Effectiveness of Ketogenic Diet for Weight Loss: A Comparative Study

This essay critically evaluates the effectiveness of ketogenic diet for weight loss in comparison to orthodox treatment. It also discusses the effect of LCKD on muscle wasting, BMI and glycemic control of the body. The essay concludes that ketogenic diet can be considered as an important medium for weight loss and is quite effective while tallied in accordance with the orthodox treatment like use of low fat diet or physical exercise.

Running head: KETOGENIC DIET
Ketogenic Diet
Name of the Student
Name of the University
Author Note

1
KETOGENIC DIET
Introduction
Over-weight or obesity is the main risk factor for type 2 diabetes mellitus, cardio-
vascular disease and some other musculoskeletal conditions. Moreover, over-weight hampers
the ability to control or manage the diseased condition (Australian Institute of Health and
Welfare, 2017). In 2014-15 28% of the Australian adults are obese and the percentage has
increased since 1995. Not only adults, children who are aged between 2 to 17 also suffer from
obesity (Australian Institute of Health and Welfare, 2017). According to the review published
by Swift, et al. (2014), physical activity (PA) and exercise training (ET) is the two of the
most effective weight loss regime. The level of weight loss depends on the rate of physical
activity. Moreover, physical activity also has numerous health benefits in association to
weight loss. However, due to hectic schedule in present day corporate life prevents people in
to entering into a regular weight loss program (Clemes, O'connell & Edwardson, 2014).
Moreover, increase in the work hours in air conditioned rooms leads to increase in the
sedentary behaviour. This lack of physical activity in association with sedentary behaviour
aggravates the risk of gaining extra weight (Clemes, O'connell & Edwardson, 2014). People,
in order to fight against obesity, take help of several diet regimes. One of the popular diet
regimes is very low carbohydrate ketogenic diet (Paoliet al., 2012). The following essay aims
to elucidate the effectiveness of this self-administered practise in comparison to the orthodox
treatment. In order to provide valid results, the essay will critically elucidate the three
published research articles based on the comparative study of LCKD and low calorie diet.
The essay will also plan to through light on the effect of LCKD on muscle wasting, BMI and
glycemic control of the body. At the end, the essay will try to provide a concluding remarks
on the efficacy of ketogenic diet on weight loss.
Very-low-carbohydrate ketogenic diet (VLCKD) Vs Low Fat diet (LFD)

2
KETOGENIC DIET
Despite the several efforts coming from the medical community, obesity continues to
be one of the major worldwide health problems. According to World Health Organisation
(2012), more than 2.8 million adults die from obesity-related diseases each year. Although
fighting against obesity is a difficult task, but rigorous lifestyle interventions can help to lose
weight. One of the main lifestyle interventions is diet. A proper diet plan helps to restrict the
total energy and fat intake and thus promoting weight loss. Very-low-carbohydrate
ketogenicdiet (VLCKD) however, differs from the orthodox dietary regimes proposed by the
doctors towards weight loss regime. According to Accursoet al. (2008), VLCKD is
associated with 50 grams of carbohydrate intake per day. This goes against the prevalent low-
carbohydrate diet that facilitates 130gram intake of carbohydrate per day. One of the
important concern regarding the use of VLCKD is its effect on the individuals as it leads to
major lifestyle change (Alhassanet al., 2008). However, according to the reports published by
Buenoet al.(2013), based on the meta-analysis of the randomised control trails, VLCKD is
effective tool against obesity and the results also showed that greater dietary carbohydrate
restrictions lead to greater rate of weight loss in comparison to LFD (orthodox diet plan). The
significance of this study lies in the fact that, it specifically selected the randomised control
trails which have used participants who are above 18 years of age with BMI greater than 27.5
Kg/m2 and are on VLCKD or VFD. Moreover, all the RCT selected by the study were re-
verified on the basis of biasness co-factor. All the traits selected were open intervention with
no blinding of the trail participants. The statistical analysis of the data from the randomised
control study revealed that individuals who are assigned to VLCK was successful in
achieving greater loss in body weight over a follow up of 12 months. These findings are
again supported by the finding of Ebbelinget al. (2012)who showed that carbohydrate-
restricted diet plan is effective in comparison to LFD in the domain of retaining individual’s
BMR. The meta-analysis further revealed that VLCKD is also suitable in reducing the

3
KETOGENIC DIET
concentration of circulating High Density Lipoprotein (HDL) along with reducing the risk of
cardio-vascular threats associated with obese persons. However, this study has certain
limitations; for example, the meta-analysis is based on aggregated data collected from RCT
instead of patient’s data. Moreover, the study only accessed the blood risk factors associated
with the diet plan and ignored the hepatic lipid infiltration and endothelial function.
Ketogenic diet and its effect on muscle
However, observance of low-calorie diet is at times associated with deliberate
dehydration along with significant wasting of muscles. According to Turocyet al. (2011), the
traditional low calorie diet are unsafe for the health backup of the individuals as it is
associated with impairment of electrolyte balance, glycogen level and lean body mass.
Moreover, the use of LCKD for weight loss, despite showing high-rate of efficacy in weight
loss regime, has raised significant controversy in terms of muscle wasting and other
metabolic profile like insulin sensitivity, glycemic control and serum-lipid values. So, Paoli
et al.(2012) designed a study to investigate the effect of VLCKD on muscle strength of
athletes, especially for those who are engaged in weight category sports. Before the initiation
of the study, each athlete was given a detailed chart of food items that are either permitted or
prohibited in a ketogenic diet. The diet consumed was mainly rich in beef, veal, poultry, eggs,
seasoned cheese and raw or cooked vegetables. Moreover, during the breaks of ketogenicdiet,
athletes were also given combinational meals which are rich in protein and fibre.
Measurements were taken both before starting the VLCKD and the procedure was repeated
after 30 days of VLCKD observance. The study finally revealed that use of VLCKD for
relatively a short span of time (one month or 30 days) lead to reduction in body weight along
with body fat with zero negative effects against strength performance of the muscles in the
high-level athletes. The reasons cited by Paoli et al.(2012) in favour of VLCKD state that
satiety of proteins lead to appetite reduction while low fat diet leads to reduction in lipid

4
KETOGENIC DIET
synthesis with increased lipolysis. Moreover, VLCKD leads to reduction in respiratory
quotient leading to increase in fat metabolism, energy utilization and high metabolic
expenditure arising out of gluconeogenesis. All these promote weight loss with negligible
muscle wasting.
Ketegenic diet and is relation with diabetes and glycemic control
Hussainet al. (2012) further proposed that LCKD in addition to decreasing overall
weight of the body and improving the glycemic balance, LCKD also help in reducing anti-
diabetic medication dosage. Hussainet al. (2012) recruited 363 overweight participants for
24-week diet intervention trials. Out of 363 participants, 102 of them were suffering from
type 2 diabetes. All these participants were advised to select either LCKD or low-calorie diet
(LCD) depending on their preference. The results indicate that ketogenic diet has better
outcome on obese patients. Ketogenic diet helped to increase the glycemic control upon the
type 2 diabetes mellitus patients. The study also found a significant decrease in the body mass
index, level of blood glucose concentration, triglycerides, cholesterol and urea. On the other
hand HDL (good cholesterol) was found to increase and these changes are more prominent in
patients with high blood glucose level than that of patient with normal blood glucose level.
The study of Hussainet al. (2012) also indicated that LCKD is also safe to use for a longer
period of time in obese diabetic patients. But under strict supervision of doctors as sudden
decrease in the blood glucose level under the action of ketogenic diet may cast adverse
impact on patient’s health who is suffering from diabetes.
Conclusion
Thus from the above discussion, it can concluded that, LCKD cast a significant
positive effect on body’s weight and waist measurements in comparison to LFD. It also helps
in the reduction of triacyglycerols and glycemic control among the patients who are suffering

5
KETOGENIC DIET
from type 2 diabetes mellitus. Thus overall, ketogenic diet can be considered as an important
medium for weighloss and is quite effective while tallied in accordance with the orthodox
treatment like use of low fat diet or physical excercise. Moreover, ketogenic diet does not
have a significant impact over the muscle strength even if the person performs regular
physical exercise. Moreover, VLCKD is very useful for rapid fat loss among the athletes wh
compete in sport on the basis of weight class. VLCKD has no effect on the strength
performance of an individual. So overall it can be summarised that ketogenic diet can turn out
be effective in weight loss regime. However further detailed study is required to be
undertaken in order to determine standard adjustment of the diet in order to avoid possible
complications associated with hypoglycaemia and dehydration. So a person who is under
LCKD need to consult with a doctor in order to properly regulates the intake of carbohydrate.
Moreover, if the person is suffering from type 2 diabetes and is taking ketogenic diet for the
weight loss then, it must also be done under the strict supervision as ketogenic diet can lead
to sudden drop in the blood glucose level.

6
KETOGENIC DIET
References
Accurso, A., Bernstein, R. K., Dahlqvist, A., Draznin, B., Feinman, R. D., Fine, E.
J., ...&Manninen, A. H. (2008). Dietary carbohydrate restriction in type 2 diabetes
mellitus and metabolic syndrome: time for a critical appraisal. Nutrition &
metabolism, 5(1), 9.
Alhassan, S., Kim, S., Bersamin, A., King, A. C., & Gardner, C. D. (2008). Dietary
adherence and weight loss success among overweight women: results from the A TO
Z weight loss study. International Journal of Obesity, 32(6), 985.
Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-
carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis
of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187.
Clemes, S. A., O'connell, S. E., & Edwardson, C. L. (2014). Office workers' objectively
measured sedentary behavior and physical activity during and outside working hours.
Journal of occupational and environmental medicine, 56(3), 298-303.
Ebbeling, C. B., Swain, J. F., Feldman, H. A., Wong, W. W., Hachey, D. L., Garcia-Lago, E.,
& Ludwig, D. S. (2012). Effects of dietary composition on energy expenditure during
weight-loss maintenance. Jama, 307(24), 2627-2634.
Hussain, T. A., Mathew, T. C., Dashti, A. A., Asfar, S., Al-Zaid, N., & Dashti, H. M.
(2012).Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2
diabetes. Nutrition, 28(10), 1016-1021.
Overweight & obesity. (2017). Australian Institute of Health and Welfare. Retrieved 8
February 2018, from https://www.aihw.gov.au/reports-statistics/behaviours-risk-
factors/overweight-obesity/overview

7
KETOGENIC DIET
Paoli, A., Grimaldi, K., D’Agostino, D., Cenci, L., Moro, T., Bianco, A., & Palma, A.
(2012).Ketogenic diet does not affect strength performance in elite artistic
gymnasts. Journal of the International Society of Sports Nutrition, 9(1), 34.
Swift, D.L., Johannsen, N.M., Lavie, C.J., Earnest, C.P. and Church, T.S., 2014. The role of
exercise and physical activity in weight loss and maintenance. Progress in
cardiovascular diseases, 56(4), pp.441-447.
Turocy, P. S., DePalma, B. F., Horswill, C. A., Laquale, K. M., Martin, T. J., Perry, A. C., ...
& Utter, A. C. (2011). National athletic trainers' association position statement: safe
weight loss and maintenance practices in sport and exercise. Journal of athletic
training, 46(3), 322-336.
World Health Organization (2012) Obesity and overweight.
http://www.who.int/mediacentre/factsheets/fs311/en/ (accessed 10 May 2012).

8
KETOGENIC DIET
Appendix
Critical Appraisal of Articles
Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-
low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-
analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187.
Yes No Unclear Not
applicable
1. Is the review question clearly and explicitly stated? □ □ □ □
2. Were the inclusion criteria appropriate for the review
question? □ □ □ □
3. Was the search strategy appropriate? □ □ □ □
4. Were the sources and resources used to search for
studies adequate? □ □ □ □
5. Were the criteria for appraising studies appropriate? □ □ □ □
6. Was critical appraisal conducted by two or more
reviewers independently? □ □ □ □
7. Were there methods to minimize errors in data
extraction? □ □ □ □
8. Were the methods used to combine studies appropriate? □ □ □ □
9. Was the likelihood of publication bias assessed? □ □ □ □
10. Were recommendations for policy and/or practice
supported by the reported data? □ □ □ □
11. Were the specific directives for new research
appropriate? □ □ □ □

9
KETOGENIC DIET
5. The criteria chosen for the critical analysis of the research papers is unclear because the
study does do not discuss if it has used any critical analysis tool for the reviewing the selected
RCT.
Overall appraisal: Include□ Exclude □ Seek further info □
The reason behind inclusion is the study has satisfied all the traits of systemic review.

10
KETOGENIC DIET
Paoli, A., Grimaldi, K., D’Agostino, D., Cenci, L., Moro, T., Bianco, A., & Palma, A.
(2012).Ketogenic diet does not affect strength performance in elite artistic
gymnasts. Journal of the International Society of Sports Nutrition, 9(1), 34.
Yes No Unclear
Not
applicab
le
1. Were the groups comparable other than
the presence of disease in cases or the
absence of disease in controls?
□ □ □ □
2. Were cases and controls matched
appropriately? □ □ □ □
3. Were the same criteria used for
identification of cases and controls? □ □ □ □
4. Was exposure measured in a standard,
valid and reliable way? □ □ □ □
5. Was exposure measured in the same way
for cases and controls? □ □ □ □
6. Were confounding factors identified? □ □ □ □
7. Were strategies to deal with confounding
factors stated? □ □ □ □
8. Were outcomes assessed in a standard,
valid and reliable way for cases and
controls?
□ □ □ □
9. Was the exposure period of interest long
enough to be meaningful? □ □ □ □
10. Was appropriate statistical analysis
used? □ □ □ □
9. The time span used for the study was very short that is 1 month or 30days and this may
impose bias results.
Overall appraisal: Include □ Exclude □ Seek further info □
Comments (Including reason for exclusion)

11
KETOGENIC DIET
Because the paper was successful is satisfying majority of the criteria of the critical appraisal
tool.

12
KETOGENIC DIET
Hussain, T. A., Mathew, T. C., Dashti, A. A., Asfar, S., Al-Zaid, N., &Dashti, H. M.
(2012).Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2
diabetes. Nutrition, 28(10), 1016-1021.
Yes No Unclear
Not
applicab
le
1. Were the groups comparable other than
the presence of disease in cases or the
absence of disease in controls?
□ □ □ □
2. Were cases and controls matched
appropriately? □ □ □ □
3. Were the same criteria used for
identification of cases and controls? □ □ □ □
4. Was exposure measured in a standard,
valid and reliable way? □ □ □ □
5. Was exposure measured in the same way
for cases and controls? □ □ □ □
6. Were confounding factors identified? □ □ □ □
7. Were strategies to deal with confounding
factors stated? □ □ □ □
8. Were outcomes assessed in a standard,
valid and reliable way for cases and
controls?
□ □ □ □
9. Was the exposure period of interest long
enough to be meaningful? □ □ □ □
10. Was appropriate statistical analysis
used? □ □ □ □
4. This is because, the participants returned after every other week for 24 month and hence
the diet plan of the participants while at home was not accessed.
Overall appraisal: Include □ Exclude □ Seek further info □
Comments (Including reason for exclusion)

13
KETOGENIC DIET
Because the paper was successful is satisfying majority of the criteria of the critical appraisal
tool and has negligible bias.
Source for critical appraisal tool: Joanna Briggs Institute