The ketogenic diet KD has gained immense popularity during the last decade, primarily because of its successful short-term effect on weight loss. In the United States, KD is utilized in a variety of patient populations for weight management, despite limited evidence regarding its efficacy and risks. This literature review provides an evaluation of data on the benefits and risks associated with the chronic use of KD, including its metabolic, endocrinological, and cardiovascular effects. Obesity is classified based on the body mass index BMI of the individual. A BMI of Obesity is associated with multiple comorbidities including type 2 diabetes, hypertension, cardiovascular disease CVD, cancer, sleep apnea, and obesity-hypoventilation syndrome OHS. The effectiveness of different types of diets based on different macronutrient restrictions has been a topic of debate for the past few years. Some researchers support restriction in carbohydrate CHO, while others endorse cutting down protein or fats [ 2 ]. This review article will focus on the ketogenic diet KD, which is defined as a low-carbohydrate diet LCD with a moderate amount of protein restriction to induce ketosis without restricting fat intake [ 3 ].
The recent article by Ludwig, although thought-provoking, is not a complete representation of the literature regarding carbohydrates and their use for weight loss 1. Notably, diets full of unrefined carbohydrates are equally as healthful, if not more, and may confer less actual and potential risks to patients 2. First, not all meta-analyses have shown that carbohydrate restriction is superior to fat restriction for the treatment of obesity: some have indeed shown the opposite 3. Furthermore, research suggests that some of the weight lost with low-carbohydrate diets is water loss or, worse, lean body mass loss 4. In some studies, lean body mass loss was actually greater in participants consuming a low-carbohydrate diet than those consuming a low-fat diet 3. Weight regain after weight loss is also a concern for those on low-carbohydrate diets. In a randomized controlled trial with prolonged follow-up, weight regain after initial weight loss at 6 y was greatest with low-carbohydrate diets 4. Next, Ludwig minimizes the concerns of the increase in LDL cholesterol seen in those consuming a ketogenic diet, a concern also shared by the National Lipid Association 4. Indeed, nearly every study examining participants on a ketogenic diet has shown an increase in LDL cholesterol, apolipoprotein-B, or both 6.
Pictures of fatty foods like bacon, cheese, and even butter in coffee. As with most topics in the spotlight, what you see may not be the whole truth. The ketogenic diet is unique from other styles of eating because of its very high fat, and very low carbohydrate intake. Ketogenesis may seem like a new concept, but it is the natural process your body reverts to when it does not have enough glucose to use as energy. Your body will begin to break down fat and create ketones as an energy source. When glucose is low, your body dips into your ketones that have been made from ketogenesis for energy. This alternative metabolic process your body switches to is known as ketosis. The rate of generating ketones slows when it is simply not needed.