Ketogenic Diet

Fact or Fad?
Truth or Trend?

Jennifer Jalbert

Nutrition 450

Dr. George

12/6/2020
 What is the ketogenic diet?
• Origin: Russell Wilder originally introduced the diet to treat
epilepsy in 1921(Masood, Annamaraju, & Uppaluri, 2020)
• 4 Types commonly used in medical nutrition therapy (MNT) are:
- classic, medium chain-triglyceride diet (MCT), modified
Atkins diet (MAD), and low glycemic index treatment (LGIT)
(Nelms & Sucher, 2020)
• Very low carbohydrate consumption, along with moderate protein,
and high fat
• Macronutrient breakdown: 35% protein, 10% carbohydrate, 55-
60% fat (Masood, Annamaraju, & Uppaluri, 2020)

Nelms, M., & Sucher, K. P. (2020). Nutrition Therapy and Pathophysiology (4th ed.). Boston, MA: Cengage Learning.
Masood, W., Annamaraju, P., & Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved December 10, 2020, from
https://www.ncbi.nlm.nih.gov/books/NBK499830/
 Rise in Popularity
• Known to give results of rapid weight loss
• Many diets stress low fat intake, the idea of a diet that
allows fat is appealing
• Widespread through social media and best-selling
books adds to the appeal
• Reported improvements in behavior, cognitive
function, and increased satisfaction with body image
(Blanco, Khatri, Kifayat, Cho, & Aronow, 2019)

Blanco, J., Khatri, A., Kifayat, A., Cho, R., & Aronow, W. (2019, November 22). Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting - A Possibly Dangerous Diet Trend.
Retrieved December 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883983/

Clarke, C., & Best, T. (2017). Low-carbohydrate, high-fat dieters: Characteristic food choice motivations, health perceptions and behaviours. Food Quality and Preference, 62, 162-171.
doi:10.1016/j.foodqual.2017.07.006
 How does it work?
• Glucose is the preferred fuel source by our body
tissues (Masood, Annamaraju, & Uppaluri, 2020
• glucose is deprived
• Glycogen stores depleted
• the body uses 2 metabolic processes:
gluconeogenesis or ketogenesis
• Ketone bodies replace glucose as primary source
of energy (Masood, Annamaraju, & Uppaluri,
2020 and Gropper, Smith, & Carr, 2018)
https://www.guwsmedical.info/amino-acids/ketogenesis-is-regulated-at-three-crucial-steps.html

Masood, W., Annamaraju, P., & Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved December 10, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK499830/
Gropper, S. S., Smith, J. L., & Carr, T. P. (2018). Advanced nutrition and human metabolism. Boston, MA: Cengage Learning.
 Formation of Ketone bodies (continued)
• Beta-hydroxybutyrate (BHB), acetoacetate transferred through blood to
peripheral tissues
• Oxidized through TCA cycle within the mitochondria (Gropper, Smith, &
Carr, 2018)
• Ketogenesis  low stimulation of insulin secretion, reducing fat and
glucose storage (Masood, Annamaraju, & Uppaluri, 2020)
• Ketosis will continue with committed ketogenic diet
Gropper, S. S., Smith, J. L., & Carr, T. P. (2018). Advanced nutrition and human metabolism. Boston, MA: Cengage Learning
Masood, W., Annamaraju, P., & Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved December 10, 2020, from
https://www.ncbi.nlm.nih.gov/books/NBK499830/
 Foods to Eat/ Foods to
Avoid
• Eat:
- Fats/Oils such as olive oil and butter
- Meat and fish
- Dairy
- Vegetables, especially leafy greens
• Avoid:
- All grains
- Starchy vegetables
- Limit nut consumption
- Limit fruit
- Empty calorie food choices
 Dietary Research
• Study by Retterstøl, Svendsen, Narverud, & Holven evaluated the effect of a 20g
Carbohydrate/day diet on LDL-Cholesterol (LDL-C) in young, healthy adults
• Randomized control trial: 3-week LCHF diet, control- habitual diet
• 30 completed study (9 did not)
• Subjects of LCHF diet had increased plasma LDL-C (Retterstøl, Svendsen, Narverud, &
Holden, 2018)
• Control group LDL-C remained unchanged
• Increase in HDL-cholesterol, Apo-B, total cholesterol, free fatty acids, and urea in LCHF
group (Retterstøl, Svendsen, Narverud, & Holden, 2018)

Retterstøl, K., Svendsen, M., Narverud, I., & Holven, K. (2018, October 17). Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in normal-weight, young
adults: A randomized controlled study. Retrieved December 14, 2020, from https://www.sciencedirect.com/science/article/abs/pii/S0021915018314321
 Dietary Research (Continued)
• 12-week randomized control trial and overweight defense force personnel
- significant weight loss and decreased waist circumference
- Increased HDL cholesterol
- promising for short-term weight loss (Zinn et al., 2017)
• 22-week diet in mice showed signs of:
- dyslipidemia, inflammation, decrease in beta and alpha cell mass ( Ellenbroek et al.,
2014)
- time when considering lifespan of rodents versus humans is of importance here

Zinn, C., Mcphee, J., Harris, N., Williden, M., Prendergast, K., & Schofield, G. (2017). A 12-week low-carbohydrate, high-fat diet improves metabolic health outcomes over a control diet in a
randomised controlled trial with overweight defence force personnel. Applied Physiology, Nutrition, and Metabolism, 42(11), 1158-1164. doi:10.1139/apnm-2017-0260
Ellenbroek, J. H., Van Dijck, L., Töns, H. A., Rabelink, T. J., Carlotti, F., Ballieux, B. E., & De Koning, E. J. (2014, January 7). Long-term ketogenic diet causes glucose intolerance and reduced β-
and α-cell mass but no weight loss in mice. Retrieved December 14, 2020, from https://pubmed.ncbi.nlm.nih.gov/24398402/
 Dietary Success
• Short- term weight loss studies show that the ketogenic diet is successful
• The Health Belief Model explains that in order to be successful with a diet/ lifestyle change, you need to
change behaviors surrounding food (Clarke & Best,2017)
• In a 48-week trial of 105 men and women, whose BMI was greater than 30
- subjects chose low carb, high-fat diet (LCHF) or low-fat/low calorie diet
- found correlation between food preferences and diet chosen
- their motivations for participating -improving health and weight loss
- subject food preferences played a major role in whether a subject adhered to the diet (Clarke &
Best,2017)

Clarke, C., & Best, T. (2017). Low-carbohydrate, high-fat dieters: Characteristic food choice motivations, health perceptions and behaviours. Food Quality
and Preference, 62, 162-171. doi:10.1016/j.foodqual.2017.07.006
 • Hard for people to adhere to diet long-term
• Common with most fad diets (Masood,
Annamaraju, & Uppaluri, 2020)
Compliance • Non-ketogenic diet limiting carbohydrate
intake to 100-150g/ day more reasonable
(Masood, Annamaraju, & Uppaluri, 2020)

Masood, W., Annamaraju, P., & Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved
December 10, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK499830/
 Should everyone partake in this diet?
• Type 2 Diabetes mellitus patients should consult a doctor before starting a ketogenic diet (Blanco,
Khatri, Kifayat, Cho, & Aronow, 2019)
• Individuals with other comorbidities should potentially avoid
• Contraindicated with people who have:
- pancreatitis
- fat metabolism disorders
- liver failure (Masood, Annamaraju, Uppaluri, 202 , and Blanco, Khatri, Kifayat, Cho, &
Aronow, 2019).

Blanco, J., Khatri, A., Kifayat, A., Cho, R., & Aronow, W. (2019, November 22). Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting - A Possibly Dangerous Diet
Trend. Retrieved December 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883983/
Masood, W., Annamaraju, P., & Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved December 10, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK499830/
 Concerns
• Possible short-term side effects
- Nausea/vomiting, fatigue, headache, insomnia, constipation
• Ketoacidosis
• Raise of LDL cholesterol
• Blood pressure
• Dyslipidemia
• Insulin Resistance/ glucose intolerance
• Micronutrient deficiencies
• Hepatic steatosis
Blanco, J., Khatri, A., Kifayat, A., Cho, R., & Aronow, W. (2019, November 22). Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting - A Possibly Dangerous Diet Trend. Retrieved
December 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883983/
Masood, W., Annamaraju, P., & Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved December 10, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK499830/
 Dangers of the Diet
• Ketoacidosis: by uncontrolled DM, starvation, or prolonged very low
carbohydrate diet (Gropper, Smith, & Carr, 2018)
• Rise of ketones in the blood to dangerous levels, which lower blood pH 
ketoacidosis
• 60 y.o. male subject hospitalized after complications with his (Blanco,
Khatri, Kifayat, Cho, & Aronow, 2019)
 • Nutritional ketosis is considered relatively
safe overall (Masood, Annamaraju, &
Uppaluri, 2020)
• Studies have found that the ketogenic diet is
safe specifically in short- term intervals
Is it safe? • There is not sufficient data on the safety of
long-term adherence to ketogenic diets
• Many subjects have report improved
cognitive function and eating behaviors
(Clarke & Best,2017)
 Key Take Away Points
• There is no one-size fits all diet
• Do what is best for your body
• Educate yourselves before starting a diet and consult with your doctor
• The ketogenic diet is safe when practiced in short intervals
• Ultimately it is the lifestyle and behavior changes that will create healthy
relationships with food to last a lifetime
 References

1. Anderson, P., Butcher, K., & Schanzenbach, D. (2019, February 28). Understanding recent trends in childhood obesity in the United States. Retrieved December
06, 2020, from https://www.sciencedirect.com/science/article/pii/S1570677X18302429

2. Blanco, J., Khatri, A., Kifayat, A., Cho, R., & Aronow, W. (2019, November 22). Starvation Ketoacidosis due to the Ketogenic Diet and Prolonged Fasting - A
Possibly Dangerous Diet Trend. Retrieved December 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883983

3. Clarke, C., & Best, T. (2017). Low-carbohydrate, high-fat dieters: Characteristic food choice motivations, health perceptions and behaviours.  Food Quality and
Preference, 62, 162- 171.doi:10.1016/j.foodqual.2017.07.006

4. Ellenbroek, J. H., Van Dijck, L., Töns, H. A., Rabelink, T. J., Carlotti, F., Ballieux, B. E., & De Koning, E. J. (2014, January 7). Long-term ketogenic diet causes
glucose intolerance and reduced β- and α-cell mass but no weight loss in mice. Retrieved December 14, 2020, from https://pubmed.ncbi.nlm.nih.gov/24398402/

5. Gropper, S. S., Smith, J. L., & Carr, T. P. (2018). Advanced nutrition and human metabolism. Boston, MA: Cengage Learning Masood, W., Annamaraju, P., &
Uppaluri, K. R. (2020, June 22). Ketogenic Diet. Retrieved December 10, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK499830/

6. Nelms, M., & Sucher, K. P. (2020). Nutrition Therapy and Pathophysiology (4th ed.). Boston, MA: Cengage Learning.

7. Retterstøl, K., Svendsen, M., Narverud, I., & Holven, K. (2018, October 17). Effect of low carbohydrate high fat diet on LDL cholesterol and gene expression in
normal-weight, young adults: A randomized controlled study. Retrieved December 14, 2020, from
https://www.sciencedirect.com/science/article/abs/pii/S0021915018314321