What is inflammation?

An inflammation is a body’s defensive response to a range of harmful or external stimuli (i.e. pathogens, chemicals, radiation). Once an injury or infection is detected, a release of inflammatory mediators signals a variety of immune pathways to be activated. They either work to recruit white blood cells to the infection or injury site, dilate the blood vessels, or to increase the permeability of capillaries. In chronic inflammation, the immune response persists for longer periods of time, lasting from months to years. Since in the long term chronic inflammation places a large stress on your body and leads to tissue damage, it has been implicated in various illnesses, such as diabetes, cancers, arthritis, and different cardiovascular diseases.

How does ketogenic diet come into play?

Ketogenic diet has been used as a non-pharmacological therapeutic intervention to combat a variety of diseases and medical conditions involving chronic inflammation, including the previously mentioned. Its potential to suppress inflammation has shown to provide protective benefits in neurodegenerative illnesses, such as Alzheimer’s disease and Parkinson’s disease. It has also shown to have a potential of slowing growth of tumor cells. Other studies have been done that indicate ketogenic diet’s ability to improve rheumatoid arthritis, multiple sclerosis, PCOS, and psoriasis.

What are some possible explanations for ketogenic diet’s anti-inflammatory effects?

Ketogenic diet is a high-fat, moderate-protein, low-carb diet that induces ketosis, a physiological state that primarily uses fatty acids, rather than glucose, as the main form of body’s energy. In ketosis, fatty acids are broken down in the liver and can be converted into ketone bodies, such as acetone, acetoacetate, and BHB (beta-hydroxybutyrate). These ketone bodies can then be readily used by organs, such as the brain, heart, and muscles. This ketone metabolism is thought to have multiple benefits including ones below:

• Antioxidant capacity:
• • One of the ways in which chronic inflammation can cause damage is through a prolonged production of reactive oxygen species (a.k.a. ROS), which can oxidize DNA, proteins, and lipids, impairing cellular structures.
  • Ketone bodies are thought to be able to work against or suppress ROS activity. BHB, in particular, has shown gene regulating effects, activating a group of genes with protective roles over inflammation and oxidative stress. Some studies showed that even exogenous ketone bodies were able to reduce ROS, both in vivo and in vitro. In a study of type 2 diabetes patients, those on ketogenic diet had significant reduction of C-reactive protein and white blood cell count (two of the biomarkers that respond to inflammation), compared to those who were not on ketogenic diet.
  • • Mitochondrial dysfunction plays a significant role in generating ROS. Production of ketone bodies through nutritional ketosis can improve mitochondrial numbers and function by inhibiting glycolysis and increasing mitochondrial oxidation-induced ATP generation, which is more efficient in generating energy.

• Increase in adenosine production:
• Ketone metabolism is thought to increase levels of adenosine, a neuromodulator. Adenosine has shown anti-inflammatory effects via inhibition of leukocyte/neutrophil adhesion to vascular endothelium.

• Activation of peroxisome proliferator-activated receptors (PPARs):
• High-fat content of ketogenic diet leads to an increase in long-chain polyunsaturated fatty acids. These polyunsaturated fatty acids can bind to peroxisome proliferator-activated receptors. It has been experimentally shown that activated PPARs can reduce inflammation, in which introduction of synthetic PPAR reduced inflammatory response, while a PPAR knockout (removal) elevated inflammation.

• Weight loss:
• Fatty liver is known to contribute to inflammation. Studies have found that weight loss has anti-inflammatory effects shown by reductions in inflammatory markers. Carbohydrate reduction in ketogenic diet increases rate of fatty acid oxidation, contributing to the net loss of liver fat. In addition, many studies observed additional benefits of the ketogenic diet (as opposed to a low-fat diet) – it correlated to lower total cholesterol and lower blood triglyceride levels and higher HDL levels.

There is still a lot more to understand about the complexity of how ketogenic diets affects chronic inflammation. Yet, even now, there is ample evidence to show its potential in supplementing treatments of numerous chronic conditions that many are suffering with today.

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