Very low-calorie ketogenic diet (VLCKD): an antihypertensive nutritional approach

Abstract

Background Obesity is accompanied by hormonal, inflammatory and endothelial alterations. These alterations induce a stimulation of several other mechanisms that contribute to the hypertensive state and to increase the cardiovascular morbidity. This pilot, open - label, single- center, prospective clinical trial aimed to evaluate the effect of very low- calorie ketogenic diet (VLCKD) on blood pressure (BP) in women with of obesity and hypertension. Methods A total of 137 women, who met the inclusion criteria and accepted to adhere to VLCKD, were consecutively enrolled. Assessment of anthropometric parameters (weight, height, and waist circumference), body composition (through bioelectrical impedance analysis), systolic (SBP) and diastolic blood pressure (DBP) and blood sample collection were carried out at baseline and after 45 days of the active phase of VLCKD. Results After VLCKD all the women experienced a significant reduction in body weight and an overall improvement of body composition parameters. In addition, high sensitivity C reactive protein (hs- CRP) levels were significantly diminished (p < 0.001), while phase angle (PhA) increased by almost 9% (p < 0.001). Interestingly, both SBP and DBP were significantly improved (-12.89% and − 10.77%, respectively; p < 0.001). At baseline, SBP and DBP showed statistically significant correlations with body mass index (BMI), waist circumference, hs-CRP levels, PhA, total body water (TBW), extracellular water (ECW), Na / K ratio, and fat mass. Even after VLCKD, all correlations among SBP and DBP with the study variables were statistically significant, except for the association between DBP and Na / K ratio. Changes (%) in both SBP and DBP were associated with ∆BMI%, ∆PhA% and ∆hs- CRP levels (p < 0.001). In addition, only ∆SBP% was associated with ∆waist circumference (p = 0.017), ∆TBW (p = 0.017), and ∆fat mass (p < 0.001); while only ∆DBP% was associated with ∆ECW (p = 0.018), and ∆Na / K ratio (p = 0.048). After adjusting for ∆BMI, ∆WC, ∆PhA, ∆TBW, and ∆fat mass, the correlation between changes in ∆SBP and ∆hs -CRP levels remained statistically significant (p < 0.001). Similarly, the correlation between ∆DBP and ∆hs- CRP levels also remained statistically significant after adjustment for ∆BMI, ∆PhA, ∆Na / K ratio, and ∆ECW (p < 0.001). From multiple regression analysis ∆hs- CRP levels seemed to be the main predictor of changes of BP (p < 0.001). Conclusion VLCKD reduces BP in women with of obesity and hypertension in a safely manner.

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“…Body composition was evaluated using a BIA phase-sensitive system administered by a certified clinical nutrition specialist with 5 years of expertise in employing the BIA method for body composition assessment (800-µA current at a single frequency of 50 kHz, BIA 101, RJL Akern Bioresearch, Florence, Italy) [ 41 ], in accordance with previously documented procedures [ 39 , 42 , 43 ]. The BIA analysis adhered to the guidelines set by the European Society of Parental and Enteral Nutrition (ESPEN) [ 44 ].…”

Genome-wide characterization of circulating metabolic biomarkers

“…It should be noted that previous studies using the NMR metabolomics platform had incorrectly labelled acetone as acetoacetate, which was detected and corrected in 2020 and later versions of the platform. The discovery regarding this potential causal relationship between acetone and hypertension is noteworthy, since the data on the role of ketogenic diets in hypertension are suggestive but inconclusive 58 , 59 and ketone bodies have also emerged as potential therapeutic agents for coronary disease 60 . This finding concords with preclinical and human studies that link interventions that alter levels of ketone bodies, such as ketogenic diets and ketone salt supplementation, with changes in blood pressure 61 , 62 , leading to suggestions that ketone bodies could be a promising potential therapeutic strategy for hypertension and other cardiovascular diseases 60 , 63 .…”

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“…Patients on the ketogenic diet find their insulin and weight dropping very fast and medication doses correspondingly need to be reduced. The ketogenic diet has shown blood pressure reduction ( 153 ), the reversal of kidney disease ( 154 ), reduction of HbA1c and increase of HDL ( 155 , 156 ) and even the reversal of type 2 diabetes ( 157 ). Many thousands of anecdotal reports point to great success with the ketogenic diet as well as with the lesser studied carnivore and LCHF diets, providing an incentive for others to try them.…”