Ketogenic diet in endocrine disorders

Abstract

Ketogenic diet (KD) is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis, long known for antiepileptic effects and has been used therapeutically to treat refractory epilepsy. This review attempts to summarize the evidence and clinical application of KD in diabetes, obesity, and other endocrine disorders. KD is usually animal protein based. An empiric vegetarian Indian variant of KD has been provided keeping in mind the Indian food habits. KD has beneficial effects on cardiac ischemic preconditioning, improves oxygenation in patients with respiratory failure, improves glycemic control in diabetics, is associated with significant weight loss, and has a beneficial impact on polycystic ovarian syndrome. Multivitamin supplementations are recommended with KD. Recently, ketones are being proposed as super-metabolic fuel; and KD is currently regarded as apt dietary therapy for “diabesity.”

Ketone Bodies Are Mildly Elevated in Subjects with Type 2 Diabetes Mellitus and Are Inversely Associated with Insulin Resistance as Measured by the Lipoprotein Insulin Resistance Index

“…These mild elevations may be related to the ability of SGLT2 inhibitors to reduce plasma glucose via renal elimination, stimulate lipolysis, elicit weight loss and enhance insulin sensitivity [8][9][10]. Consequently, physicians or patients may want to monitor ketone bodies to ensure these diets are managed correctly and are having beneficial effects while not causing very high ketone body levels [11]. Such assays may also be clinically useful while patients are on SGLT2 inhibitor therapy.…”

Baseline HOMA IR and Circulating FGF21 Levels Predict NAFLD Improvement in Patients Undergoing a Low Carbohydrate Dietary Intervention for Weight Loss: A Prospective Observational Pilot Study

“…Beside accurate diagnosis and grading from simple hepatic steatosis to steatohepatitis and fibrosis, at present no specific treatment for NAFLD is available, and currently proposed treatments focus on weight loss and insulin resistance improvement [ 9 , 22 , 23 , 24 ], with increasing attention being paid in identifying additional safe and effective means of treatment. Among them, ketogenic diets (KD) represent a safe and effective strategy shown to induce beneficial effects on NALFD [ 25 ] through a significant and rapid decrease in insulin-resistance and total body and abdominal fat [ 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], but its impact may also be independent of weight change [ 34 ]. Moreover, very low-calorie ketogenic diets (VLCKDs) proved effective in reversing T2D through a reduction in triglycerides content and insulin resistance in the liver [ 33 ].…”

Ketogenic diet increases mitochondria volume in the liver and skeletal muscle without altering oxidative stress markers in rats

“…Ketogenic diets (KD) are comprised of high fat, adequate protein, and low carbohydrates [ 1 , 2 , 3 ] and have been shown to be effective in treating certain neurological disorders [ 4 , 5 , 6 ]. In addition, there is strong evidence to suggest that a KD is effective for weight-loss in humans [ 7 , 8 , 9 , 10 ].…”