Dietary Ketosis in the Treatment of Overweight, Obesity and Metabolic Syndrome

Dr. Dana Myatt

Dietary ketosis, a normal metabolic state in fasted Homo sapiens, has a broad range of therapeutic applications including the treatment of overweight, obesity and metabolically-related conditions.

Ketosis is a much maligned and largely misunderstood state of normal metabolism, distinct from ketoacidosis. The difference between dietary ketosis and diabetic ketoacidosis is as significant as the difference between intentional weight loss and cachexia. Unfortunately, lack of clarity about the utility of dietary ketosis and the distinction between ketosis and ketoacidosis has caused many physicians to shy away from prescribing therapeutic ketogenic diets even in instances where it should be considered the diet of choice.

Ketosis Versus Ketoacidosis

In diabetic ketoacidosis, severe insulin deficiency causes ketone bodies to rise precipitously, often exceeding 25 mM in blood, a level of ketosis rarely seen in normal individuals even during advanced starvation(1-2). Non-diabetic ketoacidosis can also occur as a result of alcohol or drug-induced states(3-8), during exuberant lactation(9) and extreme hyperthyroidism(10).

The counter-regulatory bicarbonate system can be stressed until blood buffering ability is exhausted. The combination of pathologically high ketone levels and loss of blood buffering systems result in severe acidosis. In addition, hypovolemia from urinary water loss secondary to hyperglycemia and glycosuria, and sodium and potassium loss from severe ketonuria, converge to create a perfect storm of life-threatening potential(1,12-14).

In dietary ketosis, the conversion of stored fats to useable energy allows blood ketones to typically reach levels of 2 to 7 mM, an evolutionary adaptation necessary to prevent conversion of vital muscle mass to glucose in times of famine. Episodic fasting evolved as a normal state during the evolution of our hunter-gatherer ancestors and this mild ketosis resulting from fasting is unique to homo sapiens (except in some ruminants during exuberant lactation or twinning)(1-2). Humans are also distinguished from other animals by the large brain-to-body weight ratio and brain’s high energy requirements. At rest, 20% of total oxygen consumption supports 1.5 kg of brain which is approximately 2% of body weight.

Beneficial Effects of Ketosis on Obesity, Overweight and Metabolic Syndrome

Research has shown that ketogenic diets result in faster weight (fat) loss and a faster correction of the elements of metabolic syndrome than non-ketogenic diets of identical caloric composition(15-17). Further, animal and human studies have demonstrated that correctly applied ketogenic diets are not only safe, but in fact confer protective benefits to normal cells(18-23).

Dietary ketosis affords numerous metabolic advantages for the correction of overweight, obesity and metabolic syndrome including:

            1.)  decreased hunger(16, 24-26)

            2.)  protein sparing(27-30)

            3.)  increased insulin sensitivity and decreased glucose levels (27, 31-33)

            4.)  improved lipid profile including increased HDL (17,31,34-35), decreased TG's (17,35), decreased total
                  cholesterol (34-35) , lower LDL (34) , a shift from small LDL to large LDL (36), and decreased VLDL(36) .

            5.)  decreased inflammation(37-41)

            6.)  decreased radical oxygen species (ROS)(1,42-45)

            7.)  lower blood pressure(34, 46-47)

            8.)  faster weight loss(16-17,27)

            9.)  improved mitochondrial function(48-52)

This presentation will serve as a review of the biochemistry of dietary-induced ketosis and will present documented clinical nutritional strategies for using a calorie-controlled ketogenic diet in the treatment of overweight, obesity and metabolic syndrome. Specific guidelines for clinical implementation will be highlighted.


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