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Dr. Jim McCarter: The Top Myths About Ketosis Debunked by Clinical Trials

ByCrossFitDecember 25, 2019

“There’s really only one goal for this talk, and that’s to arm you to answer any question about ketogenic and low-carb nutrition approaches,” Jim McCarter said during a presentation at a CrossFit Health event on Oct. 13, 2019.

McCarter, MD and Ph.D., is an expert on the ketogenic diet, particularly its effectiveness for treating and reversing Type 2 diabetes (T2D). His personal journey with ketosis began in 2012 after he began researching the health-related effects of corn syrup and sugar. His research led him to Gary Taubes’ book, The Case Against Sugar, and the discovery of several misconceptions he had carried, “dating back to medical school.”

During his talk, McCarter focuses on correcting some of these misconceptions about nutrition and metabolic health, particularly misconceptions about nutritional ketosis. He notes several benefits of ketosis, explaining ketones provide an alternative form of energy to glucose in individuals with insulin resistance (ketones provide about 60% of the brain’s energy during fasting). Ketosis also lowers insulin levels, which improves insulin sensitivity, and ketones provide a signal for the body to reduce oxidative stress and inflammation.

McCarter then highlights the various ways clinical research has debunked 40 common myths about the ketogenic diet. As the former Head of Research for Virta, a nationwide telemedicine provider and full-stack technology company that focuses on the reversal of T2D, much of the data he uses come from the Virta-Indiana University Health (Virta-IUH) clinical trial.

One of the prevailing myths about the diet is that it is unsustainable. McCarter claims this is false, observing that of the 465 participants in the Virta-IUH trial, 74% were able to maintain participation, even with extensive tracking demands. Most agreed to extend their participation to five years, he adds.

For those interested in beginning the ketogenic diet, or those who are following the diet and would like to be equipped with data to defend the choice, McCarter explains where to go to find information debunking each of the following myths:

  1. Keto is unsustainable.
  2. Keto will cause diabetic ketoacidosis.
  3. Keto will cause hypoglycemia.
  4. Keto will deprive the brain of required glucose.
  5. Keto will impair the heart and cause vascular damage.
  6. Keto will worsen the blood lipid profile.
  7. Keto will cause inflammation.
  8. Keto will cause hypothyroidism.
  9. Keto will harm the liver and increase liver fat.
  10. Keto will harm the kidneys.
  11. Keto will cause muscle loss.
  12. Keto will cause loss of bone mineral density.
  13. Keto is just a fad.
  14. Keto is not the standard of care.
  15. Keto benefits are limited to weight loss.
  16. Keto weight loss is just water.
  17. Keto will cause “keto flu.”
  18. Keto will cause constipation.
  19. Keto will require too much sodium.
  20. Keto sodium will cause hypertension.
  21. Keto will cause adrenal fatigue.
  22. Keto will cause gallstones and requires a gallbladder.
  23. Keto increases mortality in nutritional epidemiology studies.
  24. Keto requires meat consumption.
  25. Keto will increase cancer risk.
  26. Keto increases circulating saturated fat.
  27. Keto provides inadequate dietary fiber.
  28. Keto interferes with the gut microbiome.
  29. Keto is environmentally unsustainable.
  30. Keto foods are too expensive.
  31. Keto will interfere with exercise.
  32. Keto will deplete muscle glycogen.
  33. Keto will raise long-term risk of gout.
  34. Keto will increase long-term risk of kidney stones.
  35. Keto will cause “keto crotch.”
  36. Keto will cause “keto bloat.”
  37. Keto will confuse the public.
  38. Keto will undermine science.
  39. Keto will cause diabetes.
  40. It’s better just to stay with usual care for diabetes management.

After explaining how clinical studies have debunked each of these myths, McCarter concludes his talk by addressing the doctors in the audience: “Be informed. Talk with your patients. Debunk myths meant to cause fear … . Let patients know they have a choice to reverse diabetes.”

To read a full transcript of the presentation, click here.


Dr. James McCarter is an experienced entrepreneur, executive, and researcher with a track-record of success in early-stage life science technology companies. He is currently Medical Director for New Analyte Ventures at Abbott Diabetes Care, investigating new health applications for wearable biosensors. Previously, he led research and clinical operations for San Francisco-based Virta Health, a tech-enabled nationwide medical provider that delivers the first clinically proven treatment to safely and sustainably reverse Type 2 diabetes without medications or surgery. He directed the Virta – Indiana University Health clinical trial, proving reversal of diabetes at scale.  This trial resulted in changes to the American Diabetes Association standards of care and consensus statement on nutrition in 2019 that is creating a paradigm shift in how Type 2 diabetes is managed.

McCarter is also an Adjunct Professor of Genetics and member of the National Council for the School of Medicine at Washington University in St. Louis and Senior Entrepreneur in Residence at the venture fund BioGenerator. Previously, McCarter was the founder, president and chief scientific officer of Divergence, Inc., a frontrunner in the application of genomics to infectious disease and agriculture. McCarter was a scientific advisor for startup Readout, Inc. during the creation of BioSense, the first clinical-grade portable breath acetone device, and is a board observer at Neurolutions, Inc., which is developing the first brain-computer interface (BCI) for stroke rehab.

McCarter completed his undergraduate studies in biology at Princeton University, his M.D. and Ph.D. degrees at Washington University, and postdoctoral training at the Washington University Genome Institute, leading an international genome sequencing consortium. He is the founder of Washington University’s Young Scientist Program, providing disadvantaged students access to scientific careers. He is author of over 60 scientific publications and patents and has served on 20 nonprofit boards and professional advisory boards, including two World Health Organization panels. McCarter is a recipient of the Innovation Award from the Academy of Science of St. Louis and is a Henry Crown Fellow of the Aspen Institute. He and his wife, also a doctor, have two teenage sons. The family lives in the City of St. Louis and farms in nearby Labadie, Missouri.

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