The Effects of ketogenic diets on cardiovascular disease and stroke prevention department of nursing, Masters Entry into nursing practice, DePaul University Clinton e. Wizelius MS, Rn Standard size usually 3-4 ft Background Cardiovascular disease kills an estimated 17.9 million people per year and is responsible for nearly 31% of all deaths worldwide. 39.8% of adults in the U.S. are obese, costing the taxpayers an estimated 149.9 billion dollars annually. Ketogenic diets (KDs) are low-carbohydrate, high fat diets dietary programs that are gaining significant traction in the general population and in the literature. The body is put in a state of ketosis, where the primary energy source becomes ketone bodies rather than carbohydrates. In a 2,000-calorie diet, a KD would typically consist of 80% fat, 15-20% protein and approximately 10% (50g) of carbohydrates. The ketogenic diet was developed over 80 years ago to treat epilepsy in children. Discussion Of the examined diets, evidence in the literature supports that: No studies showed any increase in weight when implementing the ketogenic diet. Reducing carbohydrate intake and increasing dietary fat intake, regardless of energy intake, tends to reduce weight. Ketogenic diets tend to be more effective and subjects are more likely to maintain this diet than traditional low-fat diets. in a majority of cases, KDs helped increase HDL while decreasing triglycerides. In three studies, LDL values increased, which is of some concern. However, LDL particles increased in size and buoyancy, thus decreasing chances of CVD risk There is inconclusive evidence about the anti-inflammatory effects in human subjects. Implications Nurses play many roles in the healthcare setting from advocacy to patient education. Healthcare providers should be able to help an overweight or obese patient assess their risk for future cardiovascular complications. Nurses should encourage overweight or obese patients to reduce their BMI and explain how this can reduce the chances of CVD, and increase the quality of life. Ketogenic diets have been shown to have higher retention rates than typical low-fat diets. Data from the literature shows that ketogenic diets are an extremely effective option for weight reduction. Studies point to beneficial effects on metabolites and cholesterol levels. Once more is known about the long term effects of KDs and LDL cholesterol, it may be used like the ”Dash” diet, to reduce CVD rates. KDs seem to be a possible alternative for some patients to lose weight and potentially help them avoid cardiac disease. Nurses should stay up to date on dietary trends and use evidence-based practice to treat their patients holistically. Purpose The purpose of this integrative literature review is to identify the role ketogenic diets have in stroke and cardiovascular disease prevention. This review will examine the effect of KDs on blood pressure, cholesterol, inflammatory markers and obesity. The analysis of metabolic and neuroprotective effects will provide an in- depth look for healthcare providers when recommending dietary measures for patients to prevent or treat CVD. Methods Design This paper will be an integrative literature review to identify the use of KDs and their impact on risk factors of CVD. The studies used will be experimental and quantitative and involve human subjects. Since the types of KDs tend to differ in regard to macronutrient intake and length they will be categorized and analyzed by their carbohydrate and fat content as a percent of total caloric intake. Literature Search Strategies The databases PubMED, ProQuest, CINAHL Complete and Google Scholar will be used to complete a search of the literature. There were 87 articles found in PubMed using the search “Ketogenic AND Cardiovascular.” Nine articles found by this method were used in this literature review. Included in the literature search were recommended articles by the search engine, for the related topic. Keywords: Ketogenic Diet, Low Carbohydrate Diet, Stroke, Ketone Bodies, Cardiovascular Disease, Cardiovascular Accident, Obesity, Hypertension, Inflammation Conclusion Evidence is growing that there could be cardiovascular and neuroprotective benefits to adopting a KD. The inconsistent findings in LDL cholesterol levels is a potential complication for recommending this diet to patients susceptible to heart disease. Once long-term studies have been conducted and there’s more evidence of how KDs effect the body, only then can it be recommended to the patient population. With the rising popularity of the ketogenic diet, nurses and healthcare professionals should have a basic understanding of KDs and their potential impacts on the patient. Although further study needs to be done, . If calorically restricted, with low-saturated fats, it seems individuals can have a significant reduction in weight, triglycerides while increasing HDL, over a long period of time. Health care providers should contemplate recommending KDs to relatively healthy individuals looking to lose weight.
Average Reduction in Weight kg Carbohydrate Intake in KD group (g , %) Author (Year) Average Reduction in Weight kg Carbohydrate Intake in KD group (g , %) HDL/LDL mg/dL Triglycerides Avg. Change in Blood Pressure SBP/DBP Participants at Completion Male/Female Length Retention Rate % % Fat Intake Unsat/saturated fats Study ketones (serum/ketonuria) Yancy et al., (2004) -9.4 <20g initial +5g/week once goal weight was reached +5.5/+1.6* -15.2 +9.6*/-6.0*mm Hg KD: 13/32 LFD: 8/26 24 Weeks 76 10-30 Total fat <10 Saturated Ketonuria Ruth et al., (2014) − 2.5 ± 1.5 <40, 10-15 5.1 ± 7.3/− 1.1 ± 36.1 − 33.2 ± 37.3 (unadjusted)** − 8.8 ± 14.1/− 5.2 ± 8.2 KD: 2/16 LFD: 2/13 12 Weeks 60 60 Total fat <7 Sat N/A Brinkworth et al., (2009) -14.5± 1.7kg <30g, 5-15 +0.23 ± 0.09 / +0.6 ±0.2 -0.36 ± 0.15 -13.8 ± 2.5 / -6.3 ± 1.6 11/22 52 Weeks 57.89 61% Serum Markers Urbain et al., (2017) −2.0 ± 1.9 20-40, 5-10 +2.3*/+11.9 -2.0* 11/31 42 Days 86.95 28 Saturated Merra et al., 2017) BMI VLCKD-1 - 1.42 ± 0.95 VLCKD-2 - 1.90 ± 0.36 VLCKD-3 - 2.34 ± 0.37 M:(<20,10) F:(<20,10) M:(<35, 20-25) F:(<35, 20-15) <20% complex carbs M:(<30, 15-20) F:(<30, 20-15) -6.6/-27.2 -2.25*/-28.5* -8.0/-17.33* -16.6* -22.0* -5.17* 1.50 ± 8.51 / 6.00 ± 8.76 0.00 ± 16.33 / 2.50 ± 5.00 -0.83 ± 6.65 / 4.17 ± 8.01 16/38 6 Months 83.07 Total Fat VLCKD-1: 40 VLCKD-2: 45 VLCKD-3: 50 Saturated: VLCKD-1: <10 VLCKD-2: <10 VLCKD-3: <10 Nazarewicz, Ziolkowski, Vaccaro, & Ghafourifar, (2007) -1.7 ± 0.2 55 ± 6, 13 NA 0/20 2 Weeks 100 Total Fat: 74 3HB serum marker Moreno et al., (2014) -19.9 ± 12.6 <50 from vegetables +7.8 / -13.6 -48.7 5/22 12 Months 69.23 Low Fat No Amount Designated Moreno et al., (2016) 12.5 5/17 24 Months 70.00 Gomez-Arbelaez et al., (2018) 20.8 ± 11.8 20 to 36 from vegetables 8/12 8 Weeks 86.96