The Ketogenic Diet: Addressing Concerns and Considering Benefits,” a free LowCarbUSA e-booklet written primarily for the lay public but rigorous enough to be useful for clinicians.
After the resource received strong positive feedback, Sarah and Doug condensed and rewrote the material, adding methods and a more academic framing, to create the peer-reviewed Journal of Metabolic Health (JMH) open access article, “Practical guidelines for addressing common questions and misconceptions about the ketogenic diet.”
The article, published July 21, 2025, notes that research publications on the ketogenic diet have increased rapidly in recent years, while common misconceptions continue to cause confusion, especially where nuance around diet quality and personalization is needed.
The JMH article has now been downloaded more than 56,000 times.
For Sarah, that reach is encouraging. But the larger purpose is not simply to count downloads. It is to give people a credible place to begin.
“I hope it’s doing more than just reaching people,” Sarah said. “I hope it’s a tool. I hope it’s a resource that starts conversations. It helps people to perhaps start their own research journey, looking at things a little bit more closely.”
Making the science accessible without losing the nuance
Sarah said the LowCarbUSA e-booklet was designed to help people move beyond the noise and confusion that often surrounds ketogenic diets.
“I hope that it groups together enough of the information that covers enough of the barriers,” Sarah said. “The curious clinician, the conservative clinician, the cautious clinician – I hope it’s really an on-ramp for further investigations and for starting conversations.”
The resource is heavily referenced, but it is not written only for academics. Sarah said that balance was intentional.
“I hope that the language is academic enough to help to encourage people to look further,” Sarah said. “And I think the references that are listed at the end of the paper will start anybody on a journey of further investigation.”
At the same time, the material needed to remain accessible.
“I think that it is readable enough that a lay person can easily access the information,” Sarah said. “But at the same time, it’s academic enough for clinicians.”
Resources designed for the curious and cautious
Sarah describes herself as “a behind-the-scenes kind of person,” more comfortable researching and writing than being in the spotlight.
“I see myself a little bit more as a wingman, not a front-of-house kind of person,” Sarah said. “I don’t really like the limelight. I prefer writing to speaking.”
That careful disposition helps explain the tone of the LowCarbUSA booklet. It is not written to oversell ketogenic diets, provoke critics or reduce complex questions to talking points. It is written to help people think more clearly.
Sarah was asked to review and refine the references and framing of the original document. She ultimately rewrote much of the draft to make it more precise, more accessible and less informal in tone.
The challenge later became converting the much longer booklet into something concise enough for academic publication while preserving enough substance to be useful.
“I took that and thought, ‘How am I going to get 13,000 words into 3,000, which is pretty tricky, and turn it into something academic’?” Sarah said.
“The goal of the paper was just to create something concise,” Sarah said. “It was a tricky job, because you want to try and communicate nuance, but you also have a limited number of words.”
“Sarah has a real gift for taking a large amount of research and turning it into something people can actually use,” Doug said. “She is careful with the science, careful with the language and always thinking about how the information will land with both clinicians and the public.”
Answering the questions people are already asking
One reason the article is useful is that it does not answer theoretical objections. It addresses questions people are already asking.
The peer-reviewed JMH article explains that common ketogenic diet questions were selected from a social media platform based on questions raised over approximately 10 years.
The authors then used those questions to develop concise, evidence-based answers intended to support clinicians seeking to implement ketogenic diets in practice.
The paper addresses practical concerns that often come up before patients or clinicians feel comfortable considering a ketogenic approach:
- What is a ketogenic diet?
- Who should use caution?
- What about side effects during the transition?
- Does keto increase the risk of gout?
- Does it cause ketoacidosis?
- Can it lead to nutrient deficiencies?
- What about saturated fat, gallbladder disease, cardiovascular health, and kidney disease?
- Can it be sustained long-term?
The paper’s practical value comes partly from its willingness to address common concerns directly, with an emphasis on context, clinical supervision when appropriate, and individualization.
That structure makes the resource especially useful because it meets people where they are.
“My passion, and my interest, is communication,” Sarah said. “Getting the science communicated in a way that’s accessible to the widest range of people, and that goes for the layperson as well as the professional.”
Why blood glucose control became personal
Sarah’s interest in ketogenic diets and therapeutic carbohydrate reduction did not begin with a dramatic personal transformation. It grew from what she saw professionally.
“For me, it was about my patients who were on the diabetic spectrum,” Sarah said.
Sarah originally qualified as an optometrist in the U.K. and worked in the National Health Service. She worked in a low-vision clinic, where she saw patients whose eyesight had been damaged by the complications of diabetes.
“For me, it’s all about type 2 diabetes and diabetes in general and blood glucose control,” Sarah said. “So any intervention that is possible to improve those outcomes, those visual outcomes, is very important to me.”
By the time patients reached her low-vision clinic, the opportunity to prevent damage had often passed.
“You want to get upstream,” Sarah said. “If you came to my low vision clinic back in the day when I was working for the NHS, I could maybe give you some magnifiers, but your quality of life is impacted, and your disease may progress. If we can stop that, that makes a huge difference.”
Her husband is a vitreoretinal surgeon, which has further shaped her concern about preventing diabetic complications before they become advanced.
“If you can get upstream and you can prevent diabetic retinopathy, that has massive implications,” Sarah said.
What a well-formulated ketogenic diet actually means
One of the most important contributions of the JMH article is that it clearly defines the ketogenic diet.
The JMH article describes a well-formulated ketogenic diet as one that supports nutritional ketosis while meeting nutritional and energy requirements.
For metabolic conditions, the paper emphasizes carbohydrate reduction; adequate protein to maintain or improve lean body mass; fat added to satiety; nutrient-dense, minimally processed whole foods; avoidance of added sugars and highly processed foods; and attention to essential vitamins and minerals.
That matters because many public criticisms of ketogenic diets are aimed at poorly formulated versions of the diet or at caricatures of what people actually eat.
Sarah repeatedly emphasized that therapeutic carbohydrate reduction exists on a spectrum and should be individualized.
“I would say that therapeutic carbohydrate reduction is a spectrum and that not everybody needs to be ketogenic,” Sarah said.
One point that stood out to Sarah while working on the article was the range of carbohydrate intakes at which different people may enter ketosis.
“What came to my attention, in terms of published work, was that the literature shows that people enter into ketosis over a range of carbohydrate intakes, which can be as high as 70 grams or as low as 20,” Sarah said.
That reinforced the importance of personalization.
“If there were patients who are going into ketosis at 70 grams of carbohydrates per day, then that’s a lot different from some people who struggle to get into ketosis at the 20- to 25-gram level,” Sarah said. “When you’re looking at ketones for therapeutic effect, that individualization is quite key.”
Highlighting ketogenic diets as an option
Sarah is careful not to present ketogenic diets as the only useful dietary approach for every person. But she believes they deserve to be part of the clinical conversation.
“The most important thing is that the low-carb and ketogenic diets are presented as an option without hyperbole, but just with a realistic framing,” Sarah said. “They belong on the table as an option.”
That is how she believes therapeutic carbohydrate reduction and ketogenic diets should be discussed.
“I just think it’s most helpful to look at it as an intervention that has utility; it belongs on the table as part of the discussion,” Sarah said. “It should come up in every discussion. When doctors talk about lifestyle, they should feel that they can offer therapeutic carbohydrate reduction and ketogenic diets as one way that patients could recover their metabolic health.”
That framing aligns closely with the conclusion of the peer-reviewed JMH article, which states that the totality of evidence supports a well-formulated, whole-food ketogenic diet as safe and effective for key features of metabolic dysfunction, while also emphasizing that experienced healthcare providers can personalize the approach according to therapeutic targets, preferences and biomarker responses.
The role of The SMHP
Sarah said her work with The SMHP (and its sister organization, LowCarbUSA) reflects a larger need in health care: clinicians and allied health professionals need credible organizations, education and professional support if they are going to incorporate metabolic health into their work.
“Fundamentally, when you incorporate metabolic health and nutrition into your practice, if it’s outside of your trained scope of practice, you need these organizations so that you can upskill and you can feel confident,” Sarah said.
Sarah said this is where The SMHP plays a vital role for clinicians and allied health professionals who want to practice at a high standard. She also mentioned the educational courses partnered with Nutrition Network as important in her own training and development, describing the broader importance of organizations that help professionals acquire certification or accreditation in nutrition and metabolic health. The SMHP accreditation also requires continuing professional education and its grand rounds and conferences have ACCME-accredited CMEs available.
“All of those things are important for standardizing, keeping the level professional and making sure that everybody is grounded in enough information to benefit their patients or clients,” Sarah said.
For The SMHP, that role extends beyond training. The society also works to produce position statements, guides and academic resources that support practitioners in the field.
“From a professional point of view, we are working on papers and position statements and guides, and it gives health care professionals confidence that they’re not alone,” Sarah said. “There’s a professional body that represents everybody who’s working in the metabolic health field.”
A document meant to be used and shared
Sarah is pleased with the number of downloads the JMH article has received, but she remains focused on utility rather than attention.
“On the one hand, I’m surprised, but on the other hand, I do think it’s a very good, concise overview, and there was a place for that sort of document,” Sarah said. “It is the kind of document that might get reached for quite a lot, because it does cover so many bases.”
One example of that utility came from Nicole Laurent, a licensed mental health counselor known for her work in metabolic psychiatry. Laurent confirmed that the Journal of Metabolic Health article is listed in her resources for psychotherapists who want to become keto-informed so they can better support patients. She also said she uses it in trainings for Psychiatry Redefined’s functional psychiatry fellowship.
For Sarah, that kind of feedback matters because it shows the article is not simply being read. It is being used by professionals who are trying to bring more accurate information about ketogenic therapies into clinical and educational settings.
Sarah also said work is continuing on additional resources through The SMHP, including an update to the TCR Implementation Guide, addenda on several complex clinical topics, and an article discussing incretin mimetics, including GLP-1 medications, as an adjunct to lifestyle interventions such as therapeutic carbohydrate reduction.
“The website also offers useful handouts for patients and practitioners, along with a practitioner listing that helps connect people with clinicians and coaches trained in therapeutic carbohydrate reduction.”
“There is a lot of work in the pipeline, obviously; we want to help more people,” Sarah said.
The goal, she said, is to continue to create practical, well-supported resources that help clinicians and patients better understand complex metabolic health topics and know where to begin.
“I think the vision is to put out robust, academic articles that serve as tools,” Sarah said. “They start conversations. They help clinicians feel more confident in using low-carb and ketogenic approaches in practice.”
A practical starting point
The JMH ketogenic diet article has reached more than 56,000 downloads because it answers a real need.
Patients are asking questions.
Clinicians are encountering those questions.
Social media is amplifying both interest and confusion.
Sarah and Doug’s work offers a practical starting point: accessible enough for the public, rigorous enough for clinicians and careful enough to preserve the nuance that ketogenic diet conversations often lose.
For Sarah, that is the purpose of the work.
“It does a good job of connecting people with a good starting point and a good foundation for looking into things, whether they’re clinicians who want to dig deeper or anyone wanting to explore options for their health journey,” Sarah said.
LowCarbUSA’s “The Ketogenic Diet: Addressing Concerns and Considering Benefits” is available as a free download from the LowCarbUSA website. The resource is also available in Spanish.
For clinicians and the informed layperson, the JMH article “Practical guidelines for addressing common questions and misconceptions about the ketogenic diet” is freely available at the Journal of Metabolic Health.