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INTERPRETINGFAST WEIGHT LOSS VS. LONG-TERM HEALTH OUTCOMES OF A
KETOGENIC DIET 1
Interpreting Fast Weight Loss vs. Long-Term Health Outcomes of a Ketogenic Diet
Sarah Hersh
University of Northern Colorado

KETOGENIC DIET 2
Abstract
When the body does not receive enough dietary sources of carbohydrates, it will shift the energy
utilization source from glucose to ketone bodies, which are synthesized in Beta-Oxidation of
fatty acids. The use of ketone bodies for a duration of time, leads to a state of ketosis and has
shown beneficial and detrimental effects on the body’s functions. The aim of this analysis is to
evaluate the short-term benefits of ketosis in disease states and weight loss verses the unknown
long-term effects of ketosis as well as the maintenance of a healthy lifestyle for a normal
individual. Several results prove substantial weight loss and initial reduction in hyperlipidemia
initially while following a ketogenic diet; however, the issue of the unknown long-term
outcomes is still present. Long-term consumption of inadequate amounts of recommended
carbohydrates can cause potential deficiencies in key nutrients. Further studies are necessary to
validate the need for a diet lower in carbohydrates than nationally recommended for the average
adult.

KETOGENIC DIET 3
Introduction
A diet that was originally designed to prevent seizures in children with epilepsy, has now
become widely popular in today’s health and wellness media. A ketogenic diet requires a large
portion of your diet to be consumed from fat; leaving a small intake of proteins and
carbohydrates. This balance of nutrients after a period of time begins ketosis within the body.
Ketosis is a metabolic state that occurs when your body has a low storage of its primary fuel
source (glucose) and has to generate ketone bodies as fuel from beta oxidation of fats (Vidalia et.
al, 2015).
The original design of the Ketogenic Diet (KD) began in the 1920’s when it was revealed
to help in the management of epilepsy in patients who suffered from uncontrollable seizures. The
KD treatment involved consumption of 65%-90% of their energy requirements from dietary fat,
with the remainder of daily energy requirements from proteins and carbohydrates. As a
reference, the recommended daily percentage of fat for a typical individual is 20-35% of total
intake. The KD used as treatment revealed an approximate 50% decrease of seizure episodes;
however, after the introduction of antiepileptic drugs in the 1940’s, this treatment became less
popular (Vidalia et. al, 2015). It was not until recent studies that have been conducted over the
last few years found that other potential health benefits are a result of following diets that put the
body into a state of ketosis for a period of time.
Research has been done to reveal the effectiveness of a KD in terms of fast weight loss,
reduced levels of blood glucose, insulin, fasting serum lipids, and cholesterol. The relevance of
these studies has caused hype in the media regarding health and wellness; resulting in popularity
in a diet that has long-term effects that are not thoroughly known (Yancy et. al, 2004). The
introduction of the idea that making a normal adult become “ketoadapted” is potentially

KETOGENIC DIET 4
dangerous and has many dietary and health care providers worried about the unknown long-term
effects. Adverse neurological effects is the major area of concern.
The purpose of this debate is to recognize the benefits of what ketosis has on the human
body on a short-term basis, as well as the argument of the unknown health outcomes that can be
dangerous. Research has shown promising results pertaining to trials of this diet; however, there
is more research that is needed. Clinical studies conducted on rats and mice are only the
beginning stages of creating a theory of benefits. It is necessary that this topic is reviewed in
more depth, given the fact that this diet is highly advertised for as a successful diet for the
average adult.
Discussion
Several studies claim a better rate of weight loss following a KD as opposed to a low-fat
diet with adequate amounts of carbohydrates for an individual. A particular study conducted a 12
month long meta-analysis of the a very-low-carbohydrate ketogenic diet (VLCKD) (consuming
less than 50 grams of carbs a day) verses participants assigned to a conventional low-fat diet
(LFD) with an intake of less than 30% of daily calories. The goal was to determine best long-
term weight loss and most benefits to lowering cardiovascular risk. Results were greater in
participants following the VLCKD; a greater weight loss over all (mean difference of 20-91), a
decrease in low density lipoproteins (weighted mean difference 0-12) and triglyceride levels
(weighted mean difference 20-18), as well as diastolic blood pressure (weighted mean difference
21-43). There was also an increase in high density lipoproteins (weighted mean difference 21-
43). The ability of the body to convert from using glucose as the primary energy source to
ketones from fatty acid degradation in times of low blood glucose levels, has revealed significant
health benefits in this study (Bueno et. al, 2013).

KETOGENIC DIET 5
Along with physiological benefits of a KD, there are documented behavioral benefits as
well. Mcclernon’s study took a sample of 119 overweight individuals who followed one of the
two diets and were required to meet 12 times and debrief on their experience and progress. It was
predominately recorded that those following the LCKD were experiencing less symptoms of
hunger, and a better recollection of mood throughout the diet as opposed to those consuming a
LFD. It can be argued that the presence of less hunger or a better mood altogether could relate to
a better adaptation to the diet with less relapses for individuals with their eating routines or
behavior (2007). This study supports the KD, and it’s relevance in providing a diet that can more
adaptable for someone struggling with obesity.
As previously mentioned, a body in ketosis is shown to decrease seizures in epilepsy; it
also has shown promising results for people who are in a diseased state. Cancer cells, as well as
tumors, rely mainly on glucose to create energy and therefore live and grow through oxidative
phosphorylation. A therapy that reveals potential help is a carbohydrate and calories restricted
diet. This diet will essentially “starve out” these cancer cells as well as tumor growth because of
their dependence of glucose will be eliminated. Ketone bodies will be used for the energy source
as a consequence of no available glucose; however, ketone bodies would not be able to be used
by cancer cells because their different process of oxidative phosphorylation (Vidalia et. al, 2015).
Short term benefits have been explored to enhance the popularity of this diet as well as
potential medical treatment options; however, there are detrimental effects that must be
acknowledged also. When consuming an amount of carbohydrates that is less than
recommended, deficiencies in key nutrients are present. Without appropriate carbohydrate
sources such as whole grains and most fruits and vegetables, low levels of fiber, calcium,
vitamins, and several phytochemicals are common in the long-term. Some common complaints

KETOGENIC DIET 6
when following a KD is constipation and bone function alterations; the consequence of
inadequate calcium and fiber intakes. Thiamine, folic acid, iron, copper, chromium, phosphorus,
riboflavin, vitamin C, are just a few of the micronutrients that are typically deficient when
carbohydrate intake is low (Frigolet et. al, 2011).
It was previously mentioned that mood and psychological effects can be enhanced during
a KD, but there is reason to believe that it can have a contrary effect. Given that the synthesis of
serotonin is dependent on carbohydrates, the amount of this “happy” hormone can be low
without enough carbohydrate sources. The consequence of this can potentially cause high levels
of stress, mood disturbances, depression, and anxiety. It is important to recognize that this
argument has been made for both opposing views, making it situational to the individual
(Frigolet et. al, 2011).
Ketone bodies have been proven to be utilized efficiently by the brain when cerebral
metabolism of glucose is low or altered. Studies conducted using rats and mice as models have
almost proven the short-term effects of ketosis as protective and ideal when in a starvation mode
(Zhang et. al, 2013). With that being said, there are results relating to the issue of cerebral blood
flow decrease at the expense of ketone bodies being used in the brain. Though this may have
beneficial outcomes for those in a diseased state or someone who experiences seizures, it can be
detrimental for the average human being (Glaser et. al, 2012).
As mentioned, the KD has shown promising results in weight loss and initial decrease in
lipid levels. The long-term effects are still uncertain, and contrary research continues to debate
the side effects. An 8 week study was conducted on type 2 diabetic mice that were fed a high-fat
diet to see the effect of glycemic control and insulin tolerance. Findings indicated that there was
more control of glucose levels with a decrease in 22.35 mmol/L in KD fed mice; however,

KETOGENIC DIET 7
hepatic steatosis was more prevalent and disruption occurred in lipid metabolism. Plasma alanine
aminotransferase (ALT) and aspartate aminotransferase (AST) were tested. High levels of these
enzymes indicate malfunctioning of the liver. In mice consuming a KD, their levels of both ALT
and AST were greater by over 100%. These results are conducive to the need for further research
and understanding of the long-term outcomes of a KD (Zang et. al, 2016).
Health care providers and Dietitians are continually debating these new diets that are
glorified in the media. Despite the benefits that are seen while consuming low amounts of
carbohydrates and proteins, and high amounts of fats while in a diseased state; a normal adult
must be wearisome of the balance of nutrients consumed. The recommended dietary intake is the
inclusion of Carbohydrates making up 45-65% of diet, 10-35% from Protein, and Fat comprising
20-35%. These necessary levels are upheld by the foundation of scientific research that claim
why the balance of nutrients are needed so the body can function properly (Knight, 2012).
With obesity being an epidemic in our society, efforts to lose weight are explored at all
costs. This diet of consuming such small amounts of carbohydrates and proteins may lead to fast
weight loss; however, it has been shown to plateau after a period of maintaining this starvation
mode (Douris et. al, 2015). The position made by these professionals who are counseling for
weight loss, state that it is necessary to adjust your lifestyle in a way that is convenient and
beneficial. This lifestyle should include a balanced diet where an individual is obtaining adequate
amounts of both macronutrients and micronutrients. This change in eating habits and hopeful
increase physical activity, will initiate a healthy weight loss of no more than 2 pounds a week.
The purpose of this side of the argument is that a person will not get obsessive or restrict
particular foods from their diet throughout a lifetime. This obsessive behavior of restricting a

KETOGENIC DIET 8
particular food category can be detrimental for a person’s psychological annotation with food or
weight loss (Roncero et. al, 2011)
Opinion
Following a ketogenic diet has clearly shown its benefits for those in a disease state,
especially those diagnosed with epilepsy. After the development of antiepileptic
pharmaceuticals, its popularity decreased. That popularity regained its efficacy and has become
widely used as a therapeutic measure for inhibiting seizures. This benefit began a vast amount of
research for revealing the positive outcomes of putting the human body into a ketosis state.
Within these studies, the short-term outcomes of weight loss, reduced triglycerides, lowered low-
density lipoproteins, and increased high-density lipoproteins are significant to note and reason to
pursue more research to foresee what the long-term outcomes consist of.
The issue that resonates most as a culprit of this particular diet is the long-term
maintenance. Even though increased weight loss is commonly seen and accomplished initially,
once fully adapted in a ketogenic state, a plateau of weight loss is reached and then the question
or plan of action for continued health and maintenance may become difficult. There have been
studies that evaluate how a person maintains their weight and physical well-being once they have
stopped following the recommendations strictly. At the point of either reaching the end of the
cycle or just wanting to adjust an eating routine, weight maintenance can be manipulated here
and become a great struggle for a person (Paoli et. al, 2015).
The introduction of another “yo-yo” diet is a problem for the continued maintenance of a
healthy lifestyle. Quick results of a KD that is relatively easy to follow initially is not ideal for a
necessary permanent life adjustment. There is also potential for an obsessive eating disorder or

KETOGENIC DIET 9
stigma towards a particular food that is being restricted from a diet. If we continue to label
carbohydrates as the only culprit for fat mass gain, we could potentially cause psychological
issues targeting a food source that is in fact, not always the villain.
Clearly, there are pros and cons to a ketogenic diet that have been debated more in depth
over the last few years. The importance of necessary further studies is continuing to rise, due to
the increasing popularity in society.
Future Directions
Many of the studies that evaluate human participants consuming a ketogenic diet,
typically do not last longer than 12- months. Results from these particular studies have shown
fast weight loss as well as enhanced metabolic processes. These results are promising for the
future of therapies for obesity management; however, these findings are far from being complete
with the necessities of knowing how the body can adjust to ketosis on a long-term basis.
There have been studies where researchers have placed rats and mice on an induced
ketogenic diet for a long-period of time to see their bodily responses. These studies have
continued to enhance the position of benefits of using ketone bodies as the main fuel source, as
opposed to glucose, but it is critical to acknowledge that the human body is not exactly the same
as a rat or mouse. Also it is typical for these types of research to be conducted in a conditioned
laboratory setting which involves very little exercise and an environment that is not entirely
stressful for the animal. The purpose for noting this aspect is that the human body undergoes
stress and physical strain in a normal daily routine, meaning how our bodies will react to altered
metabolism after a long-term basis without sufficient glucose, is still somewhat unknown
(Douris et. al, 2015).

KETOGENIC DIET 10
This needed research is necessary not only for science, but also for the safety of the
average adult who decides to partake in a diet that is very low in carbohydrate sources.
Consuming an unbalanced diet shows risk for deficiencies in macronutrients that are essential for
bodily functions, and while the media continues to advertise this diet, we must be aware of all
possible outcomes.

KETOGENIC DIET 11
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