What are the effects of ketogenic diet on cardiovascular health?

Abstract (as presented by the authors of the scientific work):

"The treatment of obesity and cardiovascular diseases is one of the most difficult and important challenges nowadays. Weight loss is frequently offered as a therapy and is aimed at improving some of the components of the metabolic syndrome. Among various diets, ketogenic diets, which are very low in carbohydrates and usually high in fats and/or proteins, have gained in popularity. Results regarding the impact of such diets on cardiovascular risk factors are controversial, both in animals and humans, but some improvements notably in obesity and type 2 diabetes have been described. Unfortunately, these effects seem to be limited in time. Moreover, these diets are not totally safe and can be associated with some adverse events. Notably, in rodents, development of nonalcoholic fatty liver disease (NAFLD) and insulin resistance have been described. The aim of this review is to discuss the role of ketogenic diets on different cardiovascular risk factors in both animals and humans based on available evidence."


Covered topics (the letter size corresponds to the frequency of mentioning in the text):

Conclusions (as presented by the authors of the scientific work):

"Based on the available literature, KD may be associated with some improvements in some cardiovascular risk factors, such as obesity, type 2 diabetes and HDL cholesterol levels, but these effects are usually limited in time. As KD are often rich in fats, some negative effects could happen. Mainly in rodents, developments of NAFLD and insulin resistance were described. In humans, insulin resistance is also a potential negative effect, but some studies have shown improvements in insulin sensitivity. Nevertheless, many subjects contemplating such diets are overweight or obese at baseline, and even a moderate weight loss could be metabolically beneficial for them. However, it is mandatory to maintain body weight after weight loss, which is usually a major problem. More studies are therefore warranted to better assess the effects of long term use of KD on metabolic diseases and cardiovascular risk factors, but also to better define which dietary macronutrient composition is optimal."


Full-text access of the referenced scientific work:

Kosinski C, Jornayvaz FR. Effects of Ketogenic Diets on Cardiovascular Risk
Factors: Evidence from Animal and Human Studies. Nutrients. 2017 May 19;9(5).
pii: E517. doi: 10.3390/nu9050517. Review. PubMed PMID: 28534852.
http://www.mdpi.com/2072-6643/9/5/517/htm


Further reading:

Ketogenic diet (Wikipedia): "The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Almost half of children, and young people, with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] The most common adverse effect is constipation, affecting about 30% of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones, and is no longer considered beneficial.[2][3]
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant drugs. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]
In the mid-1990s, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.[1]
Clinical trials and studies in animal models (including C. elegans[6]) suggest that ketogenic diets provide neuroprotective and disease-modifying benefits for a number of adult neurodegenerative disorders.[7][8] As of 2012, there is limited clinical trial data in these areas, and, outside of paediatric epilepsy, use of the ketogenic diet remains at the research stage.[3][9][10]
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Cardiovascular diseases (WHO/Europe): "Cardiovascular diseases are a group of disorders of the heart and blood vessels and include:
*coronary heart disease: disease of the blood vessels supplying the heart muscle;
*cerebrovascular disease: disease of the blood vessels supplying the brain;
*peripheral arterial disease: disease of blood vessels supplying the arms and legs;
*rheumatic heart disease: damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria;
*congenital heart disease: malformations of heart structure existing at birth;
*deep vein thrombosis and pulmonary embolism: blood clots in the leg veins, which can dislodge and move to the heart and lungs.
Heart attacks and strokes are usually acute events and are mainly caused by a blockage that prevents blood from flowing to the heart or brain. The most common reason is a build-up of fatty deposits on the inner walls of the blood vessels. Strokes can be caused by bleeding from a blood vessel in the brain or by blood clots. ...read more".

Nonalcoholic fatty liver disease (NAFLD) (Mayo Clinic): "Nonalcoholic fatty liver disease is an umbrella term for a range of liver conditions affecting people who drink little to no alcohol. As the name implies, the main characteristic of nonalcoholic fatty liver disease is too much fat stored in liver cells.
Nonalcoholic steatohepatitis, a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. This damage is similar to the damage caused by heavy alcohol use. At its most severe, nonalcoholic steatohepatitis can progress to cirrhosis and liver failure
Nonalcoholic fatty liver disease is increasingly common around the world, especially in Western nations. In the United States, it is the most common form of chronic liver disease, affecting an estimated 80 to 100 million people.
Nonalcoholic fatty liver disease occurs in every age group but especially in people in their 40s and 50s who are at high risk of heart disease because of such risk factors as obesity and type 2 diabetes. The condition is also closely linked to metabolic syndrome, which is a cluster of abnormalities including increased abdominal fat, poor ability to use the hormone insulin, high blood pressure and high blood levels of triglycerides, a type of fat.
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