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A modern look at ketogenic diets - indications and health risks

Darina Naydenova Hristova

Abstract

Introduction: The ketogenic diet (KD) is characterized by extremely high fat (F) intake and high carbohydrate (CH) restriction. It is currently used uncontrollably by the population to reduce body weight or body fat.

Aim: This article is an attempt to present the biochemical basis of KD and to summarize data regarding both the indications for its use as well as its undesirable effects and contraindications. Special attention is paid to the safety profile of KD.

Materials and Methods: Articles, scientific books and publications related to low-carbohydrate diets and KD were searched in the PubMed database and Google Scholar. Articles published in the last decade were included in the review. The search was conducted with a list of keywords: ketogenic diet, safety, obesity, health, mortality.

Results: Studies of the effect of KD on obesity showed no difference in appetite control and weight loss compared to other isocaloric (but normal carbohydrate) diets. KDs have many contraindications and create health risks. A meta-analysis of cohort studies finds a link between intake of CHs and overall mortality. The lowest risk of death is observed with the consumption of CHs, providing 50-55% of daily energy intake. Mortality is highest with an intake of CHs below 30%. A relatively higher risk of death was found when CHs on the menu were replaced with animal sources of fats and protein, and lower when replaced with vegetable fats.

Conclusion: When switching to KD, it is advisable to choose foods containing mostly unsaturated fats as a priority. It is desirable to avoid sources of saturated fatty acids and, in particular, hydrogenated oils rich in trans isomers of fatty acids. A healthier alternative to the classic KD could be the replacement of CHs with vegetable fats and proteins. This eating pattern can contribute to longevity and good health.


Keywords

ketogenic diet, safety, obesity, mortality

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References

Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Bergqvist AGC, Blackford R, еt al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2018; 3(2):175–92. doi: 10.1002/epi4.12225.

Whiteley VJ, Martin‐McGill KJ, Carroll JH, Taylor H, Schoeler NE. Nice to know: impact of NICE guidelines on ketogenic diet services nationwide. J Hum Nutr Diet. 2020;33(1):98-105. doi: 10.1111/jhn.12697. Epub 2019 Aug 20.

WHO. Healthy diet fact sheet. Available from: http://www.who.int/mediacentre/factsheets/fs394/en/, Sept 14, 2015, Date accessed: August 7, 2015.

McDonald TJW, Cervenka MC. Ketogenic diets for adults with highly refractory epilepsy. Epilepsy Curr. 2017;17(6):346–50. doi:10.5698/1535-7597.17.6.346

Ordinance No. 1 of the Ministry of Health of January 22, 2018 on the physiological standards for nutrition of the population of the Republic of Bulgaria. State Gazette; 2018; issue 11. (in Bulgarian).

Fukao T, Lopaschuk GD, Mitchell GA. Pathways and control of ketone body metabolism: on the fringe of lipid biochemistry. Prostaglandins Leukot Essent Fatty Acids. 2004;70(3):243–51. doi: 10.1016/j.plefa.2003.11.001.

Veldhorst MA, Westerterp-Plantenga MS, Westerterp KR. Gluconeogenesis and energy expenditure after a high-protein, carbohydrate-free diet. Am J Clin Nutr. 2009;90(3):519–26. doi: 10.3945/ajcn.2009.27834.

Botham KM, Mayers PA. Oxidation in Fatty Acids: Ketogenesis. In: Muray RK, Bender DA, Botham KM, Kennelly PJ, Rodwell VW, Weil PA, editors. Harper’s illustrated biochemistry. 29th ed. The McGraw-Hill Companies; 2012. p. 207-16.

Freedhoff Y, Hall KD. Weight loss diet studies: we need help not hype. Lancet. 2016; 388(10047):849-51. doi: 10.1016/S0140-6736(16)31338-1.

Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013;110(7):1178-87. doi: 10.1017/S0007114513000548.

Gibson AA, Seimon RV, Lee CM, Ayre J, Franklin J, Markovic TP, et al. Do ketogenic diets really suppress appetite? A systematic review and meta‐analysis. Obes Rev. 2015;16(1):64-76. doi: 10.1111/obr.12230.

Bravata DM, Sanders L, Huang J, Krumholz HM, Olkin I, Gardner CD, et al. Efficacy and Safety of Low-Carbohydrate Diets: A Systematic Review. JAMA. 2003;289(14):1837–50. doi:10.1001/jama.289.14.1837

Freedman MR, King J, Kennedy E. Popular diets: a scientific review. Obes Res. 2001;9(1):1S–40S. doi: 10.1038/oby.2001.113.

Last AR, Wilson SA. Low-carbohydrate diets. Am Fam Physician. 2006;73(11):1942-8.

Wing RR, Vazquez JA, Ryan CM. Cognitive effects of ketogenic weight-reducing diets. Int J Obes Relat Metab Disord. 1995;19(11):811–6.

The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol. 1989; 129(4): 687-70.

Trichopoulou A, Psaltopoulou T, Orfanos P, Hsieh CC, Trichopoulos D. Low-carbohydrate-high-protein diet and long-term survival in a general population cohort. Eur J Clin Nutr. 2007; 61(5): 575-81. doi: 10.1038/sj.ejcn.1602557.

Dehghan M, Mente A, Zhang X, Swaminathan S, Li W, Mohan V, et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries from five continents (PURE): a prospective cohort study. Lancet. 2017; 390(10107):2050-62. doi: 10.1016/S0140-6736(17)32252-3.

Fung TT, van Dam RM, Hankinson SE, Stampfer M, Willett WC, Hu FB. Low-carbohydrate diets and all-cause and cause-specific mortality: two cohort studies. Ann Intern Med. 2010; 153(5): 289-98. doi: 10.7326/0003-4819-153-5-201009070-00003.

Lagiou P, Sandin S, Weiderpass E, P. Lagiou A, Mucci L, Trichopoulos D, et al. Low carbohydrate-high protein diet and mortality in a cohort of Swedish women. J Intern Med. 2007; 261(4):366-374. doi: 10.1111/j.1365-2796.2007.01774.x.

Nilsson LM, Winkvist A, Eliasson M, Jansson JH, Hallmans G, Johansson I, et al. Low-carbohydrate, high-protein score and mortality in a northern Swedish population-based cohort. Eur J Clin Nutr. 2012; 66(6):694-700. doi: 10.1038/ejcn.2012.9.

Noto H, Goto A, Tsujimoto T, Noda M. Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PLoS One. 2013; 8(1):e55030. doi: 10.1371/journal.pone.0055030.

Seidelmann SB, Claggett B, Cheng S, Henglin M, Shah A, Steffen LM, et al. Dietary carbohydrate intake and mortality: a prospective cohort study and meta-analysis. Lancet Public Health. 2018; 3(9):e419-28. doi: 10.1016/S2468-2667(18)30135-X.

Shen X, Fang A, He J, Liu Z, Guo M, Gao R, et al. Trends in dietary fat and fatty acid intakes and related food sources among Chinese adults: a longitudinal study from the China Health and Nutrition Survey (1997–2011). Public Health Nutr. 2017; 20(16):2927-36. doi: 10.1017/S1368980017001781.

Song M, Fung TT, Hu FB, Willett WC, Longo VD, Chan AT, et al. Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA Intern Med. 2016;176(10):1453-63. doi:10.1001/jamainternmed.2016.4182.

Bergqvist AGC, Schall JI, Stallings VA, Zemel BS. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J Clin Nutr. 2008; 88(6):1678– 84. doi:10.3945/ajcn.2008.26099.

Woody RC, Steele RW,Knapple WL, Pilkington NS Jr. Impaired neutrophil function in children with seizures treated with the ketogenic diet. J Pediatr. 1989;115(3):427-30. doi: 10.1016/s0022-3476(89)80847-9.

Kang HC, Chung DE, Kim DW, Kim HD. Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia. 2004;45(9):1116-23. doi: 10.1111/j.0013-9580.2004.10004.x.

Shaw GM, Yang W. Women's periconceptional lowered carbohydrate intake and NTD‐affected pregnancy risk in the era of prefortification with folic acid. Birth Defects Research. 2019; 111(5):248-53. doi: 10.1002/bdr2.1466.

Hartman AL, Vining EP. Clinical aspects of the ketogenic diet. Epilepsia. 2007; 48(1):31-42. doi: 10.1111/j.1528-1167.2007.00914.x.

Kossoff EH, Wang HS. Dietary therapies for epilepsy. Biomed J. 2013;36(1):2-8. doi: 10.4103/2319-4170.107152.

Desrosiers TA, Siega‐Riz AM, Mosley BS, Meyer RE. Low carbohydrate diets may increase risk of neural tube defects. Birth Defects Res. 2018;110(11):901-9. doi:10.1002/bdr2.1198.

Naude CE, Schoonees A, Senekal M, Young T, Garner P, Volmink J. Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk: a systematic review and meta-analysis. PLoS One. 2014; 9(7):e100652. doi: 10.1371/journal.pone.0100652.

Ermenlieva NM, Laleva KS, Tsankova GS Hristova DN, Boyadzhiev VS, Todorova TT, et al. Ketogenic diet – from the implementation in clinical practice to nowadays. J IMAB 2018;24(1): 1904-8. doi:10.5272/jimab.2018241.1904.




DOI: http://dx.doi.org/10.14748/sssp.v5i1.6425

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About The Author

Darina Naydenova Hristova
Medical University of Varna
Bulgaria

Department of Hygiene and Epidemiology, Faculty of Public Health

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