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Ketogenic diets as treatment of obesity and type 2 diabetes mellitus

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Abstract

During the last decades, several interventions for the management of overweight and obesity have been proposed. Among diets, the first studies focused on the effect of water only and total fasting diets with or without proteins. Unfortunately, they were found to be associated with adverse events which lead to the abandon of these strategies. Interestingly, despite the radical approach, total fasting was effective and generally well tolerated. A strict connection between protein-calorie malnutrition and increased in morbidity and mortality in hospitalized patients was found at that time. Then, the seminal works of Blackburn and his collaborators lead to the introduction of the protein-sparing modified fast. Encouraged by the early results using this intervention, diets evolved to the current very-low-calorie ketogenic diets (VLCKD). In the present review, results of studies on the VLCKDs are presented and discussed, with a particular reference to the protocolled VLCKD. Also, a recent proposal on the nomenclature on the ketogenic diets is reported. Available evidence suggests VLCKDs to be effective in achieving a rapid and significant weight loss by means of an easily reversible intervention which could be repeated, if needed. Muscle mass and strength are preserved, resting metabolic rate is not impaired, hunger, appetite and mood are not worsened. Symptoms and abnormal laboratory findings can be there, but they have generally been reported as of mild intensity and transient. Preliminary studies suggest VLCKDs to be a potential game-changer in the management of type 2 diabetes too. Therefore, VLCKDs should be considered as an excellent initial step in properly selected and motivated patients with obesity or type 2 diabetes, to be delivered as a part of a multicomponent strategy and under strict medical supervision.

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Authors and Affiliations

  1. Division of Endocrinology, Department of Medicine, Santiago de Compostela University (USC), Complejo Hospitalario Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago, Spain

    Felipe F. Casanueva, Ana I. Castro, Gemma Rodriguez-Carnero, Ana B. Crujeiras & Miguel A. Martinez-Olmos

  2. CIBEROBN de Fisiopatologia de Obesidad y Nutricion, Santiago de Compostela, Santiago, Spain

    Felipe F. Casanueva, Ana I. Castro, Ana B. Crujeiras & Miguel A. Martinez-Olmos

  3. National Institute of Gastroenterology “S. De Bellis”, Bari, Castellana Grotte, Italy

    Marco Castellana

  4. Division of Endocrinology, Complejo Hospitalario Universitario de Ferrol and Coruña University, Ferrol, Spain

    Diego Bellido

  5. Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Bellinzona, Switzerland; Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland

    Pierpaolo Trimboli

  6. Medical Department Pronokal, Pronokal Group, Barcelona, Spain

    Ignacio Sajoux

  7. Faculty of Health Sciences, University of Santander (UDES), Bucaramanga, 680003, Colombia

    Diego Gomez-Arbelaez

  8. Epigenomics in Endocrinology Nutrition Group, Santiago, Spain

    Ana B. Crujeiras

Authors
  1. Felipe F. Casanueva
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  2. Marco Castellana
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  3. Diego Bellido
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  4. Pierpaolo Trimboli
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  5. Ana I. Castro
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  6. Ignacio Sajoux
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  7. Gemma Rodriguez-Carnero
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  8. Diego Gomez-Arbelaez
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  9. Ana B. Crujeiras
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  10. Miguel A. Martinez-Olmos
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Correspondence to Felipe F. Casanueva.

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Conflict of interest

FFC, DB, AIC and ABC received research grants and conference fees from Pronokal Spain. IS is currently Medical Director of Pronokal Spain. PT, MC, GRC, DGA and MAMO declare no conflict of interest.

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This narrative review was in accordance with the principles of the Declaration of Helsinki. Data extracted from published papers were reported and discussed.

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Casanueva, F.F., Castellana, M., Bellido, D. et al. Ketogenic diets as treatment of obesity and type 2 diabetes mellitus. Rev Endocr Metab Disord 21, 381–397 (2020). https://doi.org/10.1007/s11154-020-09580-7

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