{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T06:11:02Z","timestamp":1789884662470,"version":"4.0.1"},"reference-count":219,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T00:00:00Z","timestamp":1668643200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Metabolites"],"abstract":"<jats:p>Insulin resistance (IR) plays a role in the pathogenesis of many diseases, such as type 2 diabetes mellitus, cardiovascular disease, non-alcoholic fatty liver disease, obesity, and neurodegenerative diseases, including Alzheimer\u2019s disease. The ketogenic diet (KD) is a low-carbohydrate\/high-fat diet that arose in the 1920s as an effective treatment for seizure control. Since then, the KD has been studied as a therapeutic approach for various IR-related disorders with successful results. To date, the use of the KD is still debatable regarding its safety. Some studies have acknowledged its usefulness, while others do not recommend its long-term implementation. In this review, we applied a SWOC (Strengths, Weaknesses, Opportunities, and Challenges) analysis that revealed the positive, constructive strengths of the KD, its potential complications, different conditions that can make used for it, and the challenges faced by both physicians and subjects throughout a KD. This SWOC analysis showed that the KD works on the pathophysiological mechanism of IR-related disorders such as chronic inflammation, oxidative stress and mitochondrial stress. Furthermore, the implementation of the KD as a potential adjuvant therapy for many diseases, including cancer, neurodegenerative disorders, polycystic ovary syndrome, and pain management was proven. On the other hand, the short and long-term possible undesirable KD-related effects, including nutritional deficiencies, growth retardation and nephrolithiasis, should be considered and strictly monitored. Conclusively, this review provides a context for decision-makers, physicians, researchers, and the general population to focus on this dietary intervention in preventing and treating diseases. Moreover, it draws the attention of scientists and physicians towards the opportunities and challenges associated with the KD that requires attention before KD initiation.<\/jats:p>","DOI":"10.3390\/metabo12111126","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T03:05:21Z","timestamp":1668654321000},"page":"1126","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Low-Carbohydrate High-Fat Diet: A SWOC Analysis"],"prefix":"10.3390","volume":"12","author":[{"given":"Dena","family":"Nuwaylati","sequence":"first","affiliation":[{"name":"Clinical Biochemistry Department, Faculty of Medicine, University of Jeddah, Jeddah 21959, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6962-5848","authenticated-orcid":false,"given":"Basmah","family":"Eldakhakhny","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21465, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhadi","family":"Bima","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21465, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3918-3046","authenticated-orcid":false,"given":"Hussein","family":"Sakr","sequence":"additional","affiliation":[{"name":"Physiology Department, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat 123, Oman"},{"name":"Medical Physiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8731-6184","authenticated-orcid":false,"given":"Ayman","family":"Elsamanoudy","sequence":"additional","affiliation":[{"name":"Clinical Biochemistry Department, Faculty of Medicine, King Abdulaziz University, Jeddah 21465, Saudi Arabia"},{"name":"Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,11,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"254","DOI":"10.2337\/diab.9.4.254","article-title":"Plasma Insulin Concentrations in Nondiabetic and Early Diabetic Subjects: Determinations by a New Sensitive Immuno-assay Technic","volume":"9","author":"Yalow","year":"1960","journal-title":"Diabetes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.metabol.2012.01.001","article-title":"A brief history of insulin resistance: From the first insulin radioimmunoassay to selectively targeting protein kinase C pathways","volume":"61","author":"Aronis","year":"2012","journal-title":"Metabolism"},{"key":"ref_3","first-page":"6613827","article-title":"NAFLD, Insulin Resistance, and Diabetes Mellitus Type 2","volume":"2021","author":"Knobloch","year":"2021","journal-title":"Can. 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