top of page
Writer's pictureDanielle Hamlin

THE KETOGENIC DIET​: A SCIENTIFIC REVIEW ON ITS EFFICACY AND SAFETY​


 

According to the US Department of Labor, the demand for personal trainers is expected to increase faster than the average for all occupations (US Department of Labor, 2018). This increasing demand for personal trainers is in large part due to the escalation of obesity, diabetes, and various chronic diseases. Chronic disease has become the leading cause of death and disability in the United States, accounting for 70% of the deaths (Clark, Lucett, & Sutton, 2014). The number one killer in America being heart disease claims an average of 635,000 lives per year (CDC, 2017). Of America’s 15 leading causes of death, 14 out of 15 can be prevented, treated, and/or even cured simply by altering one’s daily lifestyle choices (Greger, 2012). With this in mind, it is the role of a personal trainer to advocate for these healthier lifestyle choices and inform clients about potential threats to their health and well-being as it pertains to the trainer’s scope of practice.


As a personal trainer, the ketogenic diet comes up a lot in conversation. The following review of the keto diet is in regards to its efficacy and safety. In order to be a competent trainer, it is my opinion that diets which appear to be fad in nature should be thoroughly investigated before the promotion of that diet ensues. The objective of this entry is to determine whether the keto diet should or should not be actively promoted. It is also important to note that, as with any major changes in diet, one should consult with a physician or dietitian to closely monitor any biochemical variation after starting the regimen (Harvard, 2018).


WHAT IS THE KETO DIET?

Browse anything fitness and it won't be long before you hear someone talking about “keto.” It seems to be all of the rage these days. With promises of rapid weight loss, many people have taken up the diet as a means to reduce some extra poundage. But, what exactly is the keto diet and how does it work?


The Ketogenic Diet, or more commonly referred to as the keto diet, is a diet in which one consumes high amounts of fat and low amounts of carbohydrates in order to enter a state of ketosis (Gustin, n.d.; Harvard, 2018). Typically, the main source of energy for all cells in the body is glucose. The brain demands the most glucose in steady supply since it cannot store the simple sugar (Harvard, 2018). When one is in a fasting state or consuming very little carbs, the body first pulls stored glucose from the liver and temporarily breaks down muscle to release glucose. If this continues for 3-4 days and stored glucose is completely depleted, blood levels of a hormone called insulin decrease, and the body begins to use fat as its primary fuel. The liver produces ketone bodies from fat, which can be used in the absence of glucose (Harvard, 2018; Paoli, Rubini, Volek, & Grimaldi, 2013). When the ketone bodies accumulate in the blood, this is called ketosis (Harvard, 2018).


Unlike the infamous Atkins or South Beach low carb diets, the keto diet is not particularly high in protein. The protein requirement for the ketogenic diet is right in line with the Recommended Daily Allowance and the Acceptable Macronutrient Distribution Range, which is approximately 10% to 35% of one's total calories consumed (Clark et al., 2014; Harvard, 2018). Fat is the cornerstone of the keto diet (Gustin, n.d.) While there are different macro ratio expressions for the diet depending on how strict one is attempting to be, the macro ratios usually range from 70%-80% of calories from fat, 5%-10% of calories from carbohydrates, and 15% to 25% of calories from protein (Estrada, 2018; Gustin, n.d.; Harvard, 2018)


KETO EFFICACY

Weight Loss

When it comes to short-term weight loss, there is an ample amount of evidence to support the use of low carb diets (Bueno, De Melo, De Oliveira, & Da Rocha Ataide, 2013; Paoli et al., 2013). Some studies have even shown that an ad libitum (eat as much and as often as desired) low carb, high protein diet can yield a greater amount of weight loss when comparing it to other diets (Brehm, Seeley, Daniels, & D’alessio, 2003; Paoli et al., 2013). While some might say that this phenomenon is due to an increase in energy expenditure, there has been no direct experimental evidence to support this intriguing hypothesis. On the contrary, a recent study reported that there were no changes in energy expenditure associated with a very low carbohydrate keto diet (Paoli, Grimaldi, Bianco, Lodi, Cenci, & Parmagnani, 2012; Paoli et al., 2013) According to researchers, the weight loss experienced can be attributed to a decrease in calorie consumption due to three agreeable factors (Astrup, Larsen, & Harper, 2004; Harvard, 2018; Johnstone, Horgan, Murison, Bremner, & Lobley, 2008; Paoli et al., 2013):

  • Protein and fat have higher satiating effects.

  • Ketone bodies have an appetite surpassing nature.

  • Appetite stimulating hormones, such as insulin, decrease.

It’s also important to note that when comparing the ketogenic diet to other low carb diets there is no significant difference in weight loss amongst the groups (Johnston, Tjonn, Swan, White, Hutchins, & Sears, 2006). Furthermore, studies that have investigated the diet in a long-term setting have found that there is either no significant difference between the ketogenic diet and conventional weight loss strategies or they have found that the keto diet falls just short in terms of weight loss and mood state (Brinkworth, Buckley, Noakes, Clifton, & Wilson, 2009; Stern, Iqbal, Seshadri, Chicano, Daily, McGrory, & Samaha, 2004; Wycherley, Brinkworth, Keogh, Noakes, Buckley, & Clifton, 2010).


Additional Keto Benefit Claims

Additional benefits proposed by the ketogenic diet include improvements in neurological conditions such as epilepsy, an increase in cognitive ability in healthy individuals, and an improved physical performance in athletes (Gustin, n.d.).


Neurological Conditions

In the case of neurological conditions such as epilepsy, Alzheimer’s, Parkinson’s, and brain trauma, the ketogenic diet is showing to perhaps be a promising treatment (Paoli et al., 2013). One contributing factor that may aid in these scenarios is the elevated levels of β-hydroxybutyrate, one of the three primary ketone bodies found during ketosis (Masino & Rho, 2012; Reger, Henderson, Hale, Cholerton, Baker, Watson, & Craft, 2004; Ross, Swaiman, Torres, & Hansen, 1985). This particular ketone body has been shown to protect the neurons in those who suffer from Alzheimer’s and Parkinson’s disease (Kashiwaya, Takeshima, Mori, Nakashima, Clarke, and Veech, 2000; Rho & Stafstrom, 2012). Although encouraging data has been collected, “at the present time the real clinical benefits of ketogenic diets in most neurological diseases remain largely speculative and uncertain, with the significant exception of its use in the treatment of convulsion diseases” (Paoli et al., 2013).


Cognitive Improvement

It appears that the advantageous effects of the ketogenic diet in individuals with neurological pathologies have led many healthy humans to believe that there are cognitive benefits under normal circumstances. In reality, the research is substantially lacking (Metzelaar, 2018). The studies that do exist on the matter often show that a keto diet is not efficacious at all in regards to cognitive improvements. Delving further into the research, some studies have contrastingly shown that the ketogenic diet decreases cognitive function, with one study even going as far as to state that “a high-fat, diet is detrimental to the heart and the brain in healthy subjects” (Holloway, Cochlin, Emmanuel, Murray, Codreanu, Edwards, & Lambert, 2011; Murray, Knight, Cochlin, McAleese, Deacon, Rawlins, & Clarke, 2009; Zhang, Mckeown, Muldoon, & Tang, 2006).


Increase Physical Performance

When it comes to improved physical performance, the evidence appears to be more ubiquitous and the efficacy slightly better supported than the previous assertion. With that said, there are limits to a ketogenic diet’s effectiveness on performance. Since the ketogenic diet greatly reduces the amount of glucose, and thus glycogen, in the body, anaerobic performance is limited (Phinney, 2004; Zajac, Poprzecki, Maszczyk, Czuba, Michalczyk, & Zydek, 2014). Anaerobic performance includes activities which use anaerobic glycolysis as a means to produce energy. Most gym workouts fall into this category (Clark et al., 2014). Anaerobic activity is short-lived, usually lasting approximately 30 to 50 seconds, due to the production of lactic acid (Clark et al., 2014; ISSA 2018). On the other hand, the ketogenic diet has exhibited positive correlations in regards to endurance training. This is because endurance is largely dependent on the oxidative system. This is the system in which fat can be broken. The first step in the oxidation of fat is a process referred to as β-oxidation. During β-oxidation, triglycerides are broken down into smaller subunits called free fatty acids (FFAs). The purpose of this process is to convert FFAs into acyl-CoA molecules, which are then available to enter the Krebs cycle and ultimately lead to the production of ATP, or energy (Clark et al., 2014). Since fat is the cornerstone of the ketogenic diet, endurance activities benefit significantly due to their ability to exploit the oxidative system (Cox, Kirk, Ashmore, Willerton, Evans, Smith, & King, 2016; Gustin, n.d.; Rhyu & Cho, 2014; Zajac et al., 2014).


KETO SAFETY

When it comes to the safety of a particular diet, it is important to note that anecdotal evidence holds no merit. For every individual who has said wonders about a particular diet, there has been a counterpoint story of someone who has derailed their health because of that same diet. This can also be said about the ketogenic diet. The following is not a collection of anecdotes but rather an analysis of the scientific literature over certain adverse reactions attributed to the ketogenic diet. In order to determine the suggestibility of a diet, it is essential to explore the possible dangers of that diet as to provide one’s clients with the highest degree of service and to avoid potential complications as it pertains to the trainer’s scope of practice.


Kidney Stones

Kidney stones appeared to be a small but notable occurrence amongst studies involving the ketogenic diet. Most of the studies that recorded kidney stone occurrences were found in epileptic children (Denke, 2001; Harvard, 2018; Sampath, Kossoff, Furth, Pyzik, & Vining, 2007). This was due to the presence of hypercalciuria. Oral potassium citrate was provided as an intervention to the children and acted as a preventative measure (Sampath, 2007). Other methods of reducing the chance of kidney stones on the ketogenic diet include staying well-hydrated and magnesium (Phinney, n.d.).


Impaired Concentration, Cognition, and Mood

Ironically, the ketogenic diet’s efficacy in the realm of desirable cognitive improvements not only fails but produces a contrasting effect. Diets that are low in carbohydrates and high in fat, especially trans fat and saturated fat, adversely affect cognition (Parrott, & Greenwood, 2007). In rats, the ketogenic diet has demonstrated deleterious effects in learning and memory (Murray et al., 2009; Winocur & Greenwood, 2005). Translating these experimental methods over to humans, researchers found similar results. Cognitive tests showed impaired attention, mood, reaction time, and a deterioration of cognitive functions that require higher order mental processing and flexibility in healthy humans (Brinkworth et al., 2009; Holloway et al., 2011; Edwards, Murray, Holloway, Carter, Kemp, Codreanu, & Clarke, 2011; Wing, Vazquez, & Ryan, 1995). If improved cognition is the objective, researchers advise that a diet with less fat, saturated fat and cholesterol, and more carbohydrates, fiber, vitamins (especially folate, vitamins C and E, and beta-carotene), and minerals (iron and zinc) should be followed not only to improve general health but to also improve cognitive function (Ortega, Requejo, Andrés, López-Sobaler, Quintas, Redondo, & Rivas, 1997).


Nutrient Deficiency and Disordered Mineral Metabolism

It’s important to note that there is not a single diet that can be prescribed to eliminate the risk of nutritional deficiencies. All diets that lack a variety of foods can lead to an inadequate intake of essential vitamins and minerals. Regardless of the person or particular diet, it is advisable to receive annual screenings to thwart any deficiencies that may arise from the ingestion of routine foods. With that said, the following are nutritional deficiencies that seem to emerge the most in the ketogenic diet: thiamine (Hoyt & Billson, 1979), vitamin D and calcium (Kang et al., 2004), selenium (Bergqvist, Chee, Lutchka, Rychik, & Stallings, 2003), and vitamin C (Willmott & Bryan, 2008).


Osteopenia and Osteoporosis

Bone complications are another concern that ketogenic dieters may want to make note of. Demineralization of bones occurred in a number of studies surrounding epileptic patients (Bergqvist, Schall, Stallings, & Zemel, 2008; Freeman, Veggiotti, Lanzi, Tagliabue, & Perucca, 2006; Kang et al., 2004). One study even found that osteopenia could be found in patients after the first 4 weeks of implementing the ketogenic diet. Additional doses of calcium and vitamin D can prevent the progression of osteopenia and osteoporosis while on the ketogenic diet (Kang et al., 2004).


Disturbances in Heart Health

Being the leading cause of death in the United States, extra emphasis should be placed on reducing the number of risk factors associated with heart disease. While some may believe that dietary cholesterol and saturated fat do not elevate levels of cholesterol in the body, the fact of the matter is that this is just simply not true (Clarke, Frost, Collins, Appleby, & Peto, 1997; Sacks, Donner, Castelli, Gronemeyer, Pletka, Margolius, & Kass, 1981). The mechanisms by which high cholesterol causes and furthers the development of heart disease have been well documented (American Heart Association, 2016; CDC, 2015; National Institute of Health, 2017).


Cholesterol effects heart and artery disease by first initiating with an injury. Major contributors to arterial injury are free radicals. These unstable particles pull electrons from the lining of the artery wall and cause damage. Oxidized LDL, also known as bad cholesterol, is one of these reactive particles that is a well-established cause. In fact, the higher your LDL, the more likely it is to oxidize and cause damage (Rong, Rangaswamy, Shen, Dave, Chang, Peterson, Sevanian, 1998). In the absence of LDL the injury would heal as normal but, following this injury, white blood cells build up around the damaged area and consume passing-by cholesterol. The white blood cells that engulf the cholesterol are known as foam cells and they become grossly engorged due to little negative feedback of uptake. The overfeeding leads to a diminished capacity to migrate, which results in further progression of the disease. The final step in this lethal line up is a rupture or thrombosis. Thrombosis is the main cause of heart attack death. “Dying macrophages release their lipid content and tissue factor, leading to the formation of a pro-thrombotic necrotic core, a key component of unstable plaques that contributes to their rupture and the ensuing intravascular blood clot that underlies myocardial infarction and stroke” (Moore, Sheedy, & Fisher, 2013).


In regards to the ketogenic diet, there is no denying that it increases LDL (Bueno, 2013). Knowing the process by which heart and artery disease occurs, it would only make sense for the ketogenic diet to show an increased risk of cardiovascular disease and it does. Several studies ranging from population studies to diabetes studies to epilepsy studies to metabolic studies to weightless studies to children studies and more all show an increased risk of coronary heart disease, cardiovascular disease, and hypercholesterolemia (Coppola, Natale, Torino, Capasso, D’Aniello, Pironti, & Verrotti, 2014; Kang, Chung, Kim, D., & Kim, H.,2004; Lagiou, Sandin, Lof, Trichopoulos, Adami, & Weiderpass, 2012; Sirven, Whedon, Caplan, Liporace, Glosser, O’dwyer, & Sperling, 1999; Snell-Bergeon, Chartier-Logan, Maahs, Ogden, Hokanson, Kinney, & Rewers, 2009; Yancy, Olsen, Guyton, Bakst, & Westman, 2004).


Increase in All-Cause Mortality

Probably the most disturbing association found to be connected with the ketogenic diet is all-cause mortality. In 2013, a group of researchers aimed to identify how low-carbs diets could help a worldwide epidemic of obesity and cardiovascular disease. The team included 17 studies for a systematic review, followed by a meta-analysis using pertinent data. The studies were comprised of population sample sizes ranging from 647 to 129,716. The researchers found that low carbohydrate diets were linked to a significantly higher risk of all-cause mortality (Noto, Goto, Tsujimoto, & Noda, 2013). Furthermore, a 2014 follow up study to two different long-term studies found that greater adherence to a low carbohydrate diet high in animal sources of fat and protein was associated with higher all-cause mortality as well (Li, Flint, Pai, Forman, Hu, Willett, & Rimm, 2014). In a completely different study, researchers found that a median intake of 14% animal protein was sufficient enough to significantly increase the risk of all-cause mortality (Song, Fung, Hu, Willett, Longo, Chan, & Giovannucci,2016).


Additional Concerns (Diabetes)

The previous pathologies associated with the ketogenic diet were some of the more significant complications found. As research continues to grow a better understanding of the diet and its safety will come to light. Unfortunately, the trends in science are not looking up for this low carb, high-fat diet. Many have recommended the diet to diabetes patients thinking that the low levels of glucose will improve their circumstances. This, however, may not be much of a cure for the disease but rather a treatment for its symptoms. In August 2018, researchers found evidence that a ketogenic diet caused selective hepatic insulin resistance in mice (Grandl, Straub, Rudigier, Arnold, Wueest, Konrad, & Wolfrum, 2018). Hepatic insulin resistance is the impaired suppression of glucose production by insulin in hepatocytes that can lead to hyperglycemia (Meshkani & Adeli, 2009). This hepatic insulin resistance lead to the ketogenic diet group having notably worse signs of blood glucose control than the counterpart group who consumed a high carb, high-fat diet (Grandl, 2018). Prior to this, a team of researchers established that chronic high-fat diets can lead to the apoptosis (cell death) of β-cells in the pancreas (cells that release insulin), which can lead to hyperglycemia. The loss of β-cell mass by apoptosis contributed to the progressive β-cell failure in Type 2 Diabetes (Cunha, Igoillo-Esteve, Gurzov, Germano, Naamane, Marhfour, & Marselli, 2012).


Conclusion

As stated earlier, it is the role of a personal trainer to advocate for healthier lifestyle choices and inform clients about potential threats to their health and well-being. While the ketogenic diet may appear to be advantageous for an initial jumpstart to weight loss, it raises a considerable amount of concern for safety. Chronic disease is the leading cause of death in the nation and the ketogenic diet has only thoroughly demonstrated its ability to treat one affliction that doesn’t make it anywhere near the list of America’s 15 deadliest diseases. On the other hand, it has been positively correlated with three of our top 10 killers including heart disease, stroke, and diabetes. One who partakes in the ketogenic diet, or any other low-carb diet for that matter, should participate in health screenings regularly. Without having the resources or credentials to continuously check biomarkers for health, it would seem negligent to actively promote a diet that can lead to impaired cognition, bone complications, heart disease, all-cause mortality, diabetes, and more.





 

REFERENCES

  • American Heart Association (2016). Understand Your Risks to Prevent a Heart Attack. Retrieved from https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack

  • Astrup, A., Larsen, T. M., & Harper, A. (2004). Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss?. The Lancet, 364(9437), 897-899.

  • Bergqvist, A. C., Chee, C. M., Lutchka, L., Rychik, J., & Stallings, V. A. (2003). Selenium deficiency associated with cardiomyopathy: a complication of the ketogenic diet. Epilepsia, 44(4), 618-620.

  • Bergqvist, A. C., Schall, J. I., Stallings, V. A., & Zemel, B. S. (2008). Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. The American journal of clinical nutrition, 88(6), 1678-1684.

  • Brehm, B. J., Seeley, R. J., Daniels, S. R., & D’alessio, D. A. (2003). A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. The Journal of Clinical Endocrinology & Metabolism, 88(4), 1617-1623.

  • Brinkworth, G. D., Buckley, J. D., Noakes, M., Clifton, P. M., & Wilson, C. J. (2009). Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Archives of internal medicine, 169(20), 1873-1880.

  • Bueno, N., De Melo, I., De Oliveira, S., & 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. doi:10.1017/S0007114513000548. Retrieved from https://www.cambridge.org/core/journals/british-journal-of-nutrition/article/verylowcarbohydrate-ketogenic-diet-v-lowfat-diet-for-longterm-weight-loss-a-metaanalysis-of-randomised-controlled-trials/6FD9F975BAFF1D46F84C8BA9CE860783/core-reader

  • CDC (2015). Heart Disease Risk Factors. Retrieved from https://www.cdc.gov/heartdisease/risk_factors.htm

  • CDC (2017). Leading Causes of Death. Retrieved from https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htmEstrada, C. (2018). What is the Keto Diet? Retrieved from https://www.issaonline.edu/blog/index.cfm/2018/what-is-the-keto-diet

  • Clark, M. A., Lucett, S. C., & Sutton, B. G. (2014). NASM Essentials of Personal Fitness Training (4th ed.). Burlington, MA: Jones & Barlett Learning.

  • Clarke, R., Frost, C., Collins, R., Appleby, P., & Peto, R. (1997). Dietary lipids and blood cholesterol: quantitative meta-analysis of metabolic ward studies. Bmj, 314(7074), 112.

  • Coppola, G., Natale, F., Torino, A., Capasso, R., D’Aniello, A., Pironti, E., & Verrotti, A. (2014). The impact of the ketogenic diet on arterial morphology and endothelial function in children and young adults with epilepsy: A case–control study. Seizure, 23(4), 260-265.

  • Cox, P. J., Kirk, T., Ashmore, T., Willerton, K., Evans, R., Smith, A., & King, M. T. (2016). Nutritional ketosis alters fuel preference and thereby endurance performance in athletes. Cell metabolism, 24(2), 256-268.

  • Cunha, D. A., Igoillo-Esteve, M., Gurzov, E. N., Germano, C. M., Naamane, N., Marhfour, I., & Marselli, L. (2012). Death protein 5 and p53-upregulated modulator of apoptosis mediate the endoplasmic reticulum stress–mitochondrial dialog triggering lipotoxic rodent and human β-cell apoptosis. Diabetes, DB_120123.

  • Denke, M. A. (2001). Metabolic effects of high-protein, low-carbohydrate diets. American Journal of Cardiology, 88(1), 59-61.

  • Duchowny, M. S. (2005). Food for thought: the ketogenic diet and adverse effects in children. Epilepsy currents, 5(4), 152-154.

  • Edwards, L. M., Murray, A. J., Holloway, C. J., Carter, E. E., Kemp, G. J., Codreanu, I., & Clarke, K. (2011). Short-term consumption of a high-fat diet impairs whole-body efficiency and cognitive function in sedentary men. The FASEB Journal, 25(3), 1088-1096.

  • Freeman, J., Veggiotti, P., Lanzi, G., Tagliabue, A., & Perucca, E. (2006). The ketogenic diet: from molecular mechanisms to clinical effects. Epilepsy Res, 68(2), 145-80.

  • Grandl, G., Straub, L., Rudigier, C., Arnold, M., Wueest, S., Konrad, D., & Wolfrum, C. (2018). Short‐term feeding of a ketogenic diet induces more severe hepatic insulin resistance than an obesogenic high‐fat diet. The Journal of physiology, 596(19), 4597-4609.

  • Greger, M. (2012). Uprooting the Leading Causes of Death. Retrieved from https://nutritionfacts.org/video/uprooting-the-leading-causes-of-death/

  • Gustin, A. (n.d.). The Ketogenic Diet: Everything You Need to Know to Start the Keto Diet. Retrieved from https://perfectketo.com/guide/the-ketogenic-diet/

  • Harvard (2018) Diet Review: Ketogenic Diet for Weight Loss. Retrieved from https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/

  • Holloway, C. J., Cochlin, L. E., Emmanuel, Y., Murray, A., Codreanu, I., Edwards, L. M., & Lambert, B. (2011). A high-fat diet impairs cardiac high-energy phosphate metabolism and cognitive function in healthy human subjects–. The American journal of clinical nutrition, 93(4), 748-755.

  • Hoyt, C. S., & Billson, F. A. (1979). Optic neuropathy in ketogenic diet. British Journal of Ophthalmology, 63(3), 191-194.

  • ISSA (2018). Aerobic vs. Anaerobic: How Do Workouts Change the Body? Retrieved from https://www.issaonline.edu/blog/index.cfm/2018/aerobic-vs-anaerobic-how-do-workouts-change-the-body

  • Johnston, C. S., Tjonn, S. L., Swan, P. D., White, A., Hutchins, H., & Sears, B. (2006). Ketogenic low-carbohydrate diets have no metabolic advantage over nonketogenic low-carbohydrate diets–. The American journal of clinical nutrition, 83(5), 1055-1061.

  • Johnstone, A. M., Horgan, G. W., Murison, S. D., Bremner, D. M., & Lobley, G. E. (2008). Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum–. The American journal of clinical nutrition, 87(1), 44-55.

  • Kang, H. C., Chung, D. E., Kim, D. W., & Kim, H. D. (2004). Early‐and late‐onset complications of the ketogenic diet for intractable epilepsy. Epilepsia, 45(9), 1116-1123.

  • Kashiwaya, Y., Takeshima, T., Mori, N., Nakashima, K., Clarke, K., and Veech, R. L. (2000). D-beta-hydroxybutyrate protects neurons in models of Alzheimer’s and Parkinson’s disease. Proc. Natl. Acad. Sci. U.S.A. 97, 5440–5444.

  • Lagiou, P., Sandin, S., Lof, M., Trichopoulos, D., Adami, H. O., & Weiderpass, E. (2012). Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study. Bmj, 344, e4026.

  • Li, S., Flint, A., Pai, J. K., Forman, J. P., Hu, F. B., Willett, W. C., & Rimm, E. B. (2014). Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors. Journal of the American Heart Association, 3(5), e001169.

  • Masino, S. A., & Rho, J. M. (2012). Mechanisms of ketogenic diet action. Retrieved from http://pages.ucsd.edu/~mboyle/COGS163/pdf-files/W8-Mechanisms%20of%20Ketogenic%20Diet%20Action-masino-rho.pdf

  • Meshkani, R., & Adeli, K. (2009). Hepatic insulin resistance, metabolic syndrome and cardiovascular disease. Clinical biochemistry, 42(13-14), 1331-1346.

  • Metzelaar, K. (2018). DOES THE KETO DIET REALLY GIVE YOU A MENTAL EDGE? Retrieved from https://wellseek.co/2018/08/13/keto-diet-mental-edge/

  • Moore, K. J., Sheedy, F. J., & Fisher, E. A. (2013). Macrophages in atherosclerosis: a dynamic balance. Nature Reviews Immunology, 13(10), 709.

  • Murray, A. J., Knight, N. S., Cole, M. A., Cochlin, L. E., Carter, E., Tchabanenko, K., & Deacon, R. M. (2016). Novel ketone diet enhances physical and cognitive performance. The FASEB Journal, 30(12), 4021-4032.

  • Murray, A. J., Knight, N. S., Cochlin, L. E., McAleese, S., Deacon, R. M., Rawlins, J. N. P., & Clarke, K. (2009). Deterioration of physical performance and cognitive function in rats with short-term high-fat feeding. The FASEB Journal, 23(12), 4353-4360.

  • National Institute of Health (2008). Do You Know Your Cholesterol Levels? Retrieved from https://www.nhlbi.nih.gov/files/docs/public/heart/cholesterol-chol.pdf

  • National Institute of Health (2017). What Are the Risk Factors for Heart Disease?, HHS, NIH, NHLBI. Retrieved from https://www.nhlbi.nih.gov/health/educational/hearttruth/lower-risk/risk-factors.htm

  • Noto, H., Goto, A., Tsujimoto, T., & Noda, M. (2013). Low-carbohydrate diets and all-cause mortality: a systematic review and meta-analysis of observational studies. PloS one, 8(1), e55030.

  • Ortega, R. M., Requejo, A. M., Andrés, P., López-Sobaler, A. M., Quintas, M. E., Redondo, M. R., & Rivas, T. (1997). Dietary intake and cognitive function in a group of elderly people. The American journal of clinical nutrition, 66(4), 803-809.

  • Paoli, A., Grimaldi, K., Bianco, A., Lodi, A., Cenci, L., & Parmagnani, A. (2012). Medium term effects of a ketogenic diet and a Mediterranean diet on resting energy expenditure and respiratory ratio. In BMC Proceedings (Vol. 6, No. 3, p. P37). BioMed Central.

  • Paoli, A., Rubini, A., Volek, J.S., & Grimaldi, K.A. (2013) Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Retrieved from https://www.nature.com/articles/ejcn2013116

  • Parrott, M. D., & Greenwood, C. E. (2007). Dietary influences on cognitive function with aging. Annals of the New York Academy of Sciences, 1114(1), 389-397.

  • Phinney, S. (2004). Ketogenic diets and physical performance. Nutrition & metabolism, 1(1), 2.

  • Phinney, S. (n.d.) How does a ketogenic diet affect kidney stones? Retrieved from https://blog.virtahealth.com/ketogenic-diet-kidney-stones/

  • Reger, M. A., Henderson, S. T., Hale, C., Cholerton, B., Baker, L. D., Watson, G. S., & Craft, S. (2004). Effects of β-hydroxybutyrate on cognition in memory-impaired adults. Neurobiology of aging, 25(3), 311-314.

  • Rho, J. M., & Stafstrom, C. E. (2012). The ketogenic diet as a treatment paradigm for diverse neurological disorders. Frontiers in pharmacology, 3, 59.

  • Rhyu, H. S., & Cho, S. Y. (2014). The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. Journal of exercise rehabilitation, 10(5), 326.

  • Rong, J. X., Rangaswamy, S., Shen, L., Dave, R., Chang, Y. H., Peterson, H., Sevanian, A. (1998). Arterial Injury by Cholesterol Oxidation Products Causes Endothelial Dysfunction and Arterial Wall Cholesterol Accumulation. Arteriosclerosis, Thrombosis, and Vascular Biology, 18(12), 1885-1894. doi:10.1161/01.atv.18.12.1885

  • Ross, D. L., Swaiman, K. F., Torres, F., & Hansen, J. (1985). Early biochemical and EEG correlates of the ketogenic diet in children with atypical absence epilepsy. Pediatric neurology, 1(2), 104-108.

  • Sacks, F. M., Donner, A., Castelli, W. P., Gronemeyer, J., Pletka, P., Margolius, H. S., & Kass, E. H. (1981). Effect of ingestion of meat on plasma cholesterol of vegetarians. Jama, 246(6), 640-644.

  • Sampath, A., Kossoff, E. H., Furth, S. L., Pyzik, P. L., & Vining, E. P. (2007). Kidney stones and the ketogenic diet: risk factors and prevention. Journal of child neurology, 22(4), 375-378.

  • Sirven, J., Whedon, B., Caplan, D., Liporace, J., Glosser, D., O'dwyer, J., & Sperling, M. R. (1999). The ketogenic diet for intractable epilepsy in adults: preliminary results. Epilepsia, 40(12), 1721-1726.

  • Snell-Bergeon, J. K., Chartier-Logan, C., Maahs, D. M., Ogden, L. G., Hokanson, J. E., Kinney, G. L., & Rewers, M. (2009). Adults with type 1 diabetes eat a high-fat atherogenic diet that is associated with coronary artery calcium. Diabetologia, 52(5), 801-809.

  • Song, M., Fung, T. T., Hu, F. B., Willett, W. C., Longo, V. D., Chan, A. T., & Giovannucci, E. L. (2016). Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA internal medicine, 176(10), 1453-1463.

  • Stern, L., Iqbal, N., Seshadri, P., Chicano, K. L., Daily, D. A., McGrory, J., & Samaha, F. F. (2004). The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Annals of internal medicine, 140(10), 778-785.

  • US Department of Labor (2018). Fitness Trainers and Instructors Summary. Retrieved from https://www.bls.gov/ooh/personal-care-and-service/fitness-trainers-and-instructors.htm

  • Willmott, N. S., & Bryan, R. A. E. (2008). Scurvy in child with epilepsy on a ketogenic diet with oral complications. European Archives of Paediatric Dentistry, 9(3), 148-152.

  • Winocur, G., & Greenwood, C. E. (2005). Studies of the effects of high fat diets on cognitive function in a rat model. Neurobiology of aging, 26(1), 46-49.

  • Wing, R. R., Vazquez, J. A., & Ryan, C. M. (1995). Cognitive effects of ketogenic weight-reducing diets. International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity, 19(11), 811-816.

  • Wycherley, T. P., Brinkworth, G. D., Keogh, J. B., Noakes, M., Buckley, J. D., & Clifton, P. M. (2010). Long‐term effects of weight loss with a very low carbohydrate and low fat diet on vascular function in overweight and obese patients. Journal of internal medicine, 267(5), 452-461.

  • Yancy, W. S., Olsen, M. K., Guyton, J. R., Bakst, R. P., & Westman, E. C. (2004). A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Annals of internal medicine, 140(10), 769-777.

  • Zajac, A., Poprzecki, S., Maszczyk, A., Czuba, M., Michalczyk, M., & Zydek, G. (2014). The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients, 6(7), 2493-2508.

  • Zhang, J., Mckeown, R. E., Muldoon, M. F., & Tang, S. (2006). Cognitive performance is associated with macronutrient intake in healthy young and middle-aged adults. Nutritional neuroscience, 9(3-4), 179-187.

214 views2 comments

2 comentários


Danielle Hamlin
Danielle Hamlin
08 de jan. de 2019

Thank you! I'm glad you enjoyed it and were able to take away something from it ☺️🙌

Curtir

Susan Hamlin
Susan Hamlin
08 de jan. de 2019

Really well done on this article Danielle. I see a non-partial opinion based on facts and evidence! Very interesting and I learned some new information.

Curtir
bottom of page