Long Term Effects of Ketogenic Diet in Obese Subjects with High Cholesterol Level

  • Hussein M. DashtiEmail author
  • Naji S. Al-Zaid
  • Thazhumpal C. Mathew
  • Mahdi Al-Mousawi
  • Hussain Talib
  • Sami K. Asfar
  • Abdulla I. Behbahani


Objective: Various studies have convincingly shown the beneficial effect of ketogenic diet (in which the daily consumption of carbohydrate is less than 20 grams, regardless of fat, protein and caloric intake) in reducing weight in obese subjects. However, its long term effect on obese subjects with high total cholesterol (as compared to obese subjects with normal cholesterol level is lacking. It is believed that ketogenic diet may have adverse effect on the lipid profile. Therefore, in this study the effect of ketogenic diet in obese subjects with high cholesterol level above 6 mmol/L is compared to those with normocholesterolemia for a period of 56 weeks.

Materials and methods: In this study, 66 healthy obese subjects with body mass index (BMI) greater than 30, having high cholesterol level (Group I; n = 35) and those subjects with normal cholesterol level (Group II; n = 31) were selected. The body weight, body mass index, total cholesterol, LDL-cholesterol, HDL-cholesterol, urea, creatinine, glucose and triglycerides were determined before and after the administration of the ketogenic diet. Changes in these parameters were monitored at 8, 16, 24, 32, 40, 48 and 56 weeks of the treatment.

Results: The body weight and body mass index of both groups decreased significantly (P < 0.0001). The level of total cholesterol, LDL cholesterol, triglycerides and blood glucose level decreased significantly (P < 0.0001), whereas HDL cholesterol increased significantly (P < 0.0001) after the treatment in both groups.

Conclusion: This study shows the beneficial effects of ketogenic diet following its long term administration in obese subjects with a high level of total cholesterol. Moreover, this study demonstrates that low carbohydrate diet is safe to use for a longer period of time in obese subjects with a high total cholesterol level and those with normocholesterolemia.

Key words

blood glucose cholesterol HDL ketogenic diet LDL low carbohydrate diet obesity triglycerides 


  1. Dashti HM, Bo-Abbas YY, Mathew TC, Hussein T, Behbehani A, Khoursheed M, Al-Sayer HM, Al-Zaid NS: Ketogenic diet modifies the risk factors for heart disease in obese subjects. Nutrition 19: 901–902, 2003PubMedCrossRefGoogle Scholar
  2. Wilder RM: The effect of ketonemia on the course of epilepsy. Mayo Clin Proc 2: 307–308, 1921Google Scholar
  3. Pilkington TRE, Gainsborough H, Rosenoer VM, Carey M: Diet and weight reduction in obese. Lancet 16: 856–858, 1960CrossRefGoogle Scholar
  4. Westman EC, Mavropoulos J, Yancy WS, Volek JS: A review of low-carbohydrate ketogenic diets. Curr Atheroscler Rep 5: 476–483, 2003PubMedCrossRefGoogle Scholar
  5. Volek JS, Sharman MJ, Love DM, Avery NG, Gomez AL, Scheett TP, Kraemer WJ: Body composition and hormonal responses to a carbohydrate-restricted diet. Metabolism 51: 864–870, 2002PubMedCrossRefGoogle Scholar
  6. Volek JS, Gomez AL, Kraemer WJ: Fasting lipoprotein and postprandial triacylglycerol responses to a low-carbohydrate diet supplemented with n-3 fatty acids. J Am Coll Nutr 19: 383–391, 2000PubMedGoogle Scholar
  7. Larosa JC, Fry AG, Muesing R, Rosing DR: Effects of high-protein, low carbohydrate dieting on plasma lipoproteins and body weight. J Am Diet Assoc 77: 264–270, 1980PubMedGoogle Scholar
  8. Dattilo AM, Kris Etherton PM: Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 56: 320–328, 1992PubMedGoogle Scholar
  9. Austin MA, Hokanson JE, Edwards KL: Hypertriglyceridemia as a cardiovascular risk factor. Am J Cardiol 81: 7B–I2B, 1998PubMedCrossRefGoogle Scholar
  10. Taubes G: Nutrition: the soft science of dietary fat. Science 291: 2536–2545, 2001PubMedCrossRefGoogle Scholar
  11. Zammit VA, Waterman IJ, Topping D, McKay G: Insulin stimulation of hepatic triacylglycerol secretion and the etiology of insulin resistance. J Nutr 131: 2074–2077, 2001PubMedGoogle Scholar
  12. Reaven GM: Diet and syndrome X. Curr Atheroscler Rep 2: 503–507, 2000PubMedCrossRefGoogle Scholar
  13. Krauss RM: Atherogenic lipoprotein phenotype and diet-gene interactions. J Nutr 131: 340S–343S, 2001PubMedGoogle Scholar
  14. Yancy WS Jr, Olsen MK, Guyton JR, Bakst RP, Westman EC: A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial. Ann Intern Med 140: 769–777, 2004PubMedGoogle Scholar
  15. Westman EC, Mavropoulos J, Yancy WS, Volek JS: A review of low-carbohydrate ketogenic diets. Curr Atheroscler Rep 5: 476–483, 2003PubMedCrossRefGoogle Scholar
  16. Kwiterovich PO Jr, Vining EP, Pyzik P, Skolasky R Jr, Freeman JM: Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA 290: 912–920, 2003PubMedCrossRefGoogle Scholar
  17. Sharman MJ, Kraemer WJ, Love DM, Avery NG, Gomez AL, Scheett TP, Volek JS: A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr 132: 1879–1885, 2002PubMedGoogle Scholar
  18. Lofgren IE, Herron KL, West KL, Zern TL, Patalay M, Koo SI, Fernandez} ML: Carbohydrate intake is correlated with biomarkers for coronary heart disease in a population of overweight premenopausal women. J Nutr Biochem 16: 245–250, 2005PubMedCrossRefGoogle Scholar
  19. Boden G, Sargrad K, Homko C, Mozzoli M, Stein TP: Effect of a low-carbohydrate diet on appetite, blood glucose levels, and insulin resistance in obese patients with type 2 diabetes. Ann Intern Med 142: 403–411, 2005PubMedGoogle Scholar
  20. Ezenwaka CE, Kalloo R: Carbohydrate-induced hypertriglyceridaemia among West Indian diabetic and non-diabetic subjects after ingestion of three local carbohydrate foods. Indian J Med Res 121: 23–31, 2005PubMedGoogle Scholar
  21. Bray GA: The risks and disadvantages of obesity. In: The Obese Patient. Philadelphia: Saunders, 1976, pp. 215–251Google Scholar
  22. Grundy SM, Barnett JP: Metabolic and health complications of obesity. Dis Mon 36: 641–731, 1990PubMedGoogle Scholar
  23. Pi-Sunyer FX: Medical hazards of obesity. Ann Intern Med 119: 655–660, 1993PubMedGoogle Scholar
  24. Simopoulos AP, Van Itallie TB: Body weight, health and longevity. Ann Intern Med 100: 285–295, 1984PubMedGoogle Scholar
  25. Dashti HM, Mathew TC, Hussein T, Asfar SK, Behbehani AI, Al-Sayer HM, Al-Zaid NS: Long term effects of ketogenic diet in obese subjects. Exp Clin Cardiol 9: 200–205, 2004PubMedGoogle Scholar
  26. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L: A low-carbohydrate as compared with a low-fat diet in severe obesity. N Engl J Med 22(348): 2074–2081, 2003CrossRefGoogle Scholar
  27. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S: A randomized trial of a low-carbohydrate diet for obesity. N Engl J Med 22(348): 2082–2090, 2003CrossRefGoogle Scholar
  28. Brehm BJ, Seeley RJ, Daniels SR, D'Alessio DA: A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. J Clin Endocrinol Metab 88: 1617–1623, 2003PubMedCrossRefGoogle Scholar
  29. Stern L, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams M, Gracely EJ, Samaha FF: The effects of low-carbohydrate versus conventional weight loss diets in severely obese adults: one-year follow-up of a randomized trial. Ann Intern Med 18(140): 778–785, 2004Google Scholar
  30. Astrup A, Larsen TM, Harper A: Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet 364: 897–899, 2004PubMedCrossRefGoogle Scholar
  31. Zammit VA, Waterman IJ, Topping D, McKay G: Insulin stimulation of hepatic triacylglycerol secretion and the etiology of insulin resistance. J Nutr 131: 2074–2077, 2001PubMedGoogle Scholar
  32. Gotto AM: Interrelationship of triglycerides with lipoproteins and High-density lipoproteins. Am J Cardiol 66: 20A–23A, 1990PubMedCrossRefGoogle Scholar
  33. Hodis HN, Mack WJ, Azen SP, Alaupovic P, Pagoda JM, Labree L, Hemphill LC, Kramsch DM, Blankenhorn DH: Triglyceride- and cholesterol-rich lipoproteins have a differential effect on mild/moderate and severe lesion progression as assessed by quantitative coronary angiography in a controlled trial of lovastatin. Circulation 90: 42–49, 1994PubMedGoogle Scholar
  34. Hodis HN, Mock WJ: Triglyceride-rich lipoproteins and progression of coronary artery disease. Curr Opin Lipid 6: 209–214, 1995CrossRefGoogle Scholar
  35. Bissett JK, Wyeth RP, Matts JP, Johnson JW: Plasma lipid concentrations and subsequent coronary occlusion after a first myocardial infarction. Am J Med Sci 305: 139–144, 1993PubMedCrossRefGoogle Scholar
  36. Krauss RM, Williams PT, Brensike J, Detre KM, Lindgren FT, Kelsey SF, Vranizan K, Levy RI: Intermediate-density lipoproteins and progression of coronary artery disease in hypercholesterolemic men. Lancet 2: 62–66, 1987PubMedCrossRefGoogle Scholar
  37. Hulley SB, Roseman RH, Bawol RD, Brand RJ: Epidemiology as a guide to clinical decisions: The association between triglyceride and coronary heart disease. N Engl J Med 302: 1383–1389, 1980PubMedGoogle Scholar
  38. Austin MA: Plasma triglyceride as a risk factor for coronary artery disease: the epidemiologic evidence and beyond. Am J Epidemiol 129: 249–259, 1989PubMedGoogle Scholar
  39. Hokanson JE, Austin MA: Plasma triglyceride level is a risk factor for cardiovascular disease independent of high-density lipoprotein cholesterol level: a meta-analysis of population-based prospective studies. J Cardiovasc Risk 3: 213–221, 1996PubMedCrossRefGoogle Scholar
  40. Gaziano, JM, Hennekens CH, O'Donnell CJ, Breslow JL, Buring JE: Fasting triglycerides, high-density lipoprotein, and risk of myocardial infarction. Circulation 96: 2520–2525, 1997PubMedGoogle Scholar
  41. Noakes M, Foster P, Keogh J, Clifton P: Very low carbohydrate diets for weight loss and cardiovascular risk. Asia Pac J Clin Nutr 13(Suppl): S64, 2004Google Scholar
  42. NIH Consensus development panel on triglyceride, high-density lipoprotein, and coronary heart disease. NIH Consensus conference: Triglyceride, high-density lipoprotein, and coronary heart disease. JAMA 269: 505–510, 1993Google Scholar
  43. Stampfer MJ, Sacks FM, Salvini S, Willett WC, Hennekens CH: A prospective study of cholesterol apolipoproteins and the risk of myocardial infarction. N Engl J Med 325: 373–381, 1991PubMedGoogle Scholar
  44. Harder H, Dinesen B, Astrup A: The effect of a rapid weight loss on lipid profile and glycemic control in obese type 2 diabetic subjects. Int J Obes Relat Metab Disord 28: 180–182, 2004PubMedCrossRefGoogle Scholar
  45. Battino M, Ferreiro MS: Ageing and the Mediterranean diet: a review of the role of dietary fats. Public Health Nutr 7: 953–958, 2004PubMedCrossRefGoogle Scholar
  46. La Vecchia C: Mediterranean diet and cancer. Public Health Nutr 7: 965–968, 2004PubMedCrossRefGoogle Scholar
  47. Shahtahmasebi S, Shahtahmasebi S: A case follow-up report: possible health benefits of extra virgin olive oil. Scientific World Journal 4: 853–858, 2004PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Hussein M. Dashti
    • 1
    • 5
    Email author
  • Naji S. Al-Zaid
    • 2
  • Thazhumpal C. Mathew
    • 3
  • Mahdi Al-Mousawi
    • 4
  • Hussain Talib
    • 4
  • Sami K. Asfar
    • 1
  • Abdulla I. Behbahani
    • 1
  1. 1.Department of SurgeryKuwait UniversitySafatKuwait
  2. 2.Department of PhysiologyKuwait UniversitySafatKuwait
  3. 3.Faculty of Medicine and Faculty of Allied Health SciencesKuwait UniversitySafatKuwait
  4. 4.Primary Health Care Salmeiah and Shaab ClinicSafatKuwait
  5. 5.Department of SurgeryFaculty of MedicineSafatKuwait

Personalised recommendations