Low-carbohydrate diets may miss the health advantages – such as increased intake of dietary fiber – afforded by high-quality carbohydrates found in legumes and pulses, whole grains, fruits, and vegetables. A "meta-analysis, of moderate quality," included as adverse effects of the diet halitosis, headache and constipation.
Carbohydrate-restricted diets can be as effective as low-fat diets in helping achieve weight loss over the short term when overall calorie intake is reduced. An Endocrine Society scientific statement said that "when calorie intake is held constant [...] body-fat accumulation does not appear to be affected by even very pronounced changes in the amount of fat vs carbohydrate in the diet." In the long term, effective weight loss or maintenance depends on calorie restriction, not the ratio of macronutrients in a diet. The reasoning of diet advocates that carbohydrates cause undue fat accumulation by increasing blood insulin levels, and that low-carbohydrate diets have a "metabolic advantage", is not supported by clinical evidence. Further, it is not clear how low-carbohydrate dieting affects cardiovascular health, although two reviews showed that carbohydrate restriction may improve lipid markers of cardiovascular disease risk.
Carbohydrate-restricted diets are no more effective than a conventional healthy diet in preventing the onset of type 2 diabetes, but for people with type 2 diabetes, they are a viable option for losing weight or helping with glycemic control. There is limited evidence to support routine use of low-carbohydrate dieting in managing type 1 diabetes. The American Diabetes Association recommends that people with diabetes should adopt a generally healthy diet, rather than a diet focused on carbohydrate or other macronutrients.
An extreme form of low-carbohydrate diet – the ketogenic diet – is established as a medical diet for treating epilepsy. Through celebrity endorsement during the early 21st century, it became a fad diet as a means of weight loss, but with risks of undesirable side effects, such as low energy levels and increased hunger, insomnia, nausea, and gastrointestinal discomfort. The British Dietetic Association named it one of the "top 5 worst celeb diets to avoid in 2018".