Effects of Ketogenic Diets on Cardiovascular Risk Factors: Evidence from Animal and Human Studies

Abstract

The treatment of obesity and cardiovascular diseases is one of the most difficult and important challenges nowadays. Weight loss is frequently offered as a therapy and is aimed at improving some of the components of the metabolic syndrome. Among various diets, ketogenic diets, which are very low in carbohydrates and usually high in fats and/or proteins, have gained in popularity. Results regarding the impact of such diets on cardiovascular risk factors are controversial, both in animals and humans, but some improvements notably in obesity and type 2 diabetes have been described. Unfortunately, these effects seem to be limited in time. Moreover, these diets are not totally safe and can be associated with some adverse events. Notably, in rodents, development of nonalcoholic fatty liver disease (NAFLD) and insulin resistance have been described. The aim of this review is to discuss the role of ketogenic diets on different cardiovascular risk factors in both animals and humans based on available evidence.

Increases in circulating levels of ketone bodies and cardiovascular protection with SGLT2 inhibitors: Is low‐grade inflammation the neglected component?

“…However, at present, few, if any, metabolism‐targeting drugs for the purpose of CV protection have reached the clinical stage, possibly, among other reasons, because of the complex metabolic alterations that characterize heart pathology . In addition, several additional protective effects and mechanisms have been proposed for ketone bodies, beyond the bioenergetic mechanisms . For instance, relevant preclinical models indicate a potent anti‐inflammatory effect of BHB, and observational studies in patients subjected to ketogenic diets (KDs) are consistent with this observation .…”

Glycaemic stability of a cyclist with Type 1 diabetes: 4011 km in 20 days on a ketogenic diet

“…The relationship between the ketogenic diet and dyslipidaemia remains uncertain. In some human studies, ketogenic diets have been linked to increased HDL cholesterol and reductions in total cholesterol, LDL cholesterol and triglyceride levels, whereas others have shown an increased or no effect on dyslipidaemia . As demonstrated in a study of 20 endurance athletes by Creighton et al .…”

Ketogenic diets and protective mechanisms in epilepsy, metabolic disorders, cancer, neuronal loss, and muscle and nerve degeneration

“…Probing mechanisms of KD‐induced weight loss indicated a decreased calorie intake and enhanced energy expenditure as key factors. Increased gluconeogenesis owing to carbohydrate restriction, ketosis‐induced appetite suppression and changes in insulin, lipogenesis, lipoproteins, adiponectin, and leptin levels also appeared as pertinent reasons for weight loss and metabolic syndromes, following KD intake and calorie restriction (Kosinski & Jornayvaz, ; Volek et al, ). Additionally, KD‐induced expression of fatty acid oxidative genes and decreased expression of genes causing lipid biosynthesis resulted in reduced abdominal circumference and less obesity (Kennedy et al, ).…”

“…NAFLD has a close link with insulin resistance, dyslipidemia, high blood pressure, and obesity, and is often a critical cause for cytokine and chemokine‐mediated inflammation, ROS generation, undesired lipogenesis, and obesity (Tiniakos, Vos, & Brunt, ). KD played an important role in attenuating symptoms of NAFLD, marked by altered aspartate aminotransferase and alanine aminotransferase that typically characterize intrahepatic inflammation, insulin resistance, and an overall liver damage (Kosinski & Jornayvaz, ). KD affected fibroblast growth factor 21 levels and caused a reduction in hepatic diacylglycerol with increased insulin sensitivity (Trepo, Romeo, Zucman‐Rossi, & Nahon, ).…”