Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks

Crosby, Lee; Davis, Brenda; Joshi, Shivam; Jardine, Meghan; Paul, Jennifer; Neola, Maggie; Barnard, Neal D.

doi:10.3389/fnut.2021.702802

Cited by 108 publications

(86 citation statements)

References 118 publications

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“…The VLCKD, as a part of a multicomponent strategy and under strict medical supervision, is an effective plan for the treatment of obesity [ 15 , 16 ] and type 2 diabetes [ 26 , 27 ]. Although some reports suggest that ketogenic diets have been associated with higher CV risk [ 17 ], our data do not support this hypothesis and show a positive safety profile with this weight loss approach.…”

Section: Discussioncontrasting

confidence: 99%

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Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet

et al. 2021

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Weight loss after bariatric surgery decreases the earlier expansion of the adventitial vasa vasorum (VV), a biomarker of early atheromatous disease. However, no data are available regarding weight loss achieved by very low calorie ketogenic diets (VLCKD) on VV and lipid-based atherogenic indices. A randomized clinical trial was performed to examine changes in adventitial VV density in 20 patients with moderate obesity who underwent a 6-month very low calorie ketogenic diet (VLCKD, 600–800 kcal/day), and 10 participants with hypocaloric diet based on the Mediterranean Diet (MedDiet, estimated reduction of 500 kcal on the usual intake). Contrast-enhanced carotid ultrasound was used to assess the VV. Body composition analysis was also used. The atherogenic index of plasma (log (triglycerides to high-density lipoprotein cholesterol ratio)) and the triglyceride-glucose index were calculated. Serum concentrations of soluble intercellular adhesion molecule 1 (sICAM-1), and soluble vascular cell adhesion molecule 1 (sVCAM-1) were measured. The impact of weight on quality of life-lite (IWQOL-Lite) questionnaire was administered. Participants of intervention groups displayed a similar VV values. Significant improvements of BMI (−5.3 [−6.9 to −3.6] kg/m2, p < 0.001), total body fat (−7.0 [−10.7 to −3.3] %, p = 0.003), and IWQOL-Lite score (−41.4 [−75.2 to −7.6], p = 0.027) were observed in VLCKD group in comparison with MedDiet group. Although after a 6-months follow-up period VV density (mean, right and left sides) did not change significantly in any group, participants in the VLCKD exhibited a significantly decrease both in their atherogenic index of plasma and serum concentration of sICAM-1. A 6-month intervention with VLCKD do not impact in the density of the adventitial VV in subjects with moderate obesity, but induces significant changes in markers of endothelial dysfunction and CV risk.

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Section: Discussioncontrasting

confidence: 99%

“…VLCKDs have been proposed as an effective weight loss method for patients with obesity [ 15 , 16 ]. Although this nutritional intervention is widely accepted, there are some potential negative cardiovascular effects still under discussion [ 17 ]. No previous research has been done on the effect of VLCKDs on VV.…”

Section: Introductionmentioning

confidence: 99%

Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet

et al. 2021

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“…Whereas diets high in animal foods have been commonly discouraged owing to high saturated fats content and low density of essential nutrients and bioactive compounds (e.g., fiber, phytonutrients) ( 12 ), little is known about the health status of people habitually following a carnivore eating pattern. According to a common view, long-term consumption of a strictly animal-based diet would be associated with significant nutritional deficiencies ( 13 ) and confer negative health effects compared with a plant-based diet ( 14 , 15 ), including poor gut and gut-microbiota health ( 16–19 ), an adverse cardiovascular disease risk pattern ( 20 , 21 ), and other chronic health complications ( 22 ).…”

Section: Introductionmentioning

confidence: 99%

Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a “Carnivore Diet”

Lennerz

Mey

Henn

et al. 2021

Current Developments in Nutrition

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Background The “carnivore diet,” based on animal foods and excluding most or all plant foods, has attracted recent popular attention. However, little is known about the health effects and tolerability of this diet, and concerns for nutrient deficiencies and cardiovascular disease risk have been raised. Objective We obtained descriptive data on the nutritional practices and health status of a large group of carnivore diet consumers. Methods A social media survey was conducted March 30 to June 24, 2020 among adults self- identifying as consuming a carnivore diet ≥ 6 months. Survey questions interrogated motivation, dietary intake patterns, symptoms suggestive of nutritional deficiencies or other adverse effects, satisfaction, prior and current health conditions, anthropometrics, and laboratory data. Results A total of 2029 respondents (median age 44 years, 67% male), reported consuming a carnivore diet for 14 (interquartile range 9–20) months, motivated primarily by health reasons (93%). Red meat consumption was reported ≥ daily by 85%. Under 10% reported consuming vegetables, fruits or grains > monthly, and 37% denied vitamin supplement use. Prevalence of adverse symptoms was low (<1% to 5.5%). Symptoms included gastrointestinal (3.1–5.5%), muscular (4.0%), and dermatologic (1.1–1.9%). Participants reported high levels of satisfaction and improvements in overall health (95%), wellbeing (69–91%), various medical conditions (48–93%) and BMI (from 27.2 [23.5–31.9] to 24.3 [22.1–27.0] kg/m2). Among a subset reporting current lipids, LDL-cholesterol was markedly elevated (172 mg/dL), whereas HDL-cholesterol (68 gm/dL) and triglycerides (68 mg/dL) were optimal. Participants with diabetes reported benefits including reductions in BMI (4.3 kg/m2, 1.4–7.2), HbA1C (0.4%, 0–1.7), and diabetes medication use (84–100%). Conclusions Contrary to common expectations, adults consuming a carnivore diet experienced few adverse effects and instead reported health benefits and high satisfaction. Cardiovascular risk factors were variably affected. The generalizability of these findings and the long-term effects of this dietary pattern require further study. Summary In a survey of over 2000 adults following a “carnivore diet” (i.e., one that aims to avoid plant foods), health benefits and satisfaction were generally reported.

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“…Regarding the intervention, although there is no standardized definition of the KD, studies reporting on diets high in fat, low in CHO resulting in hyperketonemia [17] such as classical KD, medium-chain triglyceride (MCT)-KD, and MAD were included. When the intervention was not specified as a KD, an upper limit of 50 g of CHO per day or 10% energy from CHO [34] was retained for inclusion. RCTs involving a co-intervention were included if both arms of the study received the same co-intervention.…”

Section: Criteria For Study Inclusionmentioning

confidence: 99%

Effect of Ketogenic Diet on Quality of Life in Adults with Chronic Disease: A Systematic Review of Randomized Controlled Trials

et al. 2021

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Background: Chronic diseases adversely affect quality of life (QOL). The ketogenic diet (KD) may improve the QOL. Objective: The aim of this systematic review was to summarize the available evidence of randomized controlled trials (RCTs) to establish the effect of KD on the QOL in adults with chronic diseases. Methods: Reporting followed PRISMA guidelines. We included randomized controlled trials (RCTs) conducted on adults with chronic disease including an intervention group that received KD and a control group, and where QOL was reported as outcome. We searched PubMed, APA PsycInfo, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and Clinicaltrials.gov, and the references of the included articles and previous relevant reviews, without language or time restrictions. We critically appraised included studies and narratively synthesized their findings. Results: Nine RCTs were included. The risk of bias was low, except of allocation concealment and blinding. In patients with cancer: one RCT found an improvement in overall QOL, another reported improved physical component summary, and one found no superiority of KD in all QOL domains. In patients with neurological disorders: improved QOL was reported in Alzheimer’s disease patients, whereas no difference in mental and physical health QOL was noted in patients with multiple sclerosis. In patients with obesity and type II diabetes: one RCT reported superiority of energy-restricted KD in improving role functioning, mental health, health perceptions, and pain compared with guideline-based diet, whereas in another RCT, high and low carbohydrate diets achieved comparable improvements. Among patients with knee osteoarthritis, no differences between KD and low-fat groups were noted. Dietary compliance with the KD, reported in three studies, was shown to be high. Side effects were mostly noted during the first weeks of intervention, and adverse events were not markedly different with KD and the comparison diet. Conclusions: The evidence from RCTs investigating the effect of KD on QOL in adults with chronic disease is inconclusive. The promising effect noted in some included studies and the low rates of adverse events and side effects encourage future investigations in this regard.

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Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks

Cited by 108 publications

References 118 publications

Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet

Randomized Clinical Trial to Evaluate the Morphological Changes in the Adventitial Vasa Vasorum Density and Biological Markers of Endothelial Dysfunction in Subjects with Moderate Obesity Undergoing a Very Low-Calorie Ketogenic Diet

Behavioral Characteristics and Self-Reported Health Status among 2029 Adults Consuming a “Carnivore Diet”

Effect of Ketogenic Diet on Quality of Life in Adults with Chronic Disease: A Systematic Review of Randomized Controlled Trials

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