Inflammation is the body’s immune response to harmful stimuli and critical in protecting the body from foreign substance.^1–3 However, inflammation can rear its ugly head when it becomes uncontrolled or chronically stimulated, becoming a chronic inflammation. Chronic inflammation is known to have deleterious effects on the body, associated with chronic inflammatory diseases and chronic conditions such as diabetes, cardiovascular disease (ie, disease of the heart and blood vessels), and cancer. Can the popularized ketogenic diet help with inflammation?

 

Does the Ketogenic Diet Reduce Inflammation?

The ketogenic diet is characterized by a high fat consumption and a very low carbohydrate consumption restricted to 5-10% of total daily intake.^4–6 Although the diet has been shown to improve various metabolic parameters, research on the effects of ketogenic diet on inflammation is currently limited. Existing studies, however, suggest that the ketogenic diet may be an effective way to combat inflammation and improve conditions known to be associated with inflammation.

For instance, a small randomized controlled trial (RCT) comparing very low carbohydrate ketogenic diet (VLCKD) to low fat diet for 12 weeks in 40 overweight women and men found that VLCKD was associated with more favorable changes in blood lipid levels and inflammatory markers.⁷ Additionally, a 2024 systematic review and meta-analysis of 43 RCTs studying the effects of ketogenic diet on inflammatory markers found similar results, concluding that the ketogenic diet was associated with reductions in inflammatory markers interleukin 6 and tumor necrosis factor-a.⁸

 

How Does the Ketogenic Diet Help With Inflammation & Inflammatory Diseases?  

High carbohydrate consumption is known to promote inflammatory pathways, and consequently, lowering dietary carbohydrates can result in reductions in proinflammatory markers.⁷ On a more molecular level, the ketogenic diet induces a state of ketosis where the body breaks down and utilizes fat reserves as the primary source of energy instead of glucose.^6–8 This state of ketosis can improve systemic inflammation by improving hyperinsulinemia (ie, elevated levels of insulin), synthesizing beta-hydroxybutyrate (ie, a form of ketone), and increasing glucagon.⁶

Additionally, the impact of weight loss on reducing inflammation cannot be overlooked. Obesity is a chronic disease associated with chronic inflammation and a host of metabolic diseases associated with inflammation.^3,9,10 Studies have consistently shown that the diet can promote weight loss and improve various parameters of metabolic health, including insulin resistance and lipid profiles.^4,5,11,12 Given that inflammation is implicated in the pathophysiology of obesity-related metabolic diseases such as diabetes and cardiovascular disease that are atherosclerotic in nature (ie, due to the build-up of cholesterol plaques in blood vessels), experts believe that the ketogenic diet improves metabolic health by alleviating inflammation.^1,3,9,10,13

References: 1. Chen L, Deng H, Cui H, et al. Inflammatory Responses and Inflammation-Associated Diseases in Organs. Oncotarget. 2017;9(6):7204-7218. doi:10.18632/oncotarget.23208 2. Stone WL, Basit H, Burns B. Pathology, Inflammation. In: StatPearls. StatPearls Publishing; 2023. Accessed August 29, 2023. http://www.ncbi.nlm.nih.gov/books/NBK534820/ 3. Hotamisligil GS. Inflammation and Metabolic Disorders. Nature. 2006;444(7121):860-867. doi:10.1038/nature05485 4. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. In: StatPearls. StatPearls Publishing; 2022. Accessed August 9, 2022. http://www.ncbi.nlm.nih.gov/books/NBK499830/ 5. Alarim RA, Alasmre FA, Alotaibi HA, Alshehri MA, Hussain SA. Effects of the Ketogenic Diet on Glycemic Control in Diabetic Patients: Meta-Analysis of Clinical Trials. Cureus. 12(10):e10796. doi:10.7759/cureus.10796 6. Ciaffi J, Mitselman D, Mancarella L, et al. The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review. Front Med (Lausanne). 2021;8:792846. doi:10.3389/fmed.2021.792846 7. Forsythe CE, Phinney SD, Fernandez ML, et al. Comparison of Low Fat and Low Carbohydrate Diets on Circulating Fatty Acid Composition and Markers of Inflammation. Lipids. 2008;43(1):65-77. doi:10.1007/s11745-007-3132-7 8. Ji J, Fotros D, Sohouli MH, Velu P, Fatahi S, Liu Y. The Effect of a Ketogenic Diet on Inflammation-Related Markers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrition Reviews. Published online January 14, 2024:nuad175. doi:10.1093/nutrit/nuad175 9. Hildebrandt X, Ibrahim M, Peltzer N. Cell Death and Inflammation During Obesity: “Know My Methods, Wat(son).” Cell Death Differ. 2023;30(2):279-292. doi:10.1038/s41418-022-01062-4 10. Wu H, Ballantyne CM. Metabolic Inflammation and Insulin Resistance in Obesity. Circulation Research. 2020;126(11):1549-1564. doi:10.1161/CIRCRESAHA.119.315896 11. Yuan X, Wang J, Yang S, et al. Effect of the Ketogenic Diet on Glycemic Control, Insulin Resistance, and Lipid Metabolism in Patients With T2DM: a Systematic Review and Meta-analysis. Nutr Diabetes. 2020;10(1):1-8. doi:10.1038/s41387-020-00142-z 12. Gershuni VM, Yan SL, Medici V. Nutritional Ketosis for Weight Management and Reversal of Metabolic Syndrome. Curr Nutr Rep. 2018;7(3):97-106. doi:10.1007/s13668-018-0235-0 13. Henein MY, Vancheri S, Longo G, Vancheri F. The Role of Inflammation in Cardiovascular Disease. Int J Mol Sci. 2022;23(21):12906. doi:10.3390/ijms232112906

  

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