EXPLORING THE PROS AND CONS OF KETOGENIC, VEGETARIAN AND MEDITERRANEAN DIETS ON MULTIFACETED HEALTH BIOMARKERS: A COMPREHENSIVE REVIEW

Main Article Content

Areej Awan
Muhammad Hamza
Tajally Naeem
Maham Naveed
Ghania Ghani
Sami Ali Babekir
Saliha Naeem
Maryam Tariq
Sidra Aslam
Amna Rafeeq

Keywords

Keto Diet, Epilepsy, Mediterranean Diet, Cognitive Health, Vegetarian Diet, Weight Loss, Diabetes, FAD Diets

Abstract

Background: This review article critically examines the impact of the Ketogenic, Vegetarian, and Mediterranean diets on multifaceted health biomarkers. By keeping in mind the growing interest in diverse dietary patterns, the study utilizes existing literature to provide a comprehensive overview of the advantages and disadvantages associated with these fad diets. 


Methodology: A systematic literature review was conducted to gather relevant studies exploring the effects of Ketogenic, Vegetarian, and Mediterranean diets on multifaceted health biomarkers. Searches were performed on reputable databases, including Google Scholar and PubMed. The search strategy included keywords such as “Ketogenic diet,” “Vegetarian diet,” “Mediterranean diet,”.


Results: The Ketogenic diet exhibited specific benefits in weight management and therapeutic applications but raised concerns regarding nutrient deficiencies and adherence challenges. The Vegetarian diet demonstrated advantages in chronic disease prevention and environmental sustainability but faced drawbacks related to potential nutrient gaps and protein intake. The Mediterranean diet showcased positive effects on heart health, cognitive function, and anti-inflammatory markers, with challenges including sourcing difficulties and higher costs.


Conclusion: In conclusion, this review provides a comprehensive understanding of the pros and cons associated with the Ketogenic, Vegetarian, and Mediterranean diets concerning multifaceted health biomarkers. The present review contributes valuable insights to the existing body of knowledge, aiding individuals, healthcare professionals, and policymakers in making informed decisions about dietary choices and their impact on overall health.

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References

1. World Health Organization. (2003). Diet, nutrition, and the prevention of chronic diseases: report of a joint WHO/FAO expert consultation (Vol. 916). World Health Organization.
2. Drummond, K. E., Reyes, A., Goodell, L. S., Cooke, N. K., & Stage, V. C. (2022). Nutrition research: Concepts and applications.
3. Brown, J. E. (2016). Nutrition through the life cycle. Cengage Learning.
4. Jacka, F. N., O’Neil, A., Opie, R., Itsiopoulos, C., Cotton, S., Mohebbi, M., ... & Berk, M. (2017). A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’trial). BMC medicine, 15(1), 1-13.
5. Gupta, L., Khandelwal, D., Kalra, S., Gupta, P., Dutta, D., & Aggarwal, S. (2017). Ketogenic diet in endocrine disorders: Current perspectives. Journal of postgraduate medicine, 63(4), 242.
6. Paoli, A., Rubini, A., Volek, J. S., & Grimaldi, K. A. (2013). Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European journal of clinical nutrition, 67(8), 789-796.
7. Gibson, A. A., Seimon, R. V., Lee, C. M., Ayre, J., Franklin, J., Markovic, T. P., ... & Sainsbury, A. (2015). Do ketogenic diets really suppress appetite? A systematic review and meta‐analysis. Obesity reviews, 16(1), 64-76.
8. Le, L. T., & Sabaté, J. (2014). Beyond meatless, the health effects of vegan diets: findings from the Adventist cohorts. Nutrients, 6(6), 2131-2147.
9. Dinu, M., Abbate, R., Gensini, G. F., Casini, A., & Sofi, F. (2017). Vegetarian, vegan diets and multiple health outcomes: a systematic review with meta-analysis of observational studies. Critical reviews in food science and nutrition, 57(17), 3640-3649.
10. Mollohan, E. A. (2022). The Plant-Based Diet Transition among People with Cardiovascular Disease (Doctoral dissertation, The University of Akron).
11. Carlos, S., De La Fuente-Arrillaga, C., Bes-Rastrollo, M., Razquin, C., Rico-Campà, A., Martínez-González, M. A., & Ruiz-Canela, M. (2018). Mediterranean diet and health outcomes in the SUN cohort. Nutrients, 10(4), 439.
12. Freeman, J. M., Kossoff, E. H., & Hartman, A. L. (2007). The ketogenic diet: one decade later. Pediatrics, 119(3), 535-543.
13. Bueno, N. B., de Melo, I. S. V., de Oliveira, S. L., & da Rocha Ataide, T. (2013). Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. British Journal of Nutrition, 110(7), 1178-1187.
14. Neal, E. G., Chaffe, H., Schwartz, R. H., Lawson, M. S., Edwards, N., Fitzsimmons, G., ... & Cross, J. H. (2008). The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. The Lancet Neurology, 7(6), 500-506.
15. Gasior, M., Rogawski, M. A., & Hartman, A. L. (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17(5-6), 431.
16. Saslow, L. R., Kim, S., Daubenmier, J. J., Moskowitz, J. T., Phinney, S. D., Goldman, V., ... & Hecht, F. M. (2014). A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes. PloS one, 9(4), e91027.
17. Masood, W., Annamaraju, P., & Uppaluri, K. R. (2022). Ketogenic diet. In StatPearls. StatPearls Publishing.
18. Ebbeling, C. B., Feldman, H. A., Klein, G. L., Wong, J. M., Bielak, L., Steltz, S. K., ... & Ludwig, D. S. (2018). Effects of a low carbohydrate diet on energy expenditure during weight loss maintenance: randomized trial. bmj, 363.
19. Bostock, E., Kirkby, K. C., Taylor, B. V., & Hawrelak, J. A. (2020). Consumer reports of “keto flu” associated with the ketogenic diet. Frontiers in nutrition, 20.
20. O'Neill, B., & Raggi, P. (2020). The ketogenic diet: Pros and cons. Atherosclerosis, 292, 119-126.
21. Anderson, J. C., Mattar, S. G., Greenway, F. L., & Lindquist, R. J. (2021). Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis. Obesity science & practice, 7(5), 646-656.
22. Harvey, C., Schofield, G., & Williden, M. (2018). The lived experience of healthy adults following a ketogenic diet: A qualitative study. The Journal of Holistic Performance, 3638.
23. Lightstone, L., Shinnar, S., Callahan, C. M., & O'Dell, C. (2001). Reasons for failure of the ketogenic diet. Journal of Neuroscience Nursing, 33(6), 292.
24. Johnstone, A. M., Horgan, G. W., Murison, S. D., Bremner, D. M., & Lobley, G. E. (2008). Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. The American journal of clinical nutrition, 87(1), 44-55.
25. Turner-McGrievy, G., & Harris, M. (2014). Key elements of plant-based diets associated with reduced risk of metabolic syndrome. Current diabetes reports, 14, 1-9.
26. Kahleova, H., Levin, S., & Barnard, N. D. (2018). Vegetarian dietary patterns and cardiovascular disease. Progress in cardiovascular diseases, 61(1), 54-61.
27. Hess, J. M., Comeau, M. E., Swanson, K., & Burbank, M. (2023). Modeling Ovo-vegetarian, Lacto-vegetarian, Pescatarian, and Vegan USDA Food Patterns and Assessing Nutrient Adequacy for Lactation among Adult Females. Current Developments in Nutrition, 7(12), 102034.
28. Austria, J. A., Richard, M. N., Chahine, M. N., Edel, A. L., Malcolmson, L. J., Dupasquier, C. M., & Pierce, G. N. (2008). Bioavailability of alpha-linolenic acid in subjects after ingestion of three different forms of flaxseed. Journal of the American College of Nutrition, 27(2), 214-221.
29. Hooper, L., Thompson, R. L., Harrison, R. A., Summerbell, C. D., Ness, A. R., Moore, H. J., ... & Smith, G. D. (2006). Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. Bmj, 332(7544), 752-760.
30. Key, T. J., Appleby, P. N., & Rosell, M. S. (2006). Health effects of vegetarian and vegan diets. Proceedings of the Nutrition Society, 65(1), 35-41.
31. Pawlak, R., Lester, S. E., & Babatunde, T. (2014). The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. European journal of clinical nutrition, 68(5), 541-548.
32. McEvoy, C. T., Temple, N., & Woodside, J. V. (2012). Vegetarian diets, low-meat diets and health: a review. Public health nutrition, 15(12), 2287-2294.
33. Satija, A., Bhupathiraju, S. N., Spiegelman, D., Chiuve, S. E., Manson, J. E., Willett, W., ... & Hu, F. B. (2017). Healthful and unhealthful plant-based diets and the risk of coronary heart disease in US adults. Journal of the American college of cardiology, 70(4), 411-422.
34. Orlich, M. J., Singh, P. N., Sabaté, J., Jaceldo-Siegl, K., Fan, J., Knutsen, S., ... & Fraser, G. E. (2013). Vegetarian dietary patterns and mortality in Adventist Health Study 2. JAMA internal medicine, 173(13), 1230-1238.
35. Barnard, N. D., Cohen, J., Jenkins, D. J., Turner-McGrievy, G., Gloede, L., Green, A., & Ferdowsian, H. (2009). A low-fat vegan diet and a conventional diabetes diet in the treatment of type 2 diabetes: a randomized, controlled, 74-wk clinical trial. The American journal of clinical nutrition, 89(5), 1588S-1596S.
36. Juraschek, S. P., Miller, E. R., Weaver, C. M., & Appel, L. J. (2017). Effects of sodium reduction and the DASH diet in relation to baseline blood pressure. Journal of the American College of Cardiology, 70(23), 2841-2848.
37. Tonstad, S., Butler, T., Yan, R., & Fraser, G. E. (2009). Type of vegetarian diet, body weight, and prevalence of type 2 diabetes. Diabetes care, 32(5), 791-796.
38. Yokoyama, Y., Nishimura, K., Barnard, N. D., Takegami, M., Watanabe, M., Sekikawa, A., ... & Miyamoto, Y. (2014). Vegetarian diets and blood pressure: a meta-analysis. JAMA internal medicine, 174(4), 577-587.
39. Huang, R. Y., Huang, C. C., Hu, F. B., & Chavarro, J. E. (2016). Vegetarian diets and weight reduction: a meta-analysis of randomized controlled trials. Journal of general internal medicine, 31(1), 109-116.
40. Huang, T., Yang, B., Zheng, J., Li, G., Wahlqvist, M. L., & Li, D. (2012). Cardiovascular disease mortality and cancer incidence in vegetarians: a meta-analysis and systematic review. Annals of nutrition and metabolism, 60(4), 233-240.
41. Clinton, S. K., Giovannucci, E. L., & Hursting, S. D. (2020). The world cancer research fund/American institute for cancer research third expert report on diet, nutrition, physical activity, and cancer: impact and future directions. The Journal of nutrition, 150(4), 663-671.
42. Joshipura, K. J., Hu, F. B., Manson, J. E., Stampfer, M. J., Rimm, E. B., Speizer, F. E., ... & Willett, W. C. (2001). The effect of fruit and vegetable intake on risk for coronary heart disease. Annals of internal medicine, 134(12), 1106-1114.
43. Craig, W. J. (2009). Health effects of vegan diets. The American journal of clinical nutrition, 89(5), S1627-S1633.
44. Aune, D., Chan, D. S., Lau, R., Vieira, R., Greenwood, D. C., Kampman, E., & Norat, T. (2011). Dietary fibre, whole grains, and risk of colorectal cancer: systematic review and dose-response meta-analysis of prospective studies. Bmj, 343.
45. Holscher, H. D. (2017). Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut microbes, 8(2), 172-184.
46. Brown, L., Rosner, B., Willett, W. W., & Sacks, F. M. (1999). Cholesterol-lowering effects of dietary fiber: a meta-analysis. The American journal of clinical nutrition, 69(1), 30-42.
47. Park, Y., Hunter, D. J., Spiegelman, D., Bergkvist, L., Berrino, F., Van Den Brandt, P. A., ... & Smith-Warner, S. A. (2005). Dietary fiber intake and risk of colorectal cancer: a pooled analysis of prospective cohort studies. Jama, 294(22), 2849-2857.
48. Leitzmann, C. (2014). Vegetarian nutrition: past, present, future. The American journal of clinical nutrition, 100(suppl_1), 496S-502S.
49. Craddock, J. C., Neale, E. P., Peoples, G. E., & Probst, Y. C. (2020). Plant‐based eating patterns and endurance performance: A focus on inflammation, oxidative stress and immune responses. Nutrition Bulletin, 45(2), 123-132.
50. Mangano, K. M., Sahni, S., & Kerstetter, J. E. (2014). Dietary protein is beneficial to bone health under conditions of adequate calcium intake: an update on clinical research. Current opinion in clinical nutrition and metabolic care, 17(1), 69.
51. Springmann, M., Godfray, H. C. J., Rayner, M., & Scarborough, P. (2016). Analysis and valuation of the health and climate change cobenefits of dietary change. Proceedings of the National Academy of Sciences, 113(15), 4146-4151.
52. Willett, W., Rockström, J., Loken, B., Springmann, M., Lang, T., Vermeulen, S., ... & Murray, C. J. (2019). Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The lancet, 393(10170), 447-492.
53. Hoekstra, A. Y., & Mekonnen, M. M. (2012). The water footprint of humanity. Proceedings of the national academy of sciences, 109(9), 3232-3237.
54. Malthus, T. J., Ohmsen, R., & Woerd, H. J. V. D. (2020). An evaluation of citizen science smartphone apps for inland water quality assessment. Remote Sensing, 12(10), 1578.
55. Gilsing, A. M., Crowe, F. L., Lloyd-Wright, Z., Sanders, T. A., Appleby, P. N., Allen, N. E., & Key, T. J. (2010). Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort study. European journal of clinical nutrition, 64(9), 933-939.
56. Obeid, R., Geisel, J., Schorr, H., Hübner, U., & Herrmann, W. (2002). The impact of vegetarianism on some haematological parameters. European Journal of Haematology, 69(5‐6), 275-279.
57. Nettleton, J. A. (1991). Omega-3 fatty acids: comparison of plant and seafood sources in human nutrition. Journal of the American Dietetic Association, 91(3), 331-338.
58. Mangels, A. R. (2014). Bone nutrients for vegetarians. The American journal of clinical nutrition, 100(suppl_1), 469S-475S.
59. Marsh, K. A., Munn, E. A., & Baines, S. K. (2013). Protein and vegetarian diets. Med J Aust, 199(4 Suppl), S7-S10.
60. Day, L., Cakebread, J. A., & Loveday, S. M. (2022). Food proteins from animals and plants: Differences in the nutritional and functional properties. Trends in Food Science & Technology, 119, 428-442.
61. Willett, W. C., Sacks, F., Trichopoulou, A., Drescher, G., Ferro-Luzzi, A., Helsing, E., & Trichopoulos, D. (1995). Mediterranean diet pyramid: a cultural model for healthy eating. The American journal of clinical nutrition, 61(6), 1402S-1406S
62. Estruch Riba, R., Ros Rahola, E., Salas Salvadó, J., Covas Planells, M. I., Corella Piquer, D., Arós, F., ... & Martínez-González, M. Á. (2013). Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine, 2013, vol. 368, num. 14, p. 1279-1290.
63. Martínez-González, M. A., Salas-Salvadó, J., Estruch, R., Corella, D., Fitó, M., Ros, E., & Predimed Investigators. (2015). Benefits of the Mediterranean diet: insights from the PREDIMED study. Progress in cardiovascular diseases, 58(1), 50-60.
64. Schwingshackl, L., Missbach, B., König, J., & Hoffmann, G. (2015). Adherence to a Mediterranean diet and risk of diabetes: a systematic review and meta-analysis. Public health nutrition, 18(7), 1292-1299.
65. Salas-Salvadó, J., Guasch-Ferré, M., Lee, C. H., Estruch, R., Clish, C. B., & Ros, E. (2015). Protective effects of the Mediterranean diet on type 2 diabetes and metabolic syndrome. The Journal of nutrition, 146(4), 920S-927S.
66. Couto, E., Boffetta, P., Lagiou, P., Ferrari, P., Buckland, G., Overvad, K., ... & Trichopoulou, A. (2011). Mediterranean dietary pattern and cancer risk in the EPIC cohort. British journal of cancer, 104(9), 1493-1499.
67. Psaltopoulou, T., Sergentanis, T. N., Panagiotakos, D. B., Sergentanis, I. N., Kosti, R., & Scarmeas, N. (2013). Mediterranean diet, stroke, cognitive impairment, and depression: a meta‐analysis. Annals of neurology, 74(4), 580-591
68. Valls-Pedret, C., Sala-Vila, A., Serra-Mir, M., Corella, D., De la Torre, R., Martínez-González, M. Á., ... & Ros, E. (2015). Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA internal medicine, 175(7), 1094-1103.
69. McNamara, R. K., Jandacek, R., Rider, T., Tso, P., Chu, W. J., Weber, W. A., ... & DelBello, M. P. (2016). Effects of fish oil supplementation on prefrontal metabolite concentrations in adolescents with major depressive disorder: a preliminary 1H MRS study. Nutritional neuroscience, 19(4), 145-155.
70. Grosso, G., Galvano, F., Marventano, S., Malaguarnera, M., Bucolo, C., Drago, F., & Caraci, F. (2014). Omega-3 fatty acids and depression: scientific evidence and biological mechanisms. Oxidative medicine and cellular longevity, 2014.
71. Skarupski, K. A., Tangney, C. C., Li, H., Evans, D. A., & Morris, M. C. (2013). Mediterranean diet and depressive symptoms among older adults over time. The journal of nutrition, health & aging, 17, 441-445.
72. Pelletier, A., Barul, C., Féart, C., Helmer, C., Bernard, C., Periot, O., ... & Samieri, C. (2015). Mediterranean diet and preserved brain structural connectivity in older subjects. Alzheimer's & Dementia, 11(9), 1023-1031.
73. Lassale, C., Batty, G. D., Baghdadli, A., Jacka, F., Sánchez-Villegas, A., Kivimäki, M., & Akbaraly, T. (2019). Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Molecular psychiatry, 24(7), 965-986.
74. Calder, P. C. (2017). Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochemical Society Transactions, 45(5), 1105-1115.
75. Tuttolomondo, A., Simonetta, I., Daidone, M., Mogavero, A., Ortello, A., & Pinto, A. (2019). Metabolic and vascular effect of the Mediterranean diet. International journal of molecular sciences, 20(19), 4716.
76. De Filippis, F., Pellegrini, N., Vannini, L., Jeffery, I. B., La Storia, A., & Laghi, L. (2016). I Serrazanetti D., Di Cagno R., Ferrocino I., Lazzi C., et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut, 65, 1812-1821.
77. Sofi, F., Cesari, F., Abbate, R., Gensini, G. F., & Casini, A. (2008). Adherence to Mediterranean diet and health status: meta-analysis. Bmj, 337.
78. Iacoviello, L. (2018). Perspectives and challenges for adoption of the Mediterranean diet. European Journal of Public Health, 28(suppl_4), cky213-766.
79. Saulle, R., Semyonov, L., & La Torre, G. (2013). Cost and cost-effectiveness of the Mediterranean diet: results of a systematic review. Nutrients, 5(11), 4566-4586.
80. Drewnowski, A., & Eichelsdoerfer, P. (2009). The Mediterranean diet: does it have to cost more?. Public health nutrition, 12(9A), 1621-1628.
81. Cavaliere, A., De Marchi, E., & Banterle, A. (2018). Exploring the adherence to the Mediterranean diet and its relationship with individual lifestyle: the role of healthy behaviors, pro-environmental behaviors, income, and education. Nutrients, 10(2), 141.

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