Skip to main content


Volume 6 Supplement 3

Metabolism, diet and disease

Medium term effects of a ketogenic diet and a Mediterranean diet on resting energy expenditure and respiratory ratio


Very low carbohydrate ketogenic type diets (VLCKD) have been shown to be more effective for body weight reduction and fat loss compared to balanced or low-calorie Mediterranean diets, at least in the short-medium term [1, 2], although the underlying mechanisms of its efficacy are still not well understood. Despite being a diet in widespread use there are few data available regarding effects on respiratory ratio (RR) [3, 4] and resting energy expenditure (REE) and, more specifically, there are no reports about the effects on RR following a return to a non ketogenic diet. The aim of this study was to compare the effects of a 20 day ketogenic Mediterranean diet with phytoextracts (KEMEPHY) and a low-calorie Mediterranean diet (MD) on RR and REE during and 20 days after finishing the ketogenic phase.

Materials and methods

Forty healthy, overweight subjects were recruited and randomly divided into two groups: MD (age 46.61 ± 14.6, BMI 26.8±2.6, weight 76.3±9.9 kg ) and KEMEPHY (age 50.63 ±11.6, BMI 28.8±2.8, weight 81.8±11.6 kg). KEMEPHY group followed a ketogenic diet (<30g/day of carbohydrates) using meals that mimic the aspect and the taste of carbohydrates but with virtually zero CHO and with phytoextracts (Tisanoreica®, Lonigo, Italy); after 20 days of strictly KD subjects followed a low carbohydrate non ketogenic diet for 20 days. The MD group followed a standard low-calorie Mediterranean diet (tot Kcal). REE and RR, together with body weight and body composition, were measured in the morning after overnight fasting at the start of the study and after 20 (t20) and 40 days (t40). An Anova test for repeated measures and unpaired t-test with Welch’s correction were performed when appropriate.


Compared to starting values RR was significantly decreased in the KEMEPHY group after 20 days (p<0.05) and after 40 days (p=0.0002) (0.86±0.06; 0.79±0.05; 0.76±0.08; respectively) whilst no significant differences were detected in RR in the MED group. No significant differences in REE were detected. Both groups showed a significant decrease in body weight at t20 and t40 compared to basal conditions (KEMEPHY basal 81.8±11.6; t20 77.8±11.4; t40 75±11.2. MED basal 76.3±9.9; t20 75.6±9.9; 71.7±9.8) with the percentage changes in body weight being significantly greater for the KEMEPHY group. Both groups showed a significant decrease in body fat mass at t20 and t40 compared to basal conditions with the percentage changes in body fat mass being significantly greater for the KEMEPHY group (P=0.0135).


These preliminary data showed that whilst both diet protocols lead to a significant decrease in body weight, the reduction was significantly greater during KEMEPHY. The KEMEPHY diet also lead to a lowering of RR and increased fat oxidation at rest without any effect on REE. These findings suggest that one of the main weight loss mechanisms of KD might be attributed to an improvement in resting nutrient oxidation and interestingly this effect was long lasting, at least for up to 20 days following cessation of the ketogenic. Data on metabolic effects of KEMEPHY 3 months the ketogenic period will soon be available.


  1. 1.

    Volek JS, Sharman MJ: Cardiovascular and hormonal aspects of very-low-carbohydrate ketogenic diets. Obes Res. 2004, 12 (Suppl 2): 115S-23S.

  2. 2.

    Paoli A, Cenci L, Grimaldi KA: Effect of ketogenic Mediterranean diet with phytoextracts and low carbohydrates/high-protein meals on weight, cardiovascular risk factors, body composition and diet compliance in Italian council employees. Nutr J. 2011, 10: 112-

  3. 3.

    Paoli A, Cenci L, Fancelli M, Parmagnani A, Fratter A, Cucchi A, Bianco A: Ketogenic diet and phytoextracts: comparison of the efficacy of mediterranean, Zone and Tisanoreica diet on some health risk factors. Agro Food Ind Hi Tec. 2010, 21: 24-29.

  4. 4.

    Tagliabue A, Bertoli S, Trentani C, Borrelli P, Veggiotti P: Effects of the ketogenic diet on nutritional status, resting energy expenditure, and substrate oxidation in patients with medically refractory epilepsy: A 6-month prospective observational study. Clin Nutr. 2012, 31: 246-249.

Download references

Author information

Correspondence to Antonio Paoli.

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Paoli, A., Grimaldi, K., Bianco, A. et al. Medium term effects of a ketogenic diet and a Mediterranean diet on resting energy expenditure and respiratory ratio. BMC Proc 6, P37 (2012).

Download citation


  • Mediterranean Diet
  • Ketogenic Diet
  • Body Weight Reduction
  • Rest Energy Expenditure
  • Overweight Subject