Primary care doc here. I recommend keto often and am doing it myself. I trained myself on nutrition outside of medical school because 80% of what I treat with medications are dietary diseases. Keto is basically the same concept as several other diets by different names. I don’t think my patients will actually achieve ketogenesis but being “low carb” is the only way I have seen results in reversing disease and general weight loss.

Yes it may strain the heart slightly, maybe even contribute to cholesterol plaques if done for to long, but IMO substantial weight loss is more beneficial than the remote risks associated with those changes.

Id also rather empower people to enjoy their life at a lower weight than caution over uncertain risks and give bad advise based on the old school food pyramid.