The ketogenic diet(keto diet) and the very low carb diet (VLCD) are widely described in books and on the web. However, the narrative is dominated by promises of miraculous weight loss, without considering the risks of do-it-yourself diets.
Therefore, let us try to elucidate the mechanisms behind these diets, which are aimed at both overweight and obese people and drug-refractory epilepsy cases in different ways. ABC to follow.
1) Keto diet, the way of acidosis.
The keto diet, or ketogenic diet, induces a metabolic state of acidosis that is not pathological but rather programmed and induced through the almost total elimination of carbohydrates.
This condition stimulates the utilization of glucose needed by the body, found in adipocytes, as glycerol. Together with fatty acids.
In practice, the body uses the fat stored in fat tissues, often in excess (1,2), to fulfill its needs.
2) Overweight and obesity, drug refractory epilepsy.
The mechanism mentioned above applies to overweight and obese individuals. As well as in cases of diabetes, dyslipidemia, hypertension, and endocrine imbalances.
Instead, individuals with drug-refractory epilepsy exclude carbohydrates from their diet to metabolize ketone bodies essential to their central nervous system. (3)
The diets under consideration, which are now so popular that they have even stimulated the production of special Apps, arise precisely from the treatment protocols for epilepsy cases described above.
3) Keto diet and very low carb diet
Two dietary patterns are distinguished:
- keto diet, aimed at stimulating acidosis (see par. 1) as well as treating individuals with drug-refractory epilepsies (see par. 2). It does not in itself provide for a reduction in daily energy intake (kcal/day),
- very low carb diet, VLCD, that is, the very low carbohydrate diet, for overweight and obesity. In this case, energy intake is reduced and nutrients allocated as follows, at different stages of treatment.
3.1) ‘Attack’ phase
The first phase, or ‘attack phase,’ lasts at least 4 weeks (depending on the individual weight loss program) and involves:
- 1-1.5 g of protein per kg of body weight,
- Elimination of carbohydrates and sugars,
- Supplementing energy intake with lipids. (4)
You can replace meals with foods designed as meal replacements for the keto diet.
Suggested dietary supplementation includes Omega 3, potassium citrate (2 sachets, at 8 a.m. and 8 p.m.), a multivitamin and multimineral supplement (also useful for the immune system, as noted. (5)
3.2) ‘Integrated’ phase
The second phase, or ‘integrated phase,’ lasts 8-12 weeks. The diet is usually based on one protein meal and some replacement meals (up to 4-6, for men, 2-3 for women), as in the first phase. However, with the addition of moderate carbohydrate intake (25-30 g/day).
Urinary ketones are measured every 3 days (with ketonuria measuring strips). A video consultation every 15 days and one visit per month are recommended.
3) ‘Transition’ phase
The third, ‘transitional’ phase begins after losing at least 10 percent of the initial weight (relative to the weight loss program). Physical activity is fully introduced, ketosis is gradually eliminated. The dietary regimen includes an intake of about 1200 kcal/day with no more than two replacement meals (at breakfast and snack).
Gradual reintroduction of carbohydrates takes place through intakes of fruits and dairy products, followed by legumes and oilseeds.
Lastly, 30/40 g of bread is inserted, and finally pasta and potatoes.
4) Maintenance
Maintenance includes a daily carbohydrate intake (e.g., bread, pasta) of no more than 60-80 g, with protein from a variety of sources (e.g., 150 grams of fish, 120 grams of meat, 2 eggs). Dietary supplementation continues.
Dietary balance contemplates an intake of protein (25 percent) lipids (30 percent) and carbohydrates, with care taken not to exceed 10 percent simple sugars.
5) Pros and cons
The good news is that this type of diet is effective, as also confirmed by the Ministry of Health, (4) as it reduces hunger and enables rapid weight loss. The state of ketosis is not dangerous, it is acidosis and not pathological hyperacidosis
Nevertheless, it should be taken into account that:
- changes in metabolism are neither continuous nor permanent,
- maintenance requires constancy and balance, which are not always easy to preserve over time,
- the need to periodically resort to new ultra-low-carbohydrate diet plans is therefore to be expected.
6) The benefits, beyond weight loss
A diet with reduced intake of carbohydrates-and especially added sugars, whose intake should be reduced to the bare minimum, also according to EFSA (5) can help reduce:
- blood glucose,
- insulin resistance,
- The transformation of excess carbohydrates into triglycerides,
- the level of inflammation and consequently the occurrence or worsening of pathological situations such as diabetes, atherosclerosis, cancer, alzheimer’s, and sarcopenia cause in the elderly and frail patients the decline in health conditions.
Thus, it is hoped for a greater awareness of how much and what we put into our bodies.
7) Food and health
The ability to modulate DNA (epigenetic action) through nutraceuticals also makes it possible to modify heredity for diseases hitherto thought to be hereditarily transmissible. Attention to the nutritional quality of foods, not just the calories (kcal) they contain, is therefore essential to maintaining the best possible state of health.
Learning how to read nutritional labels, choosing foods with balanced food profiles, and recognizing the value of organic and sustainable foods makes us active participants in an evolving food supply. Also from a socio-environmental perspective (e.g., short supply chain, respect for workers’ and farmers’ rights, animal welfare).
Conclusions
A protocol borrowed from a condition of extreme neurological stress such as drug-refractory epilepsy, in which adoption of a dietary regimen is a sine qua non for sustainable survival, may also be an acceptable solution for overweight and obese people.
The risks of serious and chronic diseases , in obese and overweight people who follow unbalanced diets, should not be underestimated in a medium- to long-term perspective, and a diet while challenging is always preferable to therapies that might result from the occurrence of so-called NCDs, Non-Communicable Diseases.
Adele Fantoni
Notes
(1) Dario Dongo, Andrea Adelmo Della Penna. Italy, overweight and obesity in adults and the elderly. ISS studies. GIFT (Great Italian Food Trade). 8.1.22
(2) Dario Dongo. Obesity, childhood obesity, and marketing. WHO Europe 2022 Report. GIFT (Great Italian Food Trade). 16.6.22
(3) People with drug-refractory epilepsy have an enzyme deficiency related to the carrier that transports sugar to the brain. The exclusion of carbohydrates from their diet has a therapeutic function, as this is the only way to metabolize the ketogenic bodies that substitute for sugar to supply energy to the central nervous system. No reduction in energy intake (kcal) is expected in these cases
(4) One gram of protein as one gram of carbohydrates provides 4 kcalories, one gram of lipids 9 kcalories
(5) Dario Dongo, Andrea Adelmo Della Penna. Over-55, strengthen the immune system with vitamin and mineral supplements. Studio. GIFT (Great Italian Food Trade). 23.8.20
(6) Marta Strinati. High-protein diet and ketogenic diet, merits and limitations. GIFT (Great Italian Food Trade). 5.12.21
Bibliography
Refresher course “Clinical application of ketogenic therapy: a theoretical-practical course” 5th edition to classic ketogenic diet to ketogenic semi-fasting. Pavia, 22-24.6.22
Tozzi R, et al. (2022). Ketone Bodies and SIRT1, Synergic Epigenetic Regulators for Metabolic Health: A Narrative Review. Nutrients. https://doi.org/10.3390/nu14153145
Dąbek A, et al. (2020). Modulation of Cellular Biochemistry, Epigenetics and Metabolomics by Ketone Bodies. Implications of the Ketogenic Diet in the Physiology of the Organism and Pathological States. Nutrients. doi: 10.3390/nu12030788. PMID: 32192146; PMCID: PMC7146425
Ruan HB, et al. (2018). Ketone bodies as epigenetic modifiers. Curr Opin Clin Nutr Metab Care. doi: 10.1097/MCO.0000000000000475. PMID: 29697540
Surgeon Specialist in dentistry, orthodontics, nutritionist and aesthetic doctor
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