Journal of Obesity & Eating Disorders

Description

The term Ketogenic Diet (KD) has become increasingly prevalent, encompassing a diverse array of dietary regimens with varying indications, from obesity management to the treatment of neurological disorders. However, the broad usage of this term has led to confusion among patients, healthcare professionals, and researchers alike. This confusion stems from the fact that not all diets labeled as ketogenic share the same metabolic characteristics or therapeutic objectives. A ketogenic diet is traditionally defined as a dietary regimen that induces a state of ketosis, characterized by increased levels of circulating ketone bodies such as beta-hydroxybutyrate, acetoacetate, and acetone. These ketone bodies are typically measured in blood, urine, or breathe to confirm the metabolic state of ketosis. However, the term ketogenic diet is often applied indiscriminately to various dietary approaches without considering the specific metabolic effects or therapeutic goals. One key distinction that must be made is between ketogenic diets used for epilepsy treatment and those employed for weight loss or other purposes. In epilepsy management, the induction of ketosis is a central component of the dietary therapy's mechanism of action.

Dietary therapy

Therefore, it is essential to reserve the term Ketogenic Dietary Therapy (KDT) specifically for protocols designed to treat neurological disorders, as recommended by the International Study Group in 2018. On the other hand, ketogenic diets aimed at weight loss or other health outcomes may not necessarily induce the same level of ketosis as those used for epilepsy treatment. These weight loss protocols often involve low-fat, low-carbohydrate, and moderate to high protein intake, which may only result in mild ketosis when combined with significant calorie restriction. Therefore, labeling these diets as ketogenic may be misleading, as the metabolic effects and therapeutic objectives differ from those of KDTs. To address this issue and clarify terminology, we propose the use of specific abbreviations to denote different types of ketogenic diets based on their dietary composition and metabolic effects. For instance, the term Very Low CarboHydrate Ketogenic Diet (VLCHKD) could be used to describe diets with a strict restriction of carbohydrates aimed at inducing ketosis for epilepsy treatment. Similarly, Very Low Energy Ketogenic Diet (VLEKD) could denote diets designed for weight loss that achieve mild ketosis through calorie restriction. Furthermore, we recommend that researchers and clinicians clearly specify the dietary protocol used when investigating the efficacy or side effects of ketogenic diets. This includes providing a unique acronym for the diet and indicating the level of ketosis achieved, particularly when ketosis is considered a key component of the diet's mechanism of action. In conclusion, the indiscriminate use of the term "ketogenic diet" has led to confusion and ambiguity in both clinical practice and research.

Dietary intervention

By adopting clear and specific terminology and differentiating between different types of ketogenic diets based on their metabolic effects and therapeutic objectives, we can improve communication and ensure accurate interpretation of research findings in the field of nutrition and metabolic health. Furthermore, by standardizing the terminology and clearly delineating the distinctions between different types of ketogenic diets, healthcare professionals can provide more accurate guidance to patients and researchers can conduct more precise studies, ultimately advancing our understanding and optimization of ketogenic dietary interventions for various health conditions.