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pISSN 2288-176X
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362
*Corresponding author: Hee-Tae Roh
Department of Physical Education, Yonsei University, 50 Yonsei-ro,
Seodaemun-gu, Seoul 120-749, Korea
Tel: +82-2-2123-3199, Fax: +82-2-2123-3199, E-mail: htroh@yonsei.ac.kr
Received: December 2, 2014 / Accepted: December 17, 2014
The effects of ketogenic diet on oxidative stress and
antioxidative capacity markers of Taekwondo athletes
Hyun-seung Rhyu
1
, Su-Youn Cho
2
, Hee-Tae Roh
3,
*
1
Department of Sports Health Medicine, College of Health Science, Jungwon University, Goesan-gun, Chungcheongbuk-do, Korea
2
Department of Human Movement Science, Seoul Women’s University, Seoul, Korea
3
Department of Physical Education, Yonsei University, Seoul, Korea
The purpose of this study was to investigate the effects of the ketogenic
diet through 3 weeks on oxidative stress and antioxidative capacity
markers in Taekwondo athletes. The participants selected for this re-
search were 18 high school taekwondo contestants aged 15-18 who
had at least 5 yr of career as contestant. The subjects were randomly
assigned to the ketogenic diet (KD) group and the Non ketogenic diet
(NDK) group. Body composition and oxidative stress and antioxidative
capacity markers (LDH, MDA, ROS, HDL, and SOD) were analysed be-
fore and after 3 weeks of ketogenic diet. No significant difference was
found between the groups in body composition, ROS and SOD level.
The KD group showed an elevated HDL level and NKD group showed
an elevated LDH and MDA level after ketogenic diet by 3 weeks. This
result suggests that weight loss by 3 weeks of calorie restriction and
exercise can cause oxidative stress, and that ketogenic diet can be ef-
fective for preventing it. It could also be inferred that ketogenic diet can
be effective for increasing blood antioxidative capacity.
Keywords: Taekwondo, Ketogenic diet, Oxidative stress, Antioxidative
capacity
INTRODUCTION
Contestants participating in a weight class contest must meet a
certain weight limit. Since a contestant with a heavier weight usually
has relatively stronger muscle power than one with a lighter weight,
most contestants with heavier weights attempt to lose weight in ab-
normal ways so as to take advantage of their stronger muscle power
by participating in contests of lower weight classes than their nor-
mal weight classes. Most of the weight loss methods used by weight
class contestants involve artificially induced short-term dehydra-
tion, restricted diet, and severe exercise inducing body fluid loss. It
has been reported that such methods might cause increased reac-
tive oxygen species (ROS) production (Anuradha and Balakrish-
nan, 1998).
ROS, produced by physiological metabolism or external stimuli,
are receiving growing recognition as a major factor that induces ox-
idative stress and thereby causes not only cell and tissue damage
but also accelerated aging and various diseases (including cardio-
vascular diseases, cancers, Alzheimer’s disease and Parkinson’s dis-
ease) (Fruehauf and Meyskens, 2007; Weinberg and Chandel,
2009). In addition, it was reported that accelerated lipid peroxida-
tion caused by ROS had a positive correlation with skeletal muscle
damage (Daekeun et al., 2012).
For this reason, an effective weight loss method has continuously
been demanded that does not deteriorate the performance and
health of the weight class contestants who definitely need weight
loss (Paoli et al., 2012). Meanwhile, Nazarewicz et al. (2007) re-
ported that 14 days of ketogenic diet with dietary restriction in-
volving healthy adult women resulted in weight loss and signifi-
cant improvement in total antioxidative status, without causing
blood oxidative stress. Ketogenic diet is a low carbohydrate and
high fat diet that causes the concentration of ketone bodies, which
are by-products of fat burning, to become higher than that of glu-
cose in the blood. When such a physiological state, called ketosis,
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Original Article
Journal of Exercise Rehabilitation 2014;10(6):362-366
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Rhyu H, et al. • Effect of ketogenic diet on oxidative stress
is reached, fat begins to be burned fast, fat accumulation stops, and
fat becomes the main source of energy metabolism (Pethick and
Lindsay, 1982). In the research of Nazarewicz et al. (2007), howev-
er, ketogenic diet was conducted without a control group, and
therefore it is not clear whether the antioxidant effect was due to
ketogenic diet or due to weight loss caused by dietary restriction.
There have been some other researches reporting the oxidative
stress and antioxidant effect by ketogenic diet, but most of their
research subjects were patients with diseases; moreover, their re-
sults disagree with each other (Gasior et al., 2006; Jain et al., 1999;
Leornardi et al., 2010; Nazarewicz et al., 2007).
Therefore, the present research involved male high school tae-
kwondo contestants to verify the efficacy of ketogenic diet for
weight loss by examining the effect of 3 weeks of diet on oxidative
stress and antioxidative capacity.
MATERIALS AND METHODS
Participants
The participants selected for this research were 18 high school
taekwondo contestants aged 15-18 who had at least 5 yr of career
as contestant and who neither had particular medical diseases (such
as muscular skeletal diseases, genetic diseases and heart diseases)
nor was taking dietary supplements (such as vitamins).
The participants were randomly assigned to 2 groups: 9 of them
to the ketogenic diet (KD) group, and the remaining 9 to the non
ketogenic diet (NDK) group. Their physical characteristics are
presented in Table 1.
Experimental procedures
Evaluation of body mass and body composition
Before and after the 3 weeks of experimental diet period, the sub-
jects fasted 12 h. Then, wearing a simple cloth in the morning, they
were subjected to the measurement of body composition. In order
to evaluate changes in body composition caused by the 3 weeks of
KD and NKD, respectively, measurements were taken of height,
weight and BMI, as well as of %body fat and lean body mass us-
ing the electric resistance method.
Method and procedure for diet
Before the experimental diet period, every research subject pre-
pared a document stating calorie intake for 3 days, and their daily
mean calorie intake was calculated. Then each of the KD and
NKD groups was provided with a different menu containing 75%
of the calculated daily mean calories.
Based on the menu used by Paoli et al. (2012), the menu for the
KD group consisted of high fat foods (such as beef, pork, fish,
bean, egg and cheese) whose lipid, protein and carbohydrate con-
tents were 55.0%, 40.7%, and 4.3%, respectively; while alcohol,
bread, rice, noodles, coffee and tea were restricted. Whereas the
NKD group was provided with a menu whose lipid, protein and
carbohydrate contents were 30%, 30%, and 40%, respectively.
Exercise program
Six days a week for 3 weeks during the weight loss period, both
groups participated in a training program that emphasized physi-
cal strength improvement. The daily plan of the program consisted
of 1 h of low intensity dawn exercise; 2 h of morning exercise, most-
ly for physical strength improvement; and 2 h of afternoon exer-
cise, mostly for taekwondo skills training.
Blood collection and analysis
Blood was collected from the antecubital vein using 22 gage
needles, in the morning of the day before the beginning of the
study, and in the morning after the 3 weeks of the study. The col-
lected blood was subjected to analysis of lactatedehydrogenase
(LDH), malondialdehyde (MDA), ROS, superoxide dismutase
(SOD) , high density lipoprotein (HDL). Serum LDH and HDL
concentrations were detected by biochemical analyzer (Kodak,
USA). Serum ROS levels were determined using an OxiSelect
TM
In
Vitro ROS/RNS Assay Kit (#STA-347, CELL BIOLABS, USA).
The MDA concentrations in the sera were determined by the Col-
orimetric Assay, using commercially available BIOXYTECH
LPO-586 kit (#21012, Oxis, USA). The SOD concentrations in
the sera were determined by the Colorimetric Assay, using com-
mercially available Superoxide Dismutase Assay Kit(#CM706002,
IBL-Internationall, Germany). All reagents, dilutions, and calcula-
tions were applied according to the manufacturer’s instructions.
The absorbance was measured at 450 nm with a microplate reader
(GENios, TECAN, Austria).
Statistical analyses
Data are presented as means
±
standard deviation (SD). The sig-
nificance of differences among mean values between pre and post-
Table 1. Physical characteristics of the subjects
Group (n = 20) Age (yr) Height (cm) Weight (kg)
KD (n = 10) 16.22 ± 0.79 174.41 ± 5.30 64.37 ± 5.21
NKD (n = 10) 16.67 ± 0.82 172.48 ± 6.19 62.51 ± 6.684
Values are means ± SD. KD, ketogenic diet; NKD, non-ketogenic diet.
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Rhyu H, et al. • Effect of ketogenic diet on oxidative stress
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diet, as well as between KD and NKD groups, were determined by
two-way analysis of variance (ANOVA) using SPSS 18.0 for Win-
dows. Statistical significance was set at
α
=
0.05.
RESULTS
Body composition
Changes in body mass and body composition after diet, com-
pared to before diet, by the diet groups are presented in Table 2.
Compared to before the diet period, there was significant de-
crease in weight after the period, as well as in %body fat, fat free
mass and BMI (P
<
0.05). However, no difference was found be-
tween the KD and NKD groups, and there was also no effect of
interaction between the independent variables.
Oxidative stress and antioxidative capacity markers
Changes in oxidative stress and antioxidative capacity markers
after diet during 3 weeks, compared to before diet, by the diet groups
are presented in Table 3.
In the cases of ROS and SOD, no significant difference was found
Table 2. Changes in body composition
Variables
KD (n = 10) NKD (n = 10)
F-value
Pre Post Pre Post
Weight (kg) 64.37 ± 5.52 60.99 ± 6.65 62.51 ± 7.08 60.11 ± 7.54 G 0.188
T 50.971*
G×T 1.460
%Body fat (%) 13.04 ± 3.88 11.90 ± 3.19 10.93 ± 1.36 10.21 ± 2.03 G 2.186
T 10.420*
G×T 0.533
Lean body mass (kg) 55.01 ± 3.99 52.72 ± 4.88 54.97 ± 6.90 52.78 ± 8.26 G 0.000
T 28.782*
G×T 0.014
BMI (kg/m
2
) 21.13 ± 0.98 19.97 ± 1.15 20.94 ± 1.30 20.13 ± 1.44 G 0.000
T 53.656*
G×T 1.734
Values are means ± SD. KD, ketogenic diet; NKD, non-ketogenic diet. *P < 0.05.
Table 3. Oxidative stress and antioxidative capacity markers
KD (n = 10) NKD (n = 10)
F-value
Pre Post Pre Post
LDH (U/L) 404.89 ± 55.94 399.78 ± 76.39 395.56 ± 32.12 422.00 ± 33.47 G 0.074
T 2.125
G×T 4.650*
MDA (pmol/mg) 0.134 ± 0.080 0.131 ± 0.064 0.131 ± 0.07 0.184 ± 0.048 G 0.745
T 4.171
G×T 5.316*
ROS (pg/mL) 87.16 ± 30.31 88.84 ± 21.57 77.73 ± 15.89 82.63 ± 30.23 G 0.638
T 0.241
G×T 0.057
HDL (mg/dL) 59.21 ± 8.41 73.32 ± 13.15 61.14 ± 6.67 63.81 ± 7.86 G 0.863
T 25.029*
G×T 11.646*
SOD (%SOD activity) 50.34 ± 5.32 46.70 ± 3.52 47.98 ± 2.55 47.25 ± 3.1 G 0.518
T 3.75
G×T 1.661
Values are means ± SD. KD, ketogenic diet; NKD, non-ketogenic diet. *P < 0.05.
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Rhyu H, et al. • Effect of ketogenic diet on oxidative stress
between the independent variables. In contrast, in the case of LDH,
MDA and HDL interaction effect was found when comparison was
made between before and after diet and between diet groups
(P
<
0.05). According to result of the main effect analysis, the KD
group showed an elevated HDL level and NKD group showed an
elevated both LDH and MDA level after diet compared to before
diet (P
<
0.05).
DISCUSSION
During the last several yr, there have been many research reports
that proved the effects of ketogenic diet on short-term weight loss,
as well as on metabolic profile with regard to insulin sensitivity,
glycemic control and serum lipid values (Nazarewicz et al., 2007;
Stafford et al., 2010; Veech, 2004). In addition, Paoli et al. (2012)
reported that 30 days of ketogenic diet could decrease the weight
and body fat mass of elite artistic gymnasts without affecting their
performance. Such research results show that ketogenic diet can be
very effective for weight class contestants who need rapid short-
term weight loss without negative effect on performance. Howev-
er, in spite of many reports on the effect of ketogenic diet, there
have been rare researches that involved athletic contestants to in-
vestigate the effect of short-term ketogenic diet on body mass and
body composition.
Therefore the present research involved taekwondo contestants
to examine the weight loss effect of 3 weeks of ketogenic diet vs
common diet, with calorie restriction. The result showed that 3
weeks of Ketogenic diet and Non ketogenic diet both caused de-
creases of weight, body fat mass and BMI, and that there was no
difference between the 2 groups in the extent of such decreases. In
addition, although Paoli et al. (2012) reported that ketogenic diet
could increase muscle mass, the result of the present research
showed decrease of lean body mass in both groups. Such a differ-
ence is considered due to the effect of the 25% calorie restriction
and extensive aerobic exercise program that were used for both
groups in this research, because preceding researches on ketogenic
diet did not involve calorie restriction.
Ketogenic diet leads to the production of ketone bodies, such as
β
-hydroxybutyrate and acetoacetate, which can be used as an alter-
native energy source. There is a recent report that ketone bodies
potentially decreased ROS production (Bough and Rho, 2007;
Gredilla and Barja, 2005). In the present research, however, both of
the 2 groups showed no change in ROS after the 3 weeks of diet.
Instead, increases in LDH and MDA were shown by the NKD
group after the 3 weeks of diet, but not by the KD group. Oxida-
tive stress caused by exercise can results in damage to skeletal mus-
cle cells, which in turn leads to increase of LDH (Brancaccio et al.,
2010). MDA is produced as the result of the degradation of poly-
unsaturated fatty acid peroxidation products, and it has been used
as a traditional oxidative stress index (Rachmilewitz et al., 1976).
In addition, increase of HDL was also shown after the 3 weeks of
KD diet in the present research. HDL has been known to be a po-
tential antioxidant suppressing the accumulation of oxidized lipids
(Vohl et al., 1999). In a research involving healthy women, Naza-
rewicz et al. (2007) showed that 14 days of ketogenic diet resulted
in improved total antioxidative status as well as increased uric acid
and HDL levels. They interpreted this result as demonstrating the
effect of ketogenic diet on antioxidative capacity. Accordingly, the
result of the present research indicates that weight loss by 3 weeks
of calorie restriction and exercise can cause oxidative stress, and
that ketogenic diet can be effective for preventing it. It could also
be inferred that ketogenic diet can be effective for increasing blood
antioxidative capacity.
Researches concerning the effects of ketogenic diet on oxidative
stress and antioxidative capacity have reported opposite results ac-
cording to the kinds of the diseases of research subjects, while re-
search involving healthy individuals has been very insufficient. Es-
pecially, there has been no research report involving weight class
contestants, and additional research would have to be carried out in
this regard.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was re-
ported.
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