Ketogenic Metabolic Therapy (Ketogenic Diet-KD) is a food prescription well defined in qualitative and quantitative terms, capable of determining that condition which induces the formation of ketone bodies in the body.

These are normoprotein nutritional plans, which provide for a limited intake of glucose and may have a reduced or increased fat intake (consequently hypo or normocaloric), depending on the therapeutic objectives. The clinical applications of the ketogenic diet concern many pathologies:

• Severe obesity, complicated obesity
  
• Overweight associated with insulin resistance, type 2 diabetes, severe osteoarticular pathologies 
• Diabetes mellitus type II 
• Metabolic syndrome 
• Hepatic steatosis (NAFLD) 
• Neurological disorders - drug-resistant epilepsy, headache
  
• General, orthopedic, bariatric surgery etc.

Evidence of efficacy is also evident in the application of kd protocols in gynecological pathologies (Polycystic Ovary Syndrome, Infertility ...).

A huge amount of scientific literature supports KD as a dietary indication for the treatment of obesity and its complications, with a protocol based on very low calorie and carbohydrate diets. These diets, which also provide a normal protein intake (they are not high protein!), And a calibrated intake of fats, are the so-called Very Low Calory Ketogenic Diet (VLCKD).

The mechanism consists in the triggering of ketosis, which is a physiological mechanism induced by the use of storage fats, in place of carbohydrates, when the latter are lacking.

The metabolism of fats, as a basis for producing energy in the body, allows, unlike what occurs in balanced low-calorie diets, not to compromise the lean mass (which is metabolically active), promoting a rapid weight loss (average of -1 , 3- 1.8 kg per week) and the maintenance of the result, by positive action on the basal metabolic rate.

• inhibition of the sense of hunger 
• efficacy on obesity complications with reduction of the pharmacological requirement for Diabetes, Hypercholesterolaemia, Hypertension etc...
• synergy with Bariatric surgery and with Orthopedic surgery 
• psycho-physical well-being (greater effort tolerance, reduction of joint pain, better sleep quality, ability to concentrate and mood) 
• better adherence to the diet, often experienced as personalized therapy, which takes into account individual lifestyle habits

VLCKD are intensive therapeutic protocols that must be administered under the supervision of the doctor; It is important that the patient, selected on the basis of therapeutic indications and contraindications, is informed about possible side effects, possible complications and practical limitations. The success of a ketogenic diet depends in fact on an in-depth evaluation of the problem to be managed and on a correct planning of the protocol.

The medical-nutritional path for a ketogenic diet includes:

• Pre-treatment evaluation of general clinical conditions, associated pathologies and contraindications, and nutritional status. Prescribes laboratory and instrumental tests ... 
  
• Periodicity of checks for weight monitoring, clinical parameters, exclusion of complications with laboratory tests ...
• Exit from the protocol with gradual reintroduction of carbohydrates (Mediterranean Diet)

Protocol planning

• Features of a VLCKD, such as the use of specifically formulated meal replacement products and progression in distinct phases: The Multiphasic Protocol combines, in progressive steps, different types of diet (VLCD 6-800 kcal with meal replacement, LCD 800- 1000 kcal with partial introduction of conventional foods, up to balanced low calorie 1200-1500 kcal with conventional foods only)
• Personalized programming and shared with the patient of the treatment timing (attack phase; transition phase with gradual reintroduction of carbohydrates, lasting at least equal to the ketosis phase; maintenance phase with balanced Mediterranean diet)
•  Primary efficacy, for the maintenance of the result obtained at the end of the KD cycle, of an educational-behavioral treatment for lifestyle modification.
• Possibility to insert periodic intensive cycles of VLCKD, in diet-behavioral pathways, in order to improve the adhesion of patients suffering from chronic pathologies, such as Obesity, which require long intervention times.