Why Low-Carb Works – But Carbs Aren’t Actually the Problem

Mario Kratz

6 hours ago

Published: May 20, 2026

Switching to a low-carb diet often feels like flicking a switch: weight starts dropping, and your blood sugar control suddenly improves and often normalizes. That’s a powerful experience, and it leads millions of people to one seemingly logical conclusion: carbs must be the ultimate villain—the cause of weight gain and problems like type 2 diabetes.

The view that carbs are a major cause of health problems is so widespread that I get comments like these here virtually every time I publish a new YouTube video:

But are they right?

In this blog post, I’ll analyze the benefits of cutting carbs, then examine the popular claim that elevated insulin levels driven by high-carb meals cause weight gain and insulin resistance. I’ll explain why low-carb works, but also HOW and WHY you have more options than just cutting carbs to lose weight or improve your blood sugar regulation.

To be very clear from the start, I am a fan of low-carb diets and see them as highly beneficial in specific situations. So this blog post is NOT about bashing low-carb or trying to convince you that all carbs are fantastic. This blog post is about what I see as an incredibly superficial, misleading, and harmful narrative on social media about “carbs” and how they affect our health.

The Impact of Low-Carb Diets on Body Weight and Blood Glucose Control

Many of you who comment on my blog posts or YouTube videos share an experience of major health benefits from adopting a low-carb, very low-carb, ketogenic, or carnivore diet. Most commonly, this includes spontaneous weight loss without counting or actively restricting calories, and improvements in blood sugar control in those of you who have prediabetes or type 2 diabetes.

Now, this is what we call anecdotal evidence, and it counts for something, but it isn’t particularly strong evidence. However, these anecdotal experiences are very much in line with data from numerous randomized controlled trials: if someone is overweight or obese and switches to a low-carb diet, they usually lose some weight spontaneously, even if they don’t actively count and restrict their calorie intake. For example, one randomized controlled trial randomized women with obesity either to an ad libitum very-low-carbohydrate diet or a calorie-restricted low-to-medium fat diet, for six months. Participants in the very-low-carb diet group spontaneously reduced their ad libitum energy intake and lost, on average 8.5 kg or 18.2 pounds of body weight over six months (which was also more than those on the calorie-restricted control diet). The company Virta Health could show that participants with type 2 diabetes who switch to a very low-carb ketogenic diet tend to spontaneously lose a substantial amount of weight. Similarly, overweight or obese participants with type 2 diabetes lost, on average, 12.7 kg or 28 pounds in 32 weeks on a very low-carb ketogenic diet, which was substantially more than participants randomized to the control group that followed the dietary recommendations of the American Diabetes Association.

Let’s take a look at another study that is of particular interest here: the DIETFITS trial. The researchers enrolled 609 participants with excess body weight, and randomized about half of them to a healthy low-carb diet. The other half received a different diet; we’ll talk about that one later.

Participants in this low-carb diet group were given detailed instructions on WHAT to eat, which foods to eat, and which to avoid. There were no instructions to count or actively restrict calories, so the goal here was simply to find out how a change in WHAT these participants ate affects their overall calorie intake and their body weight. They followed participants on this low-carb diet for 12 months.

In this study, the emphasis was on eating healthy, low-carb foods, and each participant was asked to bring their carb intake as low as they could comfortably maintain long-term. On average, carbohydrate intake was reduced from an average of 247 g per day to 119 g per day, so a reduction by roughly 50% in that low-carb group. The researchers then measured how this affected the ad libitum energy intake. With ad libitum, we mean that participants ate as much or as little as they needed to feel comfortably full, which reflects how satiating the diet is. On this low-carb diet, the participants – on average – indeed ate about 574 kcal LESS every day compared to the habitual higher-carb diet they were eating before entering the study. And this reduction in calorie intake led to a weight loss of – again on average – 6 kg or 13.2 pounds over 12 months. That’s quite meaningful if you consider that participants were not even told to eat less or lose weight.

This is just one study, and the low-carb diet tested here wasn’t even particularly low in carbs. Often, carb intake on low-carb diets is lower than 100g or even 50g per day. However, as discussed above, there are several other studies that – taken together – pretty clearly show that when people reduce their carb intake, they tend to spontaneously reduce their calorie intake and lose weight. The more they reduce carbs, the more weight they usually tend to lose.

So from these clinical studies, we can observe that low-carb diets tend to lower ad libitum energy intake and body weight.

We also have data showing that adopting a low-carb diet improves glycemic control, as measured by HbA1c, at least in people with elevated baseline HbA1c. That’s not at all surprising: our blood glucose level rises when we eat carbs, and if we eat fewer or no carbs, our blood glucose levels will rise less substantially or not at all. And that indeed lowers HbA1c in most studies.

On top of that, low-carb diets tend to improve insulin sensitivity and glucose tolerance in most people who start out insulin-resistant and glucose intolerant. Data in this area is a bit thin, particularly for assessing changes over time in insulin-resistant and glucose-intolerant people as they adopt a low-carb diet and lose weight.

That is because I want to acknowledge that with regard to insulin sensitivity and glucose tolerance, the effects of low-carb diets tend to be a bit more nuanced. That is because if you adopt a low-carb diet, your body may initially become LESS glucose tolerant, due to adaptations your body makes to the low-carb content of your diet. In essence, if you are not consuming carbs, your body doesn’t NEED to be as glucose-tolerant, and downregulates some of the blood sugar-regulating mechanisms. One particularly strong impact of adopting a low-carb diet is that insulin secretion, particularly in the first phase, is often reduced in people on low-carb diets, at least initially. It is also noteworthy in this context that within a meal, consuming fat acutely impairs insulin sensitivity, at least if the fat is rich in long-chain saturated fatty acids such as palmitic acid (C16:0). Thus, if we consume fewer carbs and more fat, that would be expected to reduce insulin sensitivity within each meal. Now, as I have summarized in a separate blog post, if we consider the cumulative evidence, this effect cannot be observed in the fasting state while consuming a high-fat diet as long as our body weight and fat mass do not change, i.e., this is most likely an acute insulin resistance-inducing effect that subsides within a few hours of eating the high-fat meal. There are also two trials that have demonstrated that a high-fat, high-saturated fat diet can induce insulin resistance, one of which by yours truly and one by another group. But aside from these temporary and reversible adaptations, low-carb diets can be a good way to address the root causes of insulin resistance and beta-cell dysfunction and, over time, lead to improvements in glucose tolerance, which would, in turn, further improve glycemic control. We’ll discuss the mechanisms behind this effect later.

Why Low-Carb Diets Work: the Social Media Narrative

Why is it then that low-carb diets help us lose weight and improve our blood sugar control? You may not care about the biological mechanisms as long as the diet works, but I argue that it is very important, for a number of reasons, to understand WHY low-carb diets work.

A very common narrative as to why low-carb diets work goes like this:

When we eat carbs, this causes our blood glucose levels to rise. This rise in blood sugar then causes a spike in the hormone insulin. And if insulin levels are high for too long, this then causes us to overeat calories and gain weight, and also to become insulin resistant, which then in turn makes us glucose intolerant and leads to type 2 diabetes.

Now, to understand this argument, let’s take a step back and explain first what insulin does in the body.

The best-known function of insulin is that after a meal rich in carbs, it binds to insulin receptors on the surface of muscle and fat cells and enables these cells to take up glucose from the blood. As a result, the blood sugar levels drop and eventually come back down to the normal fasting level, between 70 and 100 mg/dL.

Insulin has other functions, however. An important one relates to the liver. In the fasting state, the liver releases glucose into the blood to keep blood glucose levels steady in that 70-100 mg/dL range, even as some tissues, such as the brain, continuously take up glucose from the blood. Similarly, fat cells release a trickle of fatty acids into the blood when we are fasting, and these fatty acids are then used as a fuel source by other tissues. Now, after a meal, we have glucose and fat entering the blood from the gastrointestinal tract from the food we just ate, and so we no longer need the liver to release glucose, and we also don’t need the fat tissue to release fatty acids. So what happens after a meal is that the rising insulin levels cause the liver cells to stop releasing glucose and instead store glucose, in the form of glycogen. And in fat tissue, insulin causes glucose to be converted to fatty acids and be stored, and insulin also stops the release of fatty acids into the blood. So the fat cells hold on to the fat.

All of this is well documented, and I am not questioning any of this. Now, what I am questioning is the next part. And that relates to several prominent low-carb diet influencers and book authors who make the case that, because eating carbs causes an increase in insulin, they argue that eating carbs essentially causes nutrients and fuel to be trapped inside of cells. Right? When insulin levels are high, the liver cannot get rid of glucose because insulin inhibits glucose release. And even more important for our discussion here, when insulin levels are high, our fat cells cannot get rid of fat. And so they argue that now the nutrients are locked inside of specific cells, such as the liver and most importantly the fat cells, and the body cannot access these, and that causes us to be overly hungry and overeat, and eventually gain more weight and fat mass. They also argue that a high-carb diet makes it impossible to lose weight because the elevated insulin levels on high-carb diets force the fat cells to hold onto their fat. And so, in turn, they claim that the weight loss seen on low-carb diets is simply because our insulin levels rise less or not at all on low-carb diets, and so now the fat cells are able to release fatty acids into the blood, and now the body can burn them, and we can lose weight and body fat. In academic circles, this model is discussed as the carbohydrate-insulin model of obesity. It has been discussed vigorously for years, but it is my impression that only a very small minority of obesity researchers continues to adhere to the idea that carb-intake driven increases in insulin are the key or even a major driver of overeating and weight gain. If you’d like to review the arguments for and against the carbohydrate-insulin model of obesity, here are two review articles: one by two scientists who are major proponents of the model, and one by a scientist who is not. More recent noteworthy publications on this topic include a paper by Dr. David Ludwig and one by Drs. Kevin Hall and John Speakman.

Similarly, proponents of the carbohydrate-insulin model argue that if our insulin levels spike after every high-carb meal we eat, these elevated insulin levels cause insulin resistance because the body’s cells become numb to these elevated insulin levels.

And therefore, the common argument in hundreds of YouTube blog posts and several bestselling books is that eating a diet rich in carbs causes weight gain, insulin resistance, and type 2 diabetes because carbs cause blood glucose and insulin levels to rise, and the elevated insulin levels then, in turn, cause constant hunger, overeating, and weight gain, as well as insulin resistance and glucose intolerance. In other words, the hypothesis is that high-carb diets cause weight gain and insulin resistance by triggering hyperinsulinemia. And if that hypothesis were true, then this would explain why low-carb diets cause weight loss and improvements in insulin sensitivity and glycemic control.

This entire narrative is not entirely wrong in that high insulin levels are clearly not a good thing, but it is – in my interpretation of the literature – a massive oversimplification and generalization. And, most importantly, it cannot be reconciled with ALL of the evidence.

Let me explain this more.

Why the Narrative that “Carbs” are the Cause of Weight Gain and Insulin Resistance is (Almost Certainly) Wrong

Let’s go back to the DIETFITS trial we discussed earlier. Remember that those participants who were randomized to the low-carb diet roughly cut their carb intake in half, spontaneously reduced their energy intake by more than 500 kcal per day, and lost 6 kg in one year?

Now, let’s take a look at the second diet. That diet was a healthy low-fat diet, and that means that this diet was actually fairly high-carb. These participants consumed 211 g of carbs per day, which accounted for about 50% of their total calorie intake. So if the claims made by low-carbers are correct that “carbs” cause an increase in blood insulin levels, and this increase in blood insulin causes overeating and weight gain then this group should have experienced much greater insulin responses after each meal, and as a result gained weight, or at least not lost any, right? Well, what happened to body weight in this high-carb diet group? Did they gain weight? No, that was clearly NOT the case. In fact, participants on the high-carb diet also very substantially reduced their ad libitum energy intake, and they lost a similar amount of weight. Again, ad libitum means that no one told them to eat less or lose weight. Their new diet was simply more satiating per calorie, and they spontaneously ate less. Now, in terms of the weight loss, maybe participants lost a little less weight on this high-carb diet, but this difference was not statistically significant. And whether or not low-carb was better is actually not the point here. Low-carb may be a little bit more effective at inducing weight loss in the average person, but the bigger point I’d like to make is that the hypothesis that carbs cause overeating and weight gain cannot be reconciled with these data given that both groups lost similar amounts of weight even though they ate vastly different amounts of carbs.

But wait, it gets better. These authors directly tested whether people who are insulin-resistant and have a stronger insulin response to eating carbs may lose less weight on the high-carb diet than the low-carb diet. The graph below shows weight loss in the light blue and dark blue bars. Let me guide you through it.

Participants were grouped into tertiles based on how high their insulin levels rose during an oral glucose tolerance test (OGTT) that was conducted at baseline. So those labeled ‘Lowest insulin-30 tertile’, these are the participants whose insulin levels rose the least in response to consuming glucose, and those labeled ‘Highest insulin-30 tertile’ are the ones whose insulin levels rose the most. The light blue boxes show the weight loss in those consuming the low-fat, high-carb diet, and the dark blue boxes show the weight loss in those consuming the low-carb diet. The dot inside of these boxes, that’s the mean weight loss in the group, and the line is the median weight loss. The box itself, along with the lines to the side (the whiskers), shows the spread of the weight loss in each group. So if the hypothesis was correct that an increase in blood insulin in response to eating carbs is THE key driver of overeating and weight gain, then switching those participants with the highest insulin response to a high-carb diet would cause them to have pretty big glucose and insulin spikes after each meal, right? And yet, we see that they lost as much weight on a low-fat, high-carb diet as those on the low-carb diet. We also see that weight loss was about the same across all groups, regardless of which diet participants followed or whether they had high or low insulin responses to eating carbs.

Now, this is just one study, but there are many more studies that show that people with excess body weight can very well spontaneously lose weight when they switch to a high-carb diet. In a well-controlled (all food provided) single-arm trial (conducted by one of my mentors, Dr. D. Scott Weigle), participants were switched from a mixed-micronutrient diet to a very low-fat, very high-carb diet. They reported massively increased satiety, and reduced their ad libitum calorie intake by about 300 kcal per day, on average, predictably leading to a loss of body weight (by a mean of 3.8 kg or 8.4 pounds) and fat mass (by a mean of 3.4 kg or 7.5 pounds) over 12 weeks. Similarly, patients with type 2 diabetes who enrolled in the Pritikin Longevity Center and consumed a very low-fat, very high-carb diet for 26 weeks spontaneously reduced their calorie intakes and lost substantial amounts of weight, 4.7 kg or 10.4 pounds on average. Both of these studies have limitations, most importantly their non-randomized nature and lack of a control group. However, they both clearly illustrate that even a very high carb intake does not necessarily ‘trap’ fat inside of the fat cells, making it impossible to lose weight, and instead can lead to a reduction in ad libitum energy intake and body weight. Another landmark trial published in the prestigious medical journal JAMA compared four different weight loss diets, one of which was a low-fat high-carb diet designed by Dr. Dean Ornish. Over 1-year, all groups lost weight, including the high-carb diet. There are many more trials, but I think the case has been made sufficiently that people commonly lose weight when they go on a high-carb diet. In other words, the idea that carbs cause weight gain or make weight loss impossible cannot at all be reconciled with the available evidence.

How about insulin sensitivity, though? Well, in the DIETFITS trial, both fasting glucose and fasting insulin were significantly reduced in both the high-carb and the low-carb diets. Similarly, the insulin concentration at the 30-minute time point in an oral glucose tolerance test was significantly reduced in both diet groups. All of this suggests improved insulin sensitivity in both groups, so, again, these data simply do not support the idea that high-carb diets per se cause insulin resistance.

I have actually made a separate blog post about this very topic before. The gist is that across several randomized controlled trials, varying how much carbs and fat people eat has NO impact on insulin sensitivity IF body weight remains stable. Weight change is very relevant here because carrying excess fat mass, specifically visceral and ectopic fat, is the main cause of insulin resistance. And so if you lose weight on any diet, you have a good chance to improve your insulin sensitivity. And if you gain weight, your insulin sensitivity tends to be reduced. So we need to consider studies in which carb and fat content were varied, but calorie intake and body weight were kept stable. And if we do that, varying the fat vs. carb content does not seem to affect insulin sensitivity per se.

And so if we consider that minimizing carbs per se does not seem to improve insulin sensitivity, I have to conclude that the main reason why insulin sensitivity improves long-term on a low-carb diet is because people lose weight and fat mass, which leads to a loss of visceral and ectopic fat, specifically in liver and muscle, and this would be expected to improve insulin sensitivity. And of course, if you overeat on any diet and gain weight, you may become more insulin-resistant. In other words, this is much less about how many carbs and fats your diet contains than it is about how your diet affects your calorie intake, body weight, and fat mass. So pick a diet that prevents weight gain or even helps you lose weight, and that can be a very low-carb diet, a very high-carb diet, or anything in between. I see little evidence that these differentially affect insulin sensitivity independent of how these diets affect your body weight and fat mass.

So, taken together, we have now seen that switching to a low-carb diet does cause weight loss and improvements in insulin sensitivity and blood sugar control, but at the same time, it is still possible to eat a high-carb diet and also lose weight and improve insulin sensitivity.

So these observations cannot be reconciled with the hypothesis that foods that raise insulin automatically cause weight gain and insulin resistance. So if carbs, per se, are not the cause of weight gain and insulin resistance, why does cutting carbs in low-carb diets work so well?

The Mechanisms Through Which Low-Carb Diets Work (And Why Also High-Carb And Other Diets Work)

As I say quite often on this channel, we need to consider ALL of the available evidence, rather than just the one or two studies that fit our hypothesis. And if I do that, I am forced to consider other hypotheses about why low-carb diets work. Here is the one I currently consider the most plausible.

In several blog posts on this website, I have summarized scientific evidence showing that the quality and composition of the foods we eat affect how many calories we eat (summarized in the figure below). Specifically, we tend to overeat foods that are ultra-processed; that are liquid calories such as sugar-sweetened or alcoholic beverages; that are hyperpalatable, which means certain combinations of fat, carbs, and salt that we find irresistible; that are energy dense, meaning they have a lot of calories per gram; that are low in BOTH protein and fiber; that are soft textured, and – yes – that are highly glycemic and insulinemic, meaning they trigger a major roller coaster in both blood glucose and insulin. So I am not saying that this last point about how much blood glucose and insulin rise after a meal doesn’t matter at all; I simply argue that it’s one of many factors, not the only or even main one.

So, clearly, if we eat a lot of foods that meet one or more of these criteria, our ad libitum energy intake will increase. If you’d like to review the science linking these characteristics to higher ad libitum energy intake, please visit the four blog posts linked in the paragraph above.

Now let’s take a look at a few high-carb foods that people often eat.

Let’s start with regular soda. It is usually ultra-processed, it’s definitely a source of liquid calories, it’s low in both protein and fiber, and it’s highly glycemic. And yes, numerous randomized controlled trials show clearly that when people add a sugar-sweetened beverage such as soda or lemonade to their meals, their calorie intake goes up a lot, by about as many calories as the soda contains.

OK, how about a sugary breakfast cereal? Again, this meets many of the criteria that trigger overeating. It’s not liquid, but other than that, it’s perfectly designed to make us overeat.

A donut? Same thing. Or actually, worse in several ways, because this is even more energy dense and probably even more hyperpalatable.

A piece of cake? Definitely hyperpalatable, extremely energy dense, low in protein, and usually devoid of fiber, soft textured – you can basically eat a few hundred calories in two or three minutes – and certainly highly glycemic and insulinemic with all that added sugar and refined flour.

Or let’s consider what, for many people, is breakfast, if it’s not cereal. White toast with a hazelnut-chocolate cream. This would be similar with honey or jam. Probably ultra-processed, hyperpalatable with that combination of refined grains, added sugar, and fat, very energy dense, basically no protein and fiber, very soft textured, and again highly glycemic and insulinemic.

More or less the same for potato chips.

In other words, these types of high-carb foods are basically perfect combinations of all of the factors known to make us overeat. So, of course, if someone goes low-carb and cuts out all of these foods and instead eats only, say, salad, non-starchy vegetables, eggs, meat, and fish – all of which are much more satiating per calorie – they are going to eat less and lose weight.

And this is also part of the reason why participants on the low-fat, high-carb diet in the DIETFITS trial lost weight. Remember, they called this a “healthy low-fat diet”, which also translates to “healthy high-carb diet”, and so the participants – of course – were not drinking soda or eating sugary breakfast cereals, donuts, cake, white bread with sweet stuff on it, or chips.

They were eating quite a lot of carbs, but in the form of beans and lentils, fruit and berries, whole grains, and a wide variety of vegetables. All of which have one thing in common: they do NOT meet most of these criteria. For sure, some fruit and berries may have a soft texture, and breads, even whole-grain breads, are quite glycemic and insulinemic. And bread is probably the least satiating food per calorie of this group. As a group though, these foods show a lot of the qualities that makes foods more satiating per calorie: they are unprocessed or minimally processed, they are solid foods, that are not designed to be hyperpalatable, they are less energy dense than the junky carbs we talked about earlier, they are rich in protein, fiber, or both, they are hard textured, and require some or a lot of chewing, and they tend to be of a lower glycemic and insulinemic index than junky high-carb foods made from starches, refined grains, added sugars, and high-fructose corn syrup.

So I think we can all agree that if we eat a diet rich in these types of whole high-carb foods shown in the figure above, we’ll be eating a lot fewer calories than if we regularly consume soda, sugary cereal, donuts, cake, or chips. In other words, high-carb foods CAN be highly satiating per calorie, helping us be full without overeating calories, OR they can combine all of the qualities that make us overeat and gain weight.

So, if we look again at the results of the DIETFITS trial, which theory explains the results better? That carbs, per se, cause overeating and weight gain, or that SOME high-carb foods cause overeating and weight gain?

I’d say the answer is pretty clear, right?

So, PLEASE, let’s stop talking about “Carbs” as if they are all the same. Let’s stop blaming beans, lentils, apples, and carrots for what soda, donuts, cake, and chips do to you.

Why Is This Relevant to Me?

This is relevant to me – and I would argue you – because these data give us options.

You can lose weight and improve your insulin sensitivity and blood sugar control on a low-carb diet, sure. No one is questioning that. Low-carb can be a very good option.

However, you don’t NEED to go low-carb. Numerous studies show that similar weight loss can be achieved with other diets.

That is because, in spite of what you may have heard from low-carb influencers, our calorie intake and body weight are not just affected by how much our meals raise our insulin levels, but by a wide range of factors. And if we consider all of these factors, we see that many different types of diets can work. Just make sure to prioritize foods that are highly satiating per calorie and that don’t trigger you to overeat. Check out my blog posts on this topic if you’d like to know exactly how to do that. This one here, called ‘How to Lose Weight Without Counting Calories’, is a summary and a good starting point.

Now, why is that so important to me? Because research clearly shows that we will only benefit from weight loss efforts in the long term IF we can maintain our new way of eating in the long-term. I therefore feel that the most important criterion is that you pick a way of eating that you enjoy and that you can happily maintain long-term, ideally forever. And the reality is that not everyone wants to follow a low-carb diet forever, and I see it as highly beneficial to have options. So if you prefer a low-carb or ketogenic diet, go for it. But if you enjoy a high-carb, whole-foods, plant-based diet more, that’s also great. Or if a Mediterranean diet is more to your liking, great again! I feel strongly that we should only limit our choices if there is very strong evidence supporting that restriction, and that’s clearly not the case here. Most studies comparing different diets, including low-carb and high-carb, show pretty similar weight loss, as long as the diets are highly satiating per calorie and minimize consumption of hyperpalatable trigger foods.

Now, there is one situation where I do think low-carb has the edge. If you are glucose intolerant or very insulin resistant, I personally would try a low-carb diet first, or at least be religious about cutting those foods with the highest glycemic load. In other words, if you have prediabetes, type 2 diabetes, regular blood sugar spikes to 180 mg/dL or higher, regular hypoglycemic episodes, or insulin resistance, with HOMA-IR above maybe 2.5 or 3, consider adopting a diet with a lower glycemic load and potentially lower total carb content. That is simply because chronically high glucose and insulin levels are risk factors for a range of chronic diseases, and reducing our consumption of foods that trigger the strongest increases in glucose and insulin is probably a good idea in that situation. At least until insulin sensitivity and glucose tolerance have normalized largely. So what this means in practice is that if you have blood glucose issues or insulin resistance, be pretty strict about cutting out all of the added sugars and syrups, refined grains, and starches.

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