Effects of n-3 Polyunsaturated Fatty Acids (ω-3) Supplementation on Some Cardiovascular Risk Factors with a Ketogenic Mediterranean Diet

Abstract

Background: the ketogenic diet (KD) has become a widely used nutritional approach for weight loss. Some of the KD’s positive effects on metabolism and cardiovascular risk factors are similar to those seen after n-3 polyunsaturated fatty acids (ω-3) supplementation. We hypothesized that a ketogenic Mediterranean diet with phytoextracts combined with ω-3 supplementation may have increased positive effects on cardiovascular risk factors and inflammation. Methods: We analyzed 34 male overweight subjects; aged between 25 and 65 years who were overall healthy apart from overweight. The subjects followed a ketogenic diet protocol for four weeks; with (KDO3) or without (KD) ω-3 supplementation. Results: All subjects experienced a significant loss of body weight and body fat and there was no significant differences between treatment (body weight: KD—4.7 kg, KDO3—4.03 kg, body fat KD—5.41 kg, KDO3—5.86 kg). There were also significant decreases in total cholesterol, LDL-c, and glucose levels. Triglycerides and insulin levels decreased more in KDO3 vs. KD subjects, with a significant difference. All the investigated inflammatory cytokines (IL-1β, IL-6, TNF-α) decreased significantly in KDO3 subjects whilst only TNF-α showed a significant decrease in KD subjects over the 12 month study period. No significant changes were observed in anti-inflammatory cytokines (IL-10 and IL-1Ra), creatinine, urea and uric acid. Adiponectin increased significantly only in the KDO3 group. Conclusions: ω-3 supplementation improved the positive effects of a ketogenic Mediterranean diet with phytoextracts on some cardiovascular/metabolic risk factors and inflammatory state.

Mediterranean Diet and Prevention of Chronic Diseases

“…59 Clinical trials found that n-3 fatty acid supplementation decreased blood levels of cytokines (IL-1A, IL-6) and markers of systemic inflammation (i.e. tumor necrosis factor->, TNF>), while increasing blood levels of adiponectin 60 and lowering risk of UC. 61 In rodent models of Crohn's disease, administration of a fiber-supplemented diet (5% psyllium seed by weight) decreased inflammatory markers (nitric oxide and TNF>) in colonic and cecal tissue.…”

Ketogenic diet and testosterone increase: Is the increased cholesterol intake responsible? To what extent and under what circumstances can there be benefits?

“…For example, there is a type of Mediterranean KD which is mainly composed of omega-9 chiefly due to the consumption of olive oil, omega-3 derived from fish, various sources of vegetables and eggs: 9,10 there is a consensus that all these foods have antioxidant and anti-inflammatory potentials. 3,[19][20][21] Therefore, if individuals follow a KD with good dietary sources such as those mentioned above, it may even confer cardiovascular protection even with high cholesterol intake.…”

“…This is because the main factor contributing to body fat loss through a KD is the caloric deficit and, in parallel, the decrease of insulinemia and mitochondrial modulation. 9 Several studies have shown that following a KD results in loss of body weight, including fat mass, as well as reduction in body water. [9][10][11][12][13] However, the latter diet programs are characterized by a high caloric deficit, for example, ~1200 kcal/day, 9 hence, it cannot to be affirmed that the loss of body fat occurs because of the increase in endogenous testosterone.…”

“…However, when the KD is normocaloric it does not appear to alter the lipid profile to any significant degree, since lipid levels did not exceed the reference range. 9,11 The increase in cholesterol intake exerts a minimal effect on serum cholesterol; 17,18 therefore, the KD should not be considered a factor significantly affecting the lipid profile. However, it is conceivable that the KD, which is by definition hypercaloric, may negatively affect the lipid profile: interventions in this field are necessary in order to verify this fact.…”

“…Secondly, most of the KD intervention studies show a favorable or neutral effect on modulation of lipid profile. 9,11,16 A hypocaloric KD in overweight individuals may decrease LDL, total cholesterol and triglycerides while increasing HDL (+~5 mg/dL). 10,11 A study published in the Annals of Internal Medicine showed a remarkable decrease of ~105 mg/dL of serum triglycerides in obese subjects undergoing 6 months of the KD, an effect equivalent to that of fibrates.…”