Cardiologist Says Keto Reverses Diabetes, Hypertension, and Depression

What Bret Scher is really arguing

Dr. Bret Scher is not selling keto as a beach-body shortcut. He is a board-certified cardiologist and lipidologist in San Diego, and his public case for low-carb eating is built around patients who have seen hypertension, type 2 diabetes, and even treatment-resistant depression improve when the diet is used as a metabolic tool. As Medical Director at Diet Doctor and through his work with Metabolic Mind, he frames a well-formulated ketogenic diet as something closer to therapy than trend.

That framing matters because it changes the conversation. Keto advocates do not just want credit for weight loss, they want the diet treated as a serious intervention for chronic disease, with the same seriousness given to medication, monitoring, and follow-up. The strongest version of Scher’s argument is not that keto works for everyone, but that it deserves to be judged on outcomes, not dismissed because it is unpopular in mainstream nutrition circles.

Where the diabetes evidence is strongest

If you want the cleanest evidence for keto, diabetes is where the case is most convincing. A 2021 BMJ systematic review of 23 trials with 1,357 participants found that low-carbohydrate diets produced higher remission rates at six months than control diets. That does not prove a cure, but it does show that carbohydrate restriction can move blood sugar control far beyond what many people expect from a “diet.”

The medical world is also moving, carefully, toward remission language. A 2024 review in Diabetes Care said at least three major professional organizations have endorsed diabetes remission as a therapeutic goal in selected people with recently diagnosed type 2 diabetes and overweight or obesity. A primary-care case series from Norwood surgery went even further in practical terms, reporting that a low-carbohydrate diet-based approach led to remission in 20% of the practice’s entire type 2 diabetes population.

That is why keto supporters push back so hard against the fad label. When blood glucose drops, medications are reduced, and some patients no longer meet criteria for diabetes, they are not describing a lifestyle tweak. They are describing a metabolic intervention with measurable clinical consequences, especially when it is done with close supervision and a clear plan for medication changes.

Hypertension is part of the story, but not the whole story

Blood pressure improvement is one of the most common real-world claims in the low-carb community, and Scher’s patients are part of that narrative. The appeal is straightforward: if insulin levels fall, water retention can fall too, and some people see their blood pressure come down as they lose weight and normalize glucose. That makes hypertension one of the first places keto gets praised by people who have actually run it on themselves or their patients.

But this is where the evidence is less clean than the enthusiasm. The American Heart Association says cardiovascular health is best addressed through the overall dietary pattern, and its 2021 scientific statement emphasizes food-based guidance rather than a single macronutrient fix. Harvard Health has also warned, citing a 2024 review, that keto does not meet standards for a healthy diet and may not be safe for some people with heart disease.

That tension is exactly why the keto debate still feels unresolved. A diet can lower blood pressure in one patient and still raise legitimate concerns about lipids, adherence, or cardiovascular risk in another. For people in the keto world, the lesson is not to ignore those concerns, but to treat them as reasons for better monitoring, not as proof that the whole approach is worthless.

Depression is the newest frontier, and the evidence is promising but young

The depression claim is the one that grabs attention, and it is also the one that demands the most caution. A 2024 review in Current Nutrition Reports concluded that ketogenic diets show promise for mood disorders, which is a meaningful signal but not the same thing as a settled treatment standard. The field that sits behind that idea is increasingly called metabolic psychiatry, and it is trying to understand whether changing brain fuel availability can affect symptoms in people who have not responded to standard care.

The most important clinical data so far came from a 2025 randomized trial in treatment-resistant depression. It included 88 UK participants and found greater improvement in depression symptoms in the ketogenic-diet group than in the control group at six weeks. That is not a mass-market answer, and it does not mean keto is a replacement for psychiatric care, but it is enough to take the question seriously.

The research pipeline is active too. The DIME study at Oxford Health Biomedical Research Centre, part of the University of Oxford ecosystem in Oxford, England, was launched to test whether a ketogenic diet helps people with treatment-resistant depression. With Baszucki Group support tied to this work, the larger message is clear: keto is no longer being studied only as a weight-loss strategy. It is being tested as a possible intervention in brain health.

Why mainstream guidance still pushes back

The reason this story remains contentious is simple: major institutions are still cautious, and with good reason. The American Diabetes Association updates its Standards of Care every year so clinicians have the latest recommendations for diabetes treatment, but that is not the same as endorsing keto as the default approach for everyone. NICE’s type 2 diabetes guideline, last reviewed on February 18, 2026, goes further by warning that adults with type 2 diabetes who take an SGLT-2 inhibitor and follow a very low carbohydrate or ketogenic diet have an increased risk of diabetic ketoacidosis.

That warning is not a footnote. It is the kind of detail that separates an internet diet from a medical intervention. If you are on glucose-lowering medication, especially an SGLT-2 inhibitor, keto can create risks that need active management, not guesswork.

So the real divide is not whether keto can do anything. It is whether it should be treated as a serious, supervised metabolic therapy for selected patients, or as a broad public-health diet recommendation. The evidence says the first case is getting stronger, especially for type 2 diabetes remission and possibly treatment-resistant depression, while the second case remains too blunt for the people who do best on carefully formulated low-carb plans.

The practical takeaway for keto followers

A serious keto plan is not just “eat bacon and skip bread.” The evidence points toward a structured, well-formulated ketogenic diet, attention to medications, and follow-up on blood pressure, glucose, and mood symptoms. That matters because the same diet that helps one patient come off diabetes drugs can be the wrong choice for someone with certain heart conditions or on the wrong medication mix.

The honest read is this: Scher’s claims are more than hype, but they are not universal. Type 2 diabetes has the deepest support, hypertension sits in the middle with plenty of real-world improvement but ongoing cardiovascular debate, and depression is the newest, most intriguing frontier. Keto keeps moving from fad culture toward metabolic medicine, and that shift is happening because the data, while still evolving, is starting to look too real to dismiss.