Discussion Weight loss It is thought that consumption of a high-fat-protein diet will be accompanied by a higher weight gain. On the contrary, our results confirm that the SKMD is an effective therapy for obesity without caloric restriction. Our hypothesis is founded in the following statements: 1. Many studies have confirmed that the ketogenic diet is an effective therapy for obesity [ 1 , 21 - 26 ].
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Discussion Weight loss It is thought that consumption of a high-fat-protein diet will be accompanied by a higher weight gain. On the contrary, our results confirm that the SKMD is an effective therapy for obesity without caloric restriction.
Our hypothesis is founded in the following statements: 1. Many studies have confirmed that the ketogenic diet is an effective therapy for obesity [ 1 , 21 - 26 ]. Low-carbohydrate diets have even proved to be more effective than conventional diets for more selective fat loss and conserving muscle mass [ 1 , 24 - 26 ], moreover, several longer term studies have noted improvements in body composition on a higher protein pattern despite similar weight loss [ 27 ].
MUFA-rich diet prevents central fat redistribution [ 14 ]. High unsaturated fat diet is more effective to preserve lean mass than a low fat diet or a low carbohydrate diet [ 23 ]. In connection with the moderate red wine consumption of the SKMD, we agree with the statement that moderate red wine consumption ml is not associated with differences in body weight [ 29 ], so this consumption would not affect to the weight loss.
Further trials are required to examine the potential role of the SKMD for the selective fat loss and its protective effect against muscle protein catabolism. These findings could be explained by the following points: 1. A low carbohydrate diet reduces fasting glucose levels, even independently of the weight loss [ 30 , 31 ]. MUFA-rich diet prevents insulin resistance induced by a carbohydrate-rich diet in insulin-resistant subjects [ 14 ].
We think that the moderate prandial red wine consumption of the SKMD did not have effect beneficial or adverse on the glycemic control, since Gin et al. This healthy cardiovascular profile is probably due to the favorable interaction of the weight loss and the components of the SKMD: high protein ketogenic diet-virgin olive oil-fish oil-red wine-salad. Our arguments are founded in the following findings: 1.
Ketogenic diets improve all aspects of atherogenic dyslipidemia, decreasing fasting and postprandial triglyceride levels and increasing HDLc and LDLc particle size [ 1 , 33 ].
When the ketogenic diet is higher in protein than fat, the level of LDLc also decreases [ 33 - 35 ]. Ingestion of virgin olive oil increases HDLc levels [ 36 ] and decreases LDLc levels [ 37 - 39 ] and blood pressure [ 38 , 39 ]. Omega-3 PUFA reduce plasma triacylglycerol concentrations [ 40 , 41 ]. The salad consumption is inversely associated with diastolic blood pressure [ 44 ]. Explanations and Suggestions We recognize several limitations of our study that may have influenced the study findings: 1.
The sample of the study is small 31 subjects. This is not a random population study, since subjects were selected for eligibility and their eligibility was related with their compliance to the diet. Weight loss may be related with improvement in all parameters that are studied. Although the effect of vitamins is not clear, especially in short interventions, their possible contribution to better cardiovascular parameters should be possible.
Our study has no control groups to consider the interaction between the components of the SKMD. There is no way to say if the healthy results are due to the ketogenic nature of the diet, the virgin olive oil, the red wine, the higher fish intake, the higher salad intake or a synergic effect between these components.
All these limitations should be known and accordingly considered by further trials. Conclusion The SKMD is safe, an effective way of losing weight, promoting non-atherogenic lipid profiles, lowering blood pressure and improving fasting blood glucose levels.
Future research should include a larger sample size, a longer term use and a comparison with other ketogenic diets. Competing interests The authors declare that they have no competing interests. AMS was responsible for analysis and interpretation of data. AAM was responsible for study design, analysis and interpretation of data. Acknowledgements The authors thank the men and women who participated in this investigation.
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Spanish Ketogenic Mediterranean diet: a healthy cardiovascular diet for weight loss