Ketogenic diet

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Ketogenic diets are a range of low-carbohydrate/high-fat/variable protein content diets that have tended to gather more evidence of effectiveness the closer they are to a very low-carbohydrate/high-fat/low-protein, modified Atkin's diet. They have:

  • A fair observational evidence base in the treatment of intractable childhood epilepsy[1][2] and support of one randomised control trial.[3]
  • Evidence that they reverse diet-induced obesity independent of caloric intake. In the short term (up to a year) for weight loss they do no net harm[4][5] and indeed offer net loss benefit that can be better than some other approaches[6][7] with the caveats that lipid levels might need monitoring, and other morbidity and mortality outcomes than weight loss have not been established. Certainly mildly ketogenic low-carbohydrate/high-fat diets do the expected and result in weight gain. However the true issue is that it is known that reduced-calorie diets result in clinically meaningful weight loss regardless of which macronutrients they emphasize and that attendance for monitoring purposes is strongly associated with weight loss[8].
  • A short term benefit in diabetes mellitus in terms of weight loss but other diets are better for glycaemic parameter control[9].

The enclosed is an advertised theory or health belief likely to be presented or underlie some people's apparent concern with their health but which lacks or is inconsistent with scientific or medical evidence:
High fat/low carbohydrate diets have also been promoted for better health and cerebral function. These include the Atkin's diet[10].

The Atkin's diet status in the obese as to its impact on long term nutritional status and body composition, cardiovascular risk factors and adverse effects remains unknown[11].


  1. Kossoff EH. International consensus statement on clinical implementation of the ketogenic diet: agreement, flexibility, and controversy. Epilepsia. 2008 Nov; 49 Suppl 8:11-3.(Link to article – subscription may be required.)
  2. Levy R, Cooper P. Ketogenic diet for epilepsy. Cochrane database of systematic reviews (Online). 2003; (3):CD001903.(Link to article – subscription may be required.)
  3. Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G, Whitney A, Cross JH. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet neurology. 2008 Jun; 7(6):500-6.(Link to article – subscription may be required.)
  4. Westman EC, Yancy WS, Edman JS, Tomlin KF, Perkins CE. Effect of 6-month adherence to a very low carbohydrate diet program. The American journal of medicine. 2002 Jul; 113(1):30-6.
  5. Yancy WS, 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. Annals of internal medicine. 2004 May 18; 140(10):769-77.
  6. Nordmann AJ, Nordmann A, Briel M, Keller U, Yancy WS, Brehm BJ, Bucher HC. Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Archives of internal medicine. 2006 Feb 13; 166(3):285-93.(Link to article – subscription may be required.)
  7. Gardner CD, Kiazand A, Alhassan S, Kim S, Stafford RS, Balise RR, Kraemer HC, King AC. Comparison of the Atkins, Zone, Ornish, and LEARN diets for change in weight and related risk factors among overweight premenopausal women: the A TO Z Weight Loss Study: a randomized trial. JAMA : the journal of the American Medical Association. 2007 Mar 7; 297(9):969-77.(Link to article – subscription may be required.)
  8. Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishop LM, Laranjo N, Leboff MS, Rood JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. The New England journal of medicine. 2009 Feb 26; 360(9):859-73.(Link to article – subscription may be required.)
  9. McAuley KA, Hopkins CM, Smith KJ, McLay RT, Williams SM, Taylor RW, Mann JI. Comparison of high-fat and high-protein diets with a high-carbohydrate diet in insulin-resistant obese women. Diabetologia. 2005 Jan; 48(1):8-16.(Link to article – subscription may be required.)
  10. Atkins RC. Dr Atkins' new diet revolution. New York: Avon Books Inc, 1992.
  11. Astrup A, Meinert Larsen T, Harper A. Atkins and other low-carbohydrate diets: hoax or an effective tool for weight loss? Lancet. 2004 Sep 4-10; 364(9437):897-9.(Link to article – subscription may be required.)
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