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For people living with T2D, intensive lifestyle management, including increased physical activity and a hypocaloric diet alongside behaviour change, is the cornerstone of diabetes management, with the ultimate aim being to induce weight reduction of at least 15 kg which correlates to improved glucoregulatory control [13, 14]. From a dietary and nutrition management perspective it is key that people living with diabetes are supported to make healthier food choices using an individualised approach, appreciating that no one size fits all. Importantly, patients should be informed that VLCDs/KDs may worsen LDL-C levels and cardiovascular health in the long-term. For patients who report following a VLCD or KD, we recommend a clinician-patient discussion that reviews short-term risks and benefits based on the medical history and long-term health goals. Finally, in a RCT from 2008 that assigned 322 obese subjects to a LCD (vs. a low fat diet vs. a moderate fat Mediterranean) and reported a small 3 mg/dl decrease in LDL-C at 2 years, the CHO restricted dietary intervention was not a true VLCD/KD as CHO intake was 40% of calories by the end of the study, and subjects also received dietitian-led counseling to restrict SFA intake, likely limiting increases in LDL-C.16 In the latest meta-regression of 84 RCTs, each 1% of energy from SFA that is replaced with CHO raises blood TGs by approximately 1 mg/dl (0.97 mg/dL, or 0.011 mmol/L).10 In those with cardiometabolic risk, effects can be significant. A mathematical relationship between ketogenic versus non-ketogenic macronutrients, called the Ketogenic Ratio (KR), identifies whether a diet is ketogenic, but is rarely used clinically.8 Medically supervised VLCDs that severely restrict calories to 3 Once in the liver, FFAs undergo mitochondrial beta-oxidation to form acetoacetyl-CoA and, eventually, the ketone body beta-hydroxybutyrate (ßHB). These diets restrict CHO intake to varying degrees, liberalize fat intake, and side-step many of the dietary recommendations above. Sustainable weight loss is best achieved through balanced nutrition, regular physical activity, and potentially, guidance from a registered dietitian or healthcare professional. However, robust scientific evidence directly linking keto ACV gummies to significant and sustained weight loss is limited. While many individuals tolerate keto ACV gummies without issue, potential side effects exist, primarily stemming from the ingredients themselves. 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