Background

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.

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 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.

Effectiveness of VLCKD for Weight Loss

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 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.  

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.

VLCKD and Musculoskeletal Conditions

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 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.

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.

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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.

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