Steven

A patient's blood sugar improves on carnivore. Their ApoB climbs to 180 mg/dL. The coach calls it a win. Nobody measured the ApoB. This is the keto grift in one sentence: confusing the symptom fix with the disease fix. When insulin signalling is broken, carbohydrates raise blood glucose more than they should. Reducing carbohydrates removes a proximal glucose source in a system that cannot manage it. Blood sugar improves. That improvement is real. It is also a symptom response, not disease reversal. T2 Diabetes is driven by chronic energy surplus causing fat accumulation in the liver and pancreas. That is Roy Taylor's Twin Cycle Hypothesis. The DiRECT trial confirmed it: 298 participants, caloric restriction, 46% T2D remission at 12 months. The intervention was not low-carbohydrate. It was caloric deficit. Carbohydrates were not the variable. Energy balance was. The fat in the liver and pancreas resolves with energy deficit regardless of macronutrient composition. Keto produces energy deficit partly through appetite suppression. That is the mechanism. Not carbohydrate restriction per se. The grift lives in the gap between the short-term glycaemic win and the long-term cardiovascular picture. The patient whose A1c improves while ApoB rises is not winning. They are trading one risk for a larger one that nobody is measuring. Managing carbohydrate intake in established T2 Diabetes is a legitimate glycaemic tool. Selling it as a cure while directing patients away from the interventions that address energy balance and cardiovascular risk is where the science ends and the sales pitch begins.