Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome
Purpose of Review
The goal of this paper is to review current literature on nutritional ketosis within the context of weight management and metabolic syndrome, namely, insulin resistance, lipid profile, cardiovascular disease risk, and development of non-alcoholic fatty liver disease. We provide background on the mechanism of ketogenesis and describe nutritional ketosis.
Nutritional ketosis has been found to improve metabolic and inflammatory markers, including lipids, HbA1c, high-sensitivity CRP, fasting insulin and glucose levels, and aid in weight management. We discuss these findings and elaborate on potential mechanisms of ketones for promoting weight loss, decreasing hunger, and increasing satiety.
Humans have evolved with the capacity for metabolic flexibility and the ability to use ketones for fuel. During states of low dietary carbohydrate intake, insulin levels remain low and ketogenesis takes place. These conditions promote breakdown of excess fat stores, sparing of lean muscle, and improvement in insulin sensitivity.
KeywordsNutritional ketosis Metabolic syndrome Ketogenic diet Insulin resistance Weight loss Low-carbohydrate diet Ketone bodies Glucose metabolism Ketogenesis
The authors would like to thank Robin Noel for her technical assistance in the creation of the graphics for the figure.
Compliance with Ethical Standards
Conflict of Interest
Victoria M. Gershuni, Stephanie L. Yan, and Valentina Medici declare they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance
- 1.Obesity and Overweight Fact Sheet. Vol. 2018. World Health Organization; 2017.Google Scholar
- 4.Saslow LR, Kim S, Daubenmier JJ, Moskowitz JT, Phinney SD, Goldman V, et al. A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PLoS One. 2014;9:e91027.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Volek JS, Phinney SD. The art and science of low carbohydrate living. Miami: Beyond Obesity, LLC.Google Scholar
- 15.•• Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67:789–96. Excellent review that explains the role of physiologic ketosis and possible mechanisms for reversing chronic disease. CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Veldhorst MA, Westerterp KR, van Vught AJ, Westerterp-Plantenga MS. Presence or absence of carbohydrates and the proportion of fat in a high-protein diet affect appetite suppression but not energy expenditure in normal-weight human subjects fed in energy balance. Br J Nutr. 2010;104:1395–405.CrossRefPubMedGoogle Scholar
- 38.Wilson JM, et al. The effects of ketogenic dieting on body composition, strength, power, and hormonal profiles in resistance training males. J Strength Cond Res. 2017. https://www.ncbi.nlm.nih.gov/pubmed/28399015.
- 56.Chalasani N, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Hepatology. 2012;55:2005–23.CrossRefPubMedGoogle Scholar
- 61.Gershuni VM. Curr Nutr Rep (2018). https://doi.org/10.1007/s13668-018-0238-x
- 62.Kosinski C, Jornayvaz FR. Effects of ketogenic diets on cardiovascular risk factors: evidence from animal and human studies. Nutrients. 2017;9. https://www.ncbi.nlm.nih.gov/pubmed/28534852.
- 66.• Saslow LR, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutr Diabetes. 2017;7:304. Long-term, randomized human-subject dietary intervention comparing very low-carb ketogenic diet to moderate-carb low-fat diet. Demonstrating greater improvements in blood sugar (Hba1c) and weight loss, despite reducing need for hypoglycemic medications in the very low-carbohydrate ketogenic diet group. CrossRefPubMedPubMedCentralGoogle Scholar
- 70.• Bhanpuri NH, et al. Cardiovascular disease risk factor responses to a type 2 diabetes care model including nutritional ketosis induced by sustained carbohydrate restriction at 1 year: an open label, non-randomized, controlled study. Cardiovasc Diabetol. 2018;17:56. Examination of coronary vascular disease risk factors in a cohort of patients who participated in a long-term human-subject dietary intervention evaluating the use of a ketogenic diet vs. standard care in a continous care model for type 2 diabetes. Nutritional ketosis was associated with improvement in most biomarkers of CVD risk after 1 year. An increase in LDL-C was limited to the large LDL subfraction with incresed particle size. Inflammation and blood pressure decreased. CrossRefPubMedPubMedCentralGoogle Scholar
- 71.Hallberg SJ, et al. Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study. Diabetes Ther. 2018;9:583–612.Google Scholar
- 72.Leow ZZX, Guelfi KJ, Davis EA, Jones TW, Fournier PA. The glycaemic benefits of a very-low-carbohydrate ketogenic diet in adults with type 1 diabetes mellitus may be opposed by increased hypoglycaemia risk and dyslipidaemia. Diabet Med (2018). https://www.ncbi.nlm.nih.gov/pubmed/29737587.