Keto Medicine
Interesting new findings and scientific studies on keto and the ketogenic diet.
Scientific news and studies about keto. Presented by Germany’s keto doctors, Dr. Brigitte and Dr. Wolfgang Karner.
Keto and the
Immune System
The Western diet promotes chronic inflammatory processes and weakens the specific immune system. Consequences include type 2 diabetes, hypertension, gout, atherosclerosis, autoimmune diseases, and increased susceptibility to infections. The research group for Molecular Medicine led by Professor Dr. Simone Kreth was able to show that after just three weeks of a ketogenic diet, there was a significant improvement in T-cell immune performance. This improvement was based on a metabolic realignment of T-cells, with enhanced aerobic mitochondrial respiration and increased cellular energy availability. This means that a ketogenic diet could represent a real therapeutic option for both infections and autoimmune diseases, and even for tumors. Controlled clinical studies with larger sample sizes are planned for further evaluation.
“Very-low-carbohydrate diet enhances human T-cell immunity through immunometabolic reprogramming” 6-2021
Keto and the
Immune System
The Western diet promotes chronic inflammatory processes and weakens the specific immune system. Consequences include type 2 diabetes, hypertension, gout, atherosclerosis, autoimmune diseases, and increased susceptibility to infections. The research group for Molecular Medicine led by Professor Dr. Simone Kreth was able to show that after just three weeks of a ketogenic diet, there was a significant improvement in T-cell immune performance. This improvement was based on a metabolic realignment of T-cells, with enhanced aerobic mitochondrial respiration and increased cellular energy availability. This means that a ketogenic diet could represent a real therapeutic option for both infections and autoimmune diseases, and even for tumors. Controlled clinical studies with larger sample sizes are planned for further evaluation.
“Very-low-carbohydrate diet enhances human T-cell immunity through immunometabolic reprogramming” 6-2021
Glucose, Ketones, and COVID-19
(Paoli, A. et al.: The dark side of the spoon – glucose, ketones and COVID-19: a possible role for ketogenic diet? Journal of Translational Medicine 2020;18:441) Keto-experienced scientists from Rome point out that a ketogenic diet may be able to significantly reduce major risks for COVID-19 infection or for a severe course of the disease. These risks include obesity and its comorbidities, type 2 diabetes, and high blood pressure. Under a ketogenic diet, body fat can be rapidly reduced while preserving lean mass, and diabetic and hypertensive metabolic conditions also improve quickly. Added to this are the well-known anti-inflammatory and immunomodulatory effects of ketone bodies. The authors consider a ketogenic diet to be an important pillar of public health measures in combating SARS-CoV-2 infections and their consequences.
Intensive Care Medicine: Ketogenic Nutrition for Sepsis Patients
Keto has a positive effect on the course of treatment in critically ill patients. Dr. David Effinger’s team was able to demonstrate this in a randomized controlled study and was awarded the Clinical Research Prize by the German Interdisciplinary Association for Intensive and Emergency Medicine (DIVI).
Impaired immune function in sepsis could be counteracted through a ketogenic diet. As a result, there were up to 30% fewer deaths from sepsis.
“An open-label, randomized controlled trial to assess a ketogenic diet in critically ill patients with sepsis” 7-2024
Ketogenic Diet for Polycystic Kidney Disease
A nutritional study from the University Hospital Cologne showed that a keto diet can have positive effects on polycystic kidney disease. The Keto-ADPK study demonstrated that a ketogenic diet had a beneficial impact both on kidney function and on cyst growth. Since 10% of all dialysis-dependent patients develop kidney failure due to polycystic kidneys, these findings could have a significant impact on quality of life.
“Ketogenic dietary interventions in autosomal dominant polycystic kidney disease — a retrospective case series study” 6-2022
Keto and Mental Illness
Several recent studies have shown mood-stabilizing effects of a ketogenic diet. These effects have been observed in anxiety disorders, bipolar disorder, ADHD, autism spectrum disorder, depression, and schizophrenia. The effect appears to be based on several factors, including a reduction in glutamate and an increase in GABA, the strong anti-inflammatory effects of ketones, and improvements in the microbiome. Even psychiatric medications could be reduced or, in some cases, discontinued. Multicenter, larger studies are planned.
“Ketogenic diet has a positive association with mental and emotional well-being in the general population” 8-2024
“The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients” 7-2022
“Disorder-specific and transdiagnostic changes in inflammatory activity in mental disorders” 10-2022
Ketosis as a Potential Therapeutic Option to Prevent a Cytokine Storm in COVID-19 Patients
(Sukkar, SG, Bassetti, M: Induction of ketosis as a potential therapeutic option to limit hyperglycemia and prevent cytokine storm in COVID-19. Nutrition 2020;79–80:110967)
Researchers from Genoa propose the following hypothesis based on basic research findings: By reducing glucose availability for M1 macrophages, a ketogenic diet could decrease their hyperactivity and thus reduce the production of pro-inflammatory cytokines, since these immune cells primarily obtain their energy through glycolysis. At the same time, a ketogenic diet could provide M2 macrophages—anti-inflammatory immune cells—with readily available free fatty acids for energy production. These cells preferentially generate ATP through oxidative phosphorylation and can therefore use free fatty acids. As a third mechanism, the researchers found reduced lactate production, which leads to increased interferon-1 production.
Note: A ketogenic diet could therefore contribute to the prevention (!) of a cytokine storm through at least three mechanisms. However, this hypothesis still needs to be tested in clinical studies.
Urinary Ketones Indicate a Healthy Metabolism
(Kim, B-R et al.: The presence of urinary ketones according to metabolic status and obesity. Endocrinology, Nutrition & Metabolism 2020;35:e273)
The more flexibly the metabolism can switch between using glucose and fatty acids—or ketones—the greater its resilience to lifestyle-related diseases. This has been shown in many animal studies. South Korean researchers also found, in a cross-sectional study, a correlation between the presence of ketones in urine and a metabolically healthy phenotype. Participants were divided into metabolically healthy normal-weight individuals and metabolically healthy overweight individuals, as well as metabolically unhealthy normal-weight and overweight individuals. Among metabolically healthy normal-weight men, ketones were found in urine more frequently than in metabolically unhealthy obese men. A similar trend was observed among women.
Ketosis as a Potential Therapeutic Option to Prevent a Cytokine Storm in COVID-19 Patients
(White, CJ et al.: Determining the bioenergetic capacity for fatty acid oxidation in the mammalian nervous system. Molecular and Cellular Biology 2020;40:e00087-20)
Until now, it was generally assumed that the human brain is hardly capable of using fatty acids for energy. However, new basic-research data show that this is not correct. Using new methods (targeted metabolomics), U.S. scientists were able to demonstrate in vitro and in vivo that the brain “burns” fatty acids even under “normal” conditions. In particular, astrocytes (glial cells) and neural stem cells are capable of fatty-acid oxidation.
Note: This is especially interesting in the context of the ketogenic diet, which must be formulated with high fat content, particularly for neurological disorders. Incidentally, astrocytes are also able to synthesize ketones.
Ketone Bodies Promote Amyloid Clearance in a Human Blood–Brain Barrier Model
(Versele, R. et al.: Ketone bodies promote amyloid-ß1-40 clearance in a human in vitro blood–brain barrier model. International Journal of Molecular Sciences 2020;21:934)
Alzheimer’s disease is characterized, among other factors, by the accumulation of amyloid-β peptides in the brain. One proposed cause of this buildup is impaired amyloid transport. To reduce the accumulation of amyloid plaques, ketone bodies may be beneficial. The fact that ketone bodies can promote the transport of amyloid across the blood–brain barrier through multiple pathways was demonstrated in a human tissue model in vitro.
Note: This provides further evidence that ketones in the brain serve not only as an energy source, but also fulfill many additional functions.