Could very low-calorie ketogenic diets turn off low grade inflammation in obesity? Emerging evidence

Abstract

Obesity is an emerging non-communicable disease associated with chronic low-grade inflammation and oxidative stress, compounded by the development of many obesity-related diseases, such as cardiovascular disease, type 2 diabetes mellitus, and a range of cancers. Originally developed for the treatment of epilepsy in drug non-responder children, the ketogenic diet (KD) is being increasingly used in the treatment of many diseases, including obesity and obesity-related conditions. The KD is a dietary pattern characterized by high fat intake, moderate to low protein consumption, and very low carbohydrate intake (<50 g) that has proved to be an effective and weight-loss tool. In addition, it also appears to be a dietary intervention capable of improving the inflammatory state and oxidative stress in individuals with obesity by means of several mechanisms. The main activity of the KD has been linked to improving mitochondrial function and decreasing oxidative stress. β-hydroxybutyrate, the most studied ketone body, has been shown to reduce the production of reactive oxygen species, improving mitochondrial respiration. In addition, KDs exert anti-inflammatory activity through several mechanisms, e.g., by inhibiting activation of the nuclear factor kappa-light-chain-enhancer of activated B cells, and the inflammatory nucleotide-binding, leucine-rich-containing family, pyrin domain-containing-3, and inhibiting histone deacetylases. Given the rising interest in the topic, this review looks at the underlying anti-inflammatory and antioxidant mechanisms of KDs and their possible recruitment in the treatment of obesity and obesity-related disorders.

Keywords:

• Ketogenic diet
• VLCKD
• diet
• obesity
• inflammation
• low-grade inflammation
• reactive oxygen species
• ROS
• nutritionist

Acknowledgements

The expert linguistic revision by Stephanie Johnson made available by New Penta s.r.l. (Cuneo, Italy) is gratefully acknowledged.

BCM - Club delle Terapie Dietetiche in Endocrinologia e Metabolismo. Italian Society of Endocrinology (SIE). Coordinators: Luigi Barrea; Massimiliano Caprio. Secretariat: Giovanna Muscogiuri. http://www.societaitalianadiendocrinologia.it/html/pag/club-home.asp?id=15. Accessed on 21 January 2022.

Authorship

The authors’ responsibilities were as follows: LB was responsible for the concept of this paper; MC, MW, AF, and LV drafted the manuscript; GM, SS, and AM: provided a critical review of the paper. All authors contributed to and agreed on the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The author(s) reported there is no funding associated with the work featured in this article.