The use of nutritional supplements to induce ketosis and reduce symptoms associated with keto-induction: a narrative review

Abstract

BackgroundAdaptation to a ketogenic diet (keto-induction) can cause unpleasant symptoms, and this can reduce tolerability of the diet. Several methods have been suggested as useful for encouraging entry into nutritional ketosis (NK) and reducing symptoms of keto-induction. This paper reviews the scientific literature on the effects of these methods on time-to-NK and on symptoms during the keto-induction phase.MethodsPubMed, Science Direct, CINAHL, MEDLINE, Alt Health Watch, Food Science Source and EBSCO Psychology and Behavioural Sciences Collection electronic databases were searched online. Various purported ketogenic supplements were searched along with the terms “ketogenic diet”, “ketogenic”, “ketosis” and ketonaemia (/ ketonemia). Additionally, author names and reference lists were used for further search of the selected papers for related references.ResultsEvidence, from one mouse study, suggests that leucine doesn’t significantly increase beta-hydroxybutyrate (BOHB) but the addition of leucine to a ketogenic diet in humans, while increasing the protein-to-fat ratio of the diet, doesn’t reduce ketosis. Animal studies indicate that the short chain fatty acids acetic acid and butyric acid, increase ketone body concentrations. However, only one study has been performed in humans. This demonstrated that butyric acid is more ketogenic than either leucine or an 8-chain monoglyceride. Medium-chain triglycerides (MCTs) increase BOHB in a linear, dose-dependent manner, and promote both ketonaemia and ketogenesis. Exogenous ketones promote ketonaemia but may inhibit ketogenesis.ConclusionsThere is a clear ketogenic effect of supplemental MCTs; however, it is unclear whether they independently improve time to NK and reduce symptoms of keto-induction. There is limited research on the potential for other supplements to improve time to NK and reduce symptoms of keto-induction. Few studies have specifically evaluated symptoms and adverse effects of a ketogenic diet during the induction phase. Those that have typically were not designed to evaluate these variables as primary outcomes, and thus, more research is required to elucidate the role that supplementation might play in encouraging ketogenesis, improve time to NK, and reduce symptoms associated with keto-induction.

Effects of a ketogenic diet in overweight women with polycystic ovary syndrome

“…In a physiological state of ketosis as during fasting, thanks to the considerable consumption of ketones by the CNS and the balance between insulin and glucagon, ketonemia reaches maximum levels of 7-8 mmol/L [26], with no change in the pH of the blood. During a LCKD the levels of KBs are usually between 0.5-0.6 and 4 [54][55][56] and a nutritional ketosis could be defined as a blood ketones > 0.5 mmol/L [57][58][59][60][61] Indeed, our subjects showed an steep increase in blood BHB during the first 6 days reaching, at the end of the first week 0.55 ± 0.27 mmol/L BHB, whilst the mean value from day 7 to day 84 was 1.77 ± 0.55 BHB. It is therefore essential to make a clear distinction between physiological ketosis (KD, fasting) and a pathological ketosis, such as that which can occur in diabetes when hyperglycemia and insulin deficiency cause uncontrolled rates of KBs and the ketonemia may exceed 20 mmol/L, exposing to the risk of severe acidosis.…”

Systematic Review and Meta-Analysis of a Proprietary Alpha-Amylase Inhibitor from White Bean (Phaseolus vulgaris L.) on Weight and Fat Loss in Humans

“…Very low carbohydrate diets (ketogenic diets), with fewer than 50 g of carbohydrate per day, have been linked to weight loss and specific health benefits including neurological disorders. Adaptations to a ketogenic diet is often difficult and nutritional aids have been shown to be useful for entering into nutritional ketosis [ 32 ]. A recently concluded study indicated that both low-fat and low-carb diets can work for weight loss, and that there is no “best diet” when it comes to low-carb vs. low-fat diets.…”

Commentary: Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet

“…Moreover, "Flu KD" is neither a MeSh term nor a keyword related with this area of research. Symptoms of keto-induction were reported two decades ago (11), referred to in mainstream and gray literature as "keto-flu, " but these were not well-described in scientific literature (12). In recent years, other than the article by Bostock et al, there have been no publications.…”