THESES Proposal NTR 703 1st part DUE 6 HOURS
Johan.KK
PEProposal10.21.18.docxProposal
The Effect of very Low Carbohydrate Ketogenic Diets on Metabolic Syndrome in the Obese
Paula Ann Ennin
January 2019 Degree Conferral
A Project Submitted to the Graduate Faculty of
The Department of Nutrition SCHOOL OF HEALTH PROFESSIONS AND NURSING
LIU POST
In partial fulfillment of the requirements for the degree of Master of Science in Nutrition
Proposal:
The Effect of a Vvery Low Carbohydrate, Ketogenic Diets on Metabolic Syndrome in the Adults who are Obese Comment by Kathy Isoldi: Are you reviewing several types of ketogenic diets or the Ketogenic Diet?
Although it may appear that the ketogenic diet is a new concept to some, the diet hasis actually quite a longstanding concept within the field of nutrition and medicine. Originally used to treat epilepsy, it later fell out of popularity and into the background of medicine with the emergence of more convenient pharmacological remedies (Gardner et al., 2018; Blanton, 2018). Yet, in recent years, the low carbohydrate, ketogenic diet has been gaining attention, once again, for its as it advantages and therapeutic health benefits have been revealed. However, this high fat, low carbohydrate diet is created to produce a sense of “starvation” that lends to the body’s increased utilization of fat, resulting in the positive benefit of improved healths that it is intended to facilitate (Blanton, 2018). Simulation of “starvation” can create negative effects and prompts disconcerting responses. Although moderation may be the key, defining moderation may be another subjective variable that is not clearly defined and can therefore deter the realization of optimal benefits. Comment by Kathy Isoldi: Do not italicize et al. Correct throughout. Also you need to justify the entire document left (not centered) and need to double space- this is APA style guidelines. Comment by Kathy Isoldi: You need to be specific- and not use leading language such as “disconcerting.” This language would also be considered editorializing which is not appropriate for professional writing. Be specific in what you mean regarding “detrimental” or “negative health-related outcomes.”
The restriction of intake of carbohydrates leads to a lack of glucose within the body that promotes the production of ketones in the liver (Krebs, Gao, Gralla, Collins & Johnson, 2010; Paoli, Rubini, Volek, & Grimaldi, 2013). This form of metabolism that forces the body to utilize fat as an energy source and is knownis referred to as “ketosis,” and can be beneficial in weight loss ultimately reducing the risk of metabolic syndromes (Harvey, Schofield &and Williden, 2018). However, the question isof what does it costs to reap these benefits from the ketogenic diet? This question remains unanswered remains. Certainly, appropriate adherence to the diet is likely an issue. Meanwhile, it should be noted that while the benefits to epilepsy may be worth the risk, this metabolic state of ketosis is also associated with diabetes, alcoholism and severe starvation, implying that it may increase the risk of the negative outcomes associated with each of these detrimental conditions (Leow et al., 2018; Hu et al., 2012). Thus, it is imperative to evaluate the positive outcomes that can result in the population of obese individuals following a very low carbohydrate, ketogenic diet to reduce metabolic syndrome risk and to consider the risks that could be incurred from implementing a very low carbohydrate ketogenic diet. This research paper is intended to explore the effects of very low carbohydrate ketogenic diets on metabolic syndrome in individuals who arethe obese. Comment by Kathy Isoldi: The Metabolic Syndrome is singular with several component, but not plural. If you are going to use Metabolic Syndrome throughout your thesis I suggest that you introduce an abbreviation, such as MetS.
Significance of the ReviewStudy Comment by Kathy Isoldi: You are conducting a review of studies not conducting a study.
This review of studies and presentation of the findings investigating a y is important in light of the need to determine whether or not a very low carbohydrate, ketogenic diet and itsis effectiveness in ameliorating or preventing metabolic syndrome in obese individuals who are obese is an important endeavor. This is particularly critical because increase in ketone production involves an increase in acidic components within the body a including acetone, beta hydroxybutyrate and other associated compounds (; Santesso et al., 2013). Therefore, iIt is very important to explore the impacts and consequences of following a very low carbohydrate, ketogenic diet on metabolic syndrome in individuals who areon obese with regard to both positive and negative effects. Comment by Kathy Isoldi: This should be put in the introduction section where you discuss the detriments of following the ketogenic diet.
Problem Statement
The purpose of this study is to determine the effect of very low carbohydrate ketogenic diets on metabolic syndrome in the obese. In doing so, the following sub problems will be addressed:
· What are the harmful physical side effects of following the ketogenic diet?
· Are there additional (psychological) extenuating outcomes to be considered regarding the ketogenic diet?
· What are the long-term effects from following a ketogenic dietin a long-term capacity?
· Are there special populations (i.e., children and adolescents) that should be considered pertaining to outcomes?
Hypothesis Comment by Kathy Isoldi: I think you should only look into adults- adding children will make this a very difficult project.
Hypothesis:
Delimitations
1. This review will make mention of the variations that may be considered a low carbohydrate ketogenic diet, but attention will not be given to the optimal version of this diet or the most accurate levels of carbohydrates versus fat.
1. Long-term impact of effects will be mentionedtouched upon, but not fully addressed in terms of years or impact over the life span.
1. Age will be included in terms of assessing outcomes on adults versus children or adolescents, but age will not be substantially considered in terms of its influence on the impact of a ketogenic diet on metabolic syndrome as the age of the population increases. Comment by Kathy Isoldi: I don’t think you should include children as most will be done to look at use to treat seizures- not for weight loss.
1. Only the most recent studies were included, translating into publication dates of 2006-2013. Comment by Kathy Isoldi: Are you going to search the most recent studies 2013-2018? I see references from 2018 in your reference section.
Definition of Terms
Metabolic Syndrome: A collective group of risk factors that increases the risk of heart disease and other health detrimentproblems. According to the Nnational Ccholesterol Eeducation Pprogram-Adult Treatment PLAN III, the metabolic syndrome is comprised of the following five risk factors of which three are necessary for a diagnosis- abdominal obesity, high triglyceride level, low high density lipoprotein (HDL) cholesterol level, high blood pressure and/or high fasting glucose (National Institutes of Health [NIH], 2013).
Obese: A Body Mass Index (BMI) of ≥ 30 kg/m2 denotes obesity in an adult (Centers is for Disease Control and Prevention [CDC], 2013).
Very low carbohydrate ketogenic diet: A ketogenic diet is a diet that is high in fat and low in carbohydrates, which forces the body to utilize fats rather than carbohydrates for energy. However, it is defined by the level of carbohydrates within the diet. This means that not all low carbohydrate diets are ketogenic. A very low carbohydrate ketogenic diet is defined as containing less than 50 g/day of total carbohydrates (Brandon, 2018).
Methods used to Identify Literature Reviewed
In locating the relevant studies in the existing body of literature, a search was conducted using PubMed and Cochrane Central Register of Controlled Trials, The search strategy incorporated the longer, more specific search terms for inquiry, which were then to be followed by shorter, broader terms if needed. For example, the first search entailed exploring “the effect of very low carbohydrate ketogenic diets on metabolic syndrome in the obese.” If this did not render sufficient results, the secondary search included terms, such as “effects of low carbohydrate ketogenic diet”, “metabolic syndrome and low carbohydrate diet”, and “ketogenic diet in the obese”. However, this was not necessary as a plethora of results were produced of which a substantial inventory were relevant. In order to narrow down the number of relevant studies and to access the most updated, reliable data, this search was implemented a second time, limiting the search to the most recent studies. The results were as follows:
· “The effect of very low carbohydrate ketogenic diets on metabolic syndrome in the obese” 30+ results — 20 relevant.
· “The effect of very low carbohydrate ketogenic diets on metabolic syndrome in the obese since 2012” =21 results — 10 relevant (4 included above).
· “The effect of very low carbohydrate ketogenic diets on metabolic syndrome in obese adolescents or children” = 17 results — 3 relevant ) Comment by Kathy Isoldi: The methods may need to be adjusted based on my comments.
Proposed Outline of Paper
I. Introduction
a. Defining the components of metabolic syndrome in children and adolescents (Gibson et al., 2018).
b. Determining the most accurate and accepted composition of carbohydrates and fats for a low carbohydrate ketogenic diet
II. The General Effects of a Ketogenic Diet on Weight Loss versus Other Diets
a. Includes randomly controlled trials of the conventional low fat, high carbohydrate = diet on weight loss compared to the very low carbohydrate ketogenic diet (Abete et al., 2010; Wright, Saneto and Friedman, 2018).
b. Overall establishing that the weight loss effect is positive (Gardner et al., 2018;
Ill. Beyond Weight Loss: The Impact of the Low Carbohydrate Ketogenic Diet on the Metabolic Syndrome.
a. Favorable Outcomes & Statistical Significance in Adults and Children (Anderson & Fernandez, 2013; Cormier & Draznin, 2013; Johnstone et al., 2008; Krebs et al., 2010).
b. Long-term Efficacy (Gibson et al., 2014; Krebs et al., 2010).
1. Unfavorable Outcomes in Children versus Adults (Anderson & Fernandez, 2013;
Gibson et al., 2014; Mobbs et al., 2013)
Side Effects
· Psychological & Mood in Children versus Adults (Lambrechts et al., 2013; Wang et al., 2013; Wright, Saneto and Friedman, 2018).
· Adherence & Measurement Issues (Manuel-y-Keenoy, & Perez- Gallardo, 2012).
IV. Population of special interest
a. Variations in Gender (Gardner et al., 2018).
b. Variations in Age Groups: Children & Adolescents (Krebs et al., 2010; Lambrechts et al., 2013; Millichap & Yee, 2012).
V. Discussion of Findings & Implications
1. Summary of Findings
1. Discussion of Overall Quality of Life Implications
1. Limitations within the literature
1. Areas for Future Study
References
Abete, I., Astrup, A., Martinez, J., Thorsdottir, [. & Zulet, M. (2010). Obesity and the metabolic syndrome: role of different dietary macronutrient distribution patterns and specific nutritional components on weight loss and maintenance. Nutrition Reviews, 68(4), 214-231.
Andersen, C. & Fernandez, M. (2013). Dietary strategies to reduce metabolic syndrome. Reviews in Endocrine and Metabolic Disorders, 14(3), 241-254.
Blanton, Jarad, "Implications of the Ketogenic Diet on Metabolic Syndrome" (2018). HS 5900 Project Papers. 1.
Centers for Disease Control and Prevention (CDC). (2013). Obese versus Overweight-definition. Retrieved from http://www.cdc.gov/obesity/adult/defining.html
Cornier, M. & Draznin, B (2013). Low-carbohydrate diets in the treatment of metabolic syndrome. The Metabolic Syndrome, 87-98.
Gardner, C. D., Trepanowski, J. F., Del Gobbo, L. C., Hauser, M. E., Rigdon, J., Ioannidis, J. P. A., … King, A. C. (2018). Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association with Genotype Pattern or Insulin Secretion. JAMA, 319(7), 667.
Gibson, A. A., Seimon, R. V., Lee, C. M. Y., Ayre, J., Franklin, J., Markovic, T. P., … Sainsbury, A. (2014). Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obesity Reviews, 16(1), 64–76.
Harvey, C. J. d C., Schofield, G. M., & Williden, M. (2018). The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review. PeerJ, 6, 4488.
Hu, T., Mills, K., Yao, L., Demanelis, K., Eloustez, M., Yancy, W., ... Bazzano, L. (2012). Effects of low-carbohydrate diets versus low-fat diets on metabolic risk factors: A meta- analysis of randomized controlled clinical trials. American Journal of Epidemiology, 176(S7), 844- $54.
Krebs, N., Gao, D., Gralla, J., Collins, J. & Johnson, S. (2010). Efficacy and safety of a high protein low carbohydrate diet for weight loss in severely obese adolescents. The Journal of Pediatrics, 157(2), 252-258.
Lambrechts, D., Bovens, M., de la Parra, N., Hendrikesen, J., Aldenkamp, A., & Majoie, M. (2013). Ketogenic diet effects on cognition, mood, and psychosocial adjustment in children. Acta Neurologica Scandinavica, 127(2), 103-108.
Leow, Z. Z. X., Guelfi, K. J., Davis, E. A., Jones, T. W., & Fournier, P. A. (2018). 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. Diabetic Medicine, 35(9), 1258–1263.
Manuel-y-Keenoy, B. & Perez-Gallardo, L. (2012). Metabolic impact of the amount and type of dietary carbohydrates on the risk of obesity and diabetes. The Open Nutrition Journal, 6, 21-34,
Millichap, J. & Yee, M. (2012). The diet factor in attention-deficit/hyperactivity disorder. Pediatrics, 129(2), 330-337.
Mobbs, C., Mastaitis, J., Isoda, F. & Poplawski, M. (2013). Treatment of diabetes and diabetic complications with a ketogenic diet. Child Neurology, 5(J1), 11-23.
National Institutes of Health (NIH). (2013). Metabolic Syndrome- definition. Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/ms/
Paoli, A., Rubini, A., Volek, J. & Grimaldi, K. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition, 67, 789-796.
Payne, N., Cross, J., Sander, J. & Sisodiya, S. (2011). The ketogenic and related diets in adolescents and adults—A review. Epilepsia, 52(11), 1941-1948.
Santesso, N., Akl, E., Bianchi, M., Mente, A., Mustafa, R., Heels-Ansdell, D. & Schtinemann, J. (2012). Effects of higher- versus lower-protein diets on health outcomes: a systematic review and meta-analysis. European Journal of Clinical Nutrition, 66, 780-788. 11
Wang, C., Adochio, R., Leitner, J., Abeyta, I., Draznin, B. & Cornier, M. (2013). Acute effects of different diet compositions on skeletal muscle insulin signalling in obese individuals during caloric restriction. Metabolism, 62(4), 595-603.
Wright, J. N., Saneto, R. P., & Friedman, S. D. (2018). β-Hydroxybutyrate Detection with Proton MR Spectroscopy in Children with Drug-Resistant Epilepsy on the Ketogenic Diet. American Journal of Neuroradiology, 39(7), 1336–1340.
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