High-protein and ketogenic diet




With high-protein diet it indicates a particular diet characterized by a greater consumption of foods containing proteins and fats than those composed of carbohydrates, both simple and complex, whose use is very limited.

According to the guidelines for proper nutrition, drawn up by the Italian Society of Human Nutrition (SINU), in a healthy and balanced diet, the percentage of proteins must be around 12-15% of the kilocalories introduced each day with food. The remaining intake should derive mostly from carbohydrates (45-60%) (read the Hoax or watch the Video) and secondly from fats (25-35%). In high-protein diets this breakdown is modified and the proteins consumed reach higher percentages.

Under normal (physiological) conditions, the main task of proteins is to provide amino acids for the construction and renewal of tissues. They are involved in energy production only to a negligible extent. This function, on the other hand, becomes prevalent during prolonged fasting, a "demanding physical activity of long duration and in all those situations in which the main sources of energy, namely carbohydrates, are reduced or even eliminated, as happens in diets such as high in protein.

Differences between ketogenic diet and high protein diet

The most common high-protein diets are actually born along the lines of a diet widely studied and validated by the scientific community: the ketogenic diet. It is a diet that is prescribed by experts only in special and well-selected cases, carefully defining the goal to be achieved and the maximum duration times.

The two diets, high protein and ketogenic, however, should not be confused.

The ketogenic diet

The ketogenic diet is a highly low-calorie diet with which the quantity of the different nutrients to be consumed is accurately calculated so that precise proportions are respected between them. Compared to the SINU guidelines, the percentage of carbohydrates is reduced to about 10%; proteins are only slightly increased, while the fat intake can reach even over 60% of the kilocalories consumed. Doing so favors the mobilization of storage fats for energy production and the appearance of a particular metabolic condition called ketosis (or acetonemia), i.e. an accumulation in the blood of ketone bodies, substances that are formed when fats are used to produce energy.

This also happens when a person fasts. In fact, during fasting, the body goes through various phases to adapt to the unfavorable situation. First, the sugar reserves (glycogen) present in the muscles and liver are used; when these reserves are finished, proteins, especially those of the muscles, are used to produce the sugar necessary for survival (through a process called gluconeogenesis); this situation stimulates the body to use fat as an energy source with a consequent increase in ketone bodies. The ability to adapt to the unfavorable situation of fasting is a very important response that the body implements in the event of a famine in order to survive; the brain, in fact, in conditions of lack of sugars, is able to use the ketone bodies to carry out its important functions.

When and how the ketogenic diet should be used

The true ketogenic diet isn't for everyone. Before recommending it to a person, you must:

  • assess the general state of health (clinical history) to highlight possible contraindications
  • define the objectives and the maximum duration of the diet
  • plan the diet, to allow a gradual exit from the ketosis phase

It is therefore a real therapy that must be performed under the supervision of a specialist and not on the basis of "do it yourself".
Self-management could expose the person to nutritional deficiencies or inadequacies (see below).

Scientific data shows that the main areas of use are:

  • obesity or overweight in the presence of other associated diseases (hypertension, dyslipidemia, type 2 diabetes, obstructive sleep apnea syndrome (OSAS), severe osteoarticular diseases)
  • significant obesity with indication for bariatric surgery (obesity surgery)
  • drug resistant epilepsy

On the other hand, it is strongly contraindicated in the presence of:

  • hepatic, renal and cardiac insufficiency
  • type 1 diabetes
  • pregnancy and breastfeeding
  • mental or behavioral disorders
  • abuse of alcohol and other substances

Once the general state of health has been assessed, the ketogenic diet should be prescribed by adapting it to the person and defining the adequate amount of nutrients (carbohydrates, proteins and fats) needed. Different foods can have different effects on the condition of ketosis, affecting it positively or negatively. As you can imagine, carbohydrates play a role anti-ketogenic, that is, they remove the metabolism from the condition of ketosis. On the contrary, proteins and fats are pro-ketogenic, that is to say that they favor the onset of ketosis.

In the elaboration of the feeding scheme, each meal must be structured in compliance with a ketogenic ratio between nutrients, ie the grams of fats, proteins and carbohydrates must be calculated accurately so that a correct condition of ketosis can be determined.

Information on the person's state of health and on present and past diseases (clinical history) must be collected paying particular attention to the presence of any contraindications to the ketogenic diet, evaluating any drug therapy in progress, checking the results of recent blood tests aimed at highlighting any diseases present.

Furthermore, once the ketogenic diet has been started, it is necessary to closely monitor its progress and its effects by scheduling periodic visits.

Another very important aspect, which must be carefully evaluated, is the return to a "normal", adequate diet, which must be gradual and the maintenance of medium and long-term results.

The high-protein diet

The high-protein diet is characterized by a very high protein consumption that far exceeds the percentages recommended by the guidelines and is associated with a strong reduction in the consumption of carbohydrates. The basic idea is that by significantly reducing the amount of carbohydrates and greatly increasing that of proteins, the body is pushed to use the stored fats for energy. This, however, occurs only when the high-protein diet is also low-calorie because the amount of carbohydrates and fats introduced is not sufficient to cover the body's energy needs and consequently the body uses storage proteins and fats to produce energy. Otherwise, the excess protein is used up through a metabolic pathway (gluconeogenesis) which leads to the formation of glucose and this can favor the formation of new storage fat.

Both the ketogenic diet and the high-protein diet lead to a metabolic situation which, if carried out for too long periods of time and without strict control, can present health risks. In fact, they can:

  • cause a deficiency of various substances, such as micronutrients (vitamins, minerals) and fibers, contained in foods rich in complex carbohydrates (legumes, fruit, vegetables) excluded from the diet
  • reduce liver glucose (glycogen) deposits, used to maintain a normal blood glucose level
  • cause episodes of ketoacidosis due to the excessive accumulation of ketone bodies in the blood, creating imbalances that are harmful to the body

It should also be considered that an excessive consumption of proteins increases the work of the kidneys responsible for their degradation with the formation of urea.


When we talk about the ketogenic diet we refer to a useful and effective therapy that must be recommended and followed over time by an expert eye able to evaluate its real need and identify the best strategy to achieve the desired goals.

The high-protein diet partly exploits the same principles but is too often used in the wrong way.

An increased intake of proteins may have some effectiveness in promoting the increase of muscle mass and the reduction of body fat, but in order to protect the health of the organism it is important that the excess of protein consumed is only one aspect of the diet. and that it is not taken to extremes, which is why it is always wrong to do it yourself or to follow generic trends.

The specialists to contact before starting a diet are: dietician, nutritionist.



Pezzana A, Amerio M L, Fatati G, Caregaro Negrin L, Muratori F, Rovera G M, Zanardi M. The ketogenic diet. News in Dietetics and Clinical Nutrition.2014; 2: 38-43

Further links

Further links

Council for Agricultural Research and Analysis of the Agricultural Economy (CREA). Guidelines for healthy eating 2018

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