Ketogenic Diet In Obese Patients

ABSTRACT

BACKGROUND:

Even though many researches have looked over the short-term consequences of a ketogenic diet in bringing down the weight in obese patients, its long-term outcomes on different physical and biochemical factors are unknown.

OBJECTIVE:

To find out the results of a 24-week ketogenic diet which comprised of 30 g carbohydrate, protein equivalent to 1 g/kg body weight, 20% saturated fat, and 80% polyunsaturated and monounsaturated fat) in obese patients.

PATIENTS AND METHODS:

In this research, 83 obese patients (among which 39 were men and 44 women) with a body mass index higher than 35 kg/m2, and high glucose and cholesterol levels were chosen. The body weight, body mass index, total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, triglycerides, fasting blood sugar, urea and creatinine levels were diagnosed pre and post implementation of the ketogenic diet. Differences in these parameters were observed after 8, 16 and 24 weeks of this change made in the diet.

HISTORY OF THE KETOGENIC DIET

It all began as a treatment for childhood Epilepsy in the early 1900’s in which the use of total fasting was promoted, but the researchers found that fasting is not something that can be carried out for a long period of time. Therefore, they wanted fasting to be replaced with a diet that mimics fasting in the terms of its positive effects on the body but without having to fast. They got to know through their experiments that a high fat, low carbohydrate and a small amount of protein diet could keep the ketosis up for long periods of time.

Then in 1923 a doctor called Russell Wilder coined the term ketogenic diet and his diet followed a nutritional plan consisting of 90% fats, 6% protein and 4% carbohydrates. This kind of diet enables body to utilize fats rather than burning carbohydrates for energy. Hence, the body gets into the state of ketosis in which the body keeps on burning the stored fat, which causes body to produce an especially healthy alternative fuel source called ketones.

INTRODUCTION

In today’s world, obesity has become a severe chronic health problem in both evolving and already evolved nations. Over and above that it is also linked to many different long-standing health disorders for instance diseases like diabetes, heart related problems, arthritis, blood pressure issues, cancer etc. It has been seen that in the United States alone round about 300,000 persons pass away due to obesity-related diseases every year. A great deal of approaches for decreasing weight using lowered calorie and fat consumption put together with exercise have turned out to be unsuccessful to show continued long lasting positive outcomes. Current researches from multiple laboratories have proved that a diet consisting of high quantities of polyunsaturated fatty acids (i.e. ketogenic diet) is pretty much helpful in bringing down the body weight and the risk factors for different chronic diseases. The fat to carbohydrate ratio in this diet is 5:1. While there was a considerable decrease in the weight of obese patients who followed the ketogenic diet, the opposite happened when they switched their diet to one high in carbohydrates.

It must be referred to that the idea that fats may be eaten ad libitum and nevertheless result in weight loss in overweight people isn't a current one. Ketosis happens as an outcome of the variation within the body’s fuel from carbohydrate to fats. Partial oxidation of fatty acids by the liver results in the building up of ketone bodies within the body. A ketogenic eating regimen keeps the body in a state of ketosis, that is characterised by a boost in D-b-hydroxybutyrate and acetoacetate.

Slight ketosis is an innate phenomenon that takes place in human beings throughout fasting and lactation. Postexercise ketosis is a familiar phenomenon in mammals. Despite the fact that maximum of the modifications in the physiological parameters precipitated following exercise return to their ordinary values quickly, the degree of flowing ketone bodies goes up for a couple of hours after muscular movement comes to a halt. It's been discovered that in trained individuals, a low blood ketone level saves from the occurence of hypoglycemia throughout extended intermittent exercise. Moreover, ketosis has a tremendous effect on putting down hunger. Therefore, a ketogenic diet is an outstanding governor of the body’s calorie uptake and imitates the impact of fasting or starvation inside the body.

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It is typically thought that high fat diets may give rise to the formation of weight problems and numerous different diseases for instance cancer, coronary artery disorder and diabetes. This outlook, however, is derived from the studies performed on animals that were made to eat a high fat diet abundant in polyunsaturated fatty acids. In contrast, the latest studies have shown that a ketogenic diet reduced the risk factors for heart disease in obese patients.

Even though many short-term researches analysing the outcome of a ketogenic diet in decreasing the weight of overweight patients have been performed, its long-term consequences in obese subjects are unknown. Hence, this study was conducted to find out the long-term consequences of a ketogenic diet on obesity and obesity-related risk factors in a huge population of obese patients.

PATIENTS AND METHODS

PATIENTS AND BIOCHEMICAL ANAYSIS

The expected study was performed at the Academic Department of Surgery, Consultation and Training Centre, Faculty of Medicine, Kuwait University (Jabriya, Kuwait) in 83 obese subjects (39 men and 44 women). The body mass index (BMI) of males and females was 35.9±1.2 kg/m2 and 39.4±1.0 kg/m2, respectively. The average age was 42.6±1.7 years and 40.6±1.6 years for males and females, respectively. The average age, initial height, weight and BMI for all patients are given in table 1. Fasting blood tests were done for all the patients. First of all, all sufferers were made to go through liver and renal function assessments, and glucose and lipid profiles, using fasting blood samples, and a complete blood count. Subsequently, fasting blood samples were examined for total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triglycerides, blood sugar, urea and creatinine levels at the 8th, 16th and 24th week. On the top of that weight and height measurements, and blood pressure were also checked at every visit.

All the 83 patients were provided with the ketogenic diet which included 20 g to 30 g of carbohydrate in the form of green vegetables and salad, and 80 g to 100 g of protein in the form of meat, fish, fowl, eggs, shellfish and cheese. Polyunsaturated and monounsaturated fats were also added in the diet. 12 weeks after, a further 20 g of carbohydrate were inserted in the meal plan of the subjects to make 40 g to 50 g of carbohydrate in total. Each one of the subjects took micronutrients ( vitamins and minerals ) in the form of one capsule daily (table 2).

DISCUSSION

Until lately, ketosis was seen with a terror in the medical world; but, recent evolutions in nutritional research have brushed off this terror and escalated public consciousness about its beneficial outcomes. In human beings, ketone bodies are the only auxiliary fuel for brain after glucose. Hence, using ketone bodies by the brain could be a huge evolutionary advancement that happened alongside brain development in humans. Hepatic production of ketone bodies throughout fasting is crucial to supply an alternate fuel to glucose. This is important to prevent the breakdown of muscles from glucose synthesis.

One dispute in opposition to the utilization of a high fat diet is that it leads to weight problems i.e. obesity. The foremost concern in this regard is whether an excessive percentage of dietary fats encourages increase in weight more than a low percentage of fats consumption. Due to the fact that fat has a larger caloric density than carbohydrate, it is widely held view that the intake of an excessive fat diet will be associated with a higher energy consumption. In contrast, latest researches from lots of laboratories have discovered that a ketogenic diet can be implemented as a treatment for weight loss in obese patients.

In this study, a control population on a low fat diet was not involved because of the problems in enlisting subjects for a control group. But, various studies with suitable control groups that differentiated the result of a low fat diet with a low carbohydrate ketogenic diet have lately been published. Brehm et al confirmed that overweight ladies on a low carbohydrate ketogenic diet lost 8.5 kg in six months of duration in comparison with 4.2 kg reduced by those in the low fat eating plan group. 22 subjects from the low carbohydrate ketogenic diet and 20 subjects from the low fat diet finished the study, with both groups decreasing their energy consumption by almost 450 kcal from the baseline level. In a different experiment executed on 132 drastically obese subjects for six months, there was more weight reduction in the low carbohydrate ketogenic diet group than in the low fat diet group (5.8 kg versus 1.9 kg). Therefore, until now it has been proven many times that low carbohydrate ketogenic diet is superior than the low fat diet when it comes to body fat reduction in obese patients as well as in general.

CONCLUSION

The information given out in this study confirmed that a ketogenic diet served as a natural treatment for weight loss in obese people. This is a distinctive study observing the impact of a ketogenic diet for 24 weeks. There was a considerable reduction in the level of triglycerides, general cholesterol, LDL cholesterol and glucose, and a large boom in the level of HDL cholesterol in the subjects. The consequences of drugs typically used for the lowering of body weight in these type of patients were not seen in the patients that were on the ketogenic diet. Hence, these outcomes show that the implementation of a ketogenic diet for a fairly long time is beneficial.