Going keto changes more than the number on the scale. Some of those changes are excellent. Insulin drops, triglycerides and blood pressure often improve. So can liver fat in people with prediabetes. But that's not the same as “keto is the one true diet.” Let's take a closer look at the results of a new clinical trial. The study put people with prediabetes and fatty liver on keto, Mediterranean or low-fat plant-based food. All three produced about 10% weight loss and similar improvements in cholesterol, ApoB and blood pressure. Keto’s extra edge was less liver-fat production and better prediabetes numbers. The tradeoffs are real: keto flu, gut changes, gout flares in some people and LDL/ApoB spikes in others. Weight loss does a lot of the work. The best diet is the whole-food pattern you can actually keep.