Is Ketogenic Diet Superior to Standard American Diet for Diabetes, Metabolic Syndrome and Weight Loss?
Title: Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies
Author: Gibas et al
Journal: Diabetes & Metabolic Syndrome: Clinical Research and Reviews
Objectives: To assess if prolonged maintenance of induced and controlled physiological, dietary ketosis, would reverse pathological processes induced by metabolic syndrome including a reduction in fasting triglycerides, BMI (body mass index) and body fat mass (BFM), weight, a significant decrease and/or normalization of hemoglobin A1c (HgA1c) and an increase in resting metabolic rate (RMR) and blood ketones.
Diabetes and it’s precursor metabolic syndrome are a public health crisis in the United States and in other parts of the world. The CDC estimates that 30.3 million Americans have diabetes and another 84.1 million (33%) adults have metabolic syndrome or pre-diabetes.
Treating and preventing these diseases is the goal of physicians and the subject of much research across the country. One of the major areas of interest and one that is particularly difficult to study is the role of diet and how to change dietary decisions that lead to these diseases.
In healthy individuals with normal glucose regulation, an individual can switch between burning fat and carbohydrates seamlessly depending on their dietary intake. It has been proposed decreased insulin sensitivity leading to impaired fat breakdown contributes to metabolic syndrome. Ketosis is essentially a shift from carbohydrates to fat for energy production. The authors of this study wanted to compare a ketogenic diet to american diets to see if it could have positive effects on markers of diabetes and metabolic syndrome.
The authors took 30 adults previously diagnosed with metabolic syndrome by their primary care physician and randomly assigned them to one of three groups:
- Sustained ketogenic diet with no exercise
- Standard American diet with no exercise
- Standard American diet with 30 minutes of exercise 3-5 days per week
At weeks 0, 3, 6 and 10 they measured the following:
- Body weight
- Hemoglobin A1c (HgA1c)
- Body Mass Index (BMI)
- RMR (Resting Metabolic Rate)
- Serum Ketones
- Body Fat Mass
In the ketogenic group, there was a statistically significant change over time in the following ( P= 0.001)
- Body weight
- Body fat percentage
- Serum Ketones
All of the variables outperformed both the standard american diet with and without the exercise.
Triglycerides and resting metabolic rate also trended toward improvement in the ketogenic group but were not statistically significant.
The findings suggest that a ketogenic diet even without exercise is superior to standard American diet. Specifically, the folks following the ketogenic diet achieved more weight loss, had a lower body fat percentage, body mass index and decreased their HgA1c. These folks were also true compared to American diet with exercise.
The results of this study are quite compelling. This study has some major limitations however, and she be interpreted in that context. The study was small with only 30 people split between the groups over just 10 weeks.
More importantly, the ketogenic arm was a “diet” arm while the other two did not “diet” regardless of whatever they were eating. So you could easily argue that the “diet” was what improved their health and not the type of diet. In other words, maybe caloric restriction was superior when compared to a standard diet. Additionally, the authors also did not measure calories or report on their actual food intake.
Generally, supporters of ketogenic diet should feel confident that this study will pave the way for better, more definitive research in the future.
Gibas, M. K., & Gibas, K. J. (2017). Induced and controlled dietary ketosis as a regulator of obesity and metabolic syndrome pathologies. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 11. doi:10.1016/j.dsx.2017.03.022