Since the introduction of keto in 1920, research has emerged to understand its mechanisms and uses in various clinical conditions and, recently, ketones have been proposed as super-metabolic fuel because of their various favorable impacts on cellular metabolism in many tissues.
Up until now, these are the disorders that are being treated with the ketogenic diet:
- Endocrine Disorders: Diabetes, Obesity, Metabolic Syndrome, PCOS, Conegnital hyperinsulinism, Non-Alcoholic Fatty Liver Disease (NAFLD).
- Neurological Disorders: Intractable Epilepsy, Lennox-Gastaut syndrome, Myoclonic-astatic epilepsy, Parkinson's Disease, Alzheimer's Disease, ALS, Migraines, Narcolepsy, Depression, Autism.
- Metabolic Disorders: Glucose transporter type 1 deficiency, Pyruvate dehydrogenase complex deficiency, Phosphofructokinase deficiency.
- Others: Trauma and ischemia, Cancer and malignancy.
But, is it safe? 🤨
Our ketone build-up depends on several physiological parameters such as body fat percentage, body mass index (BMI), and resting metabolic rate; that’s why keto should ideally be supervised by a registered dietitian - nutritionist (among other professionals).
Keto is perfectly safe as the concentration of ketones in persons on this diet is far lower than the concentration seen in diabetic ketoacidosis (a really severe and life-threatening state that has nothing to do with ketosis) and is not associated with any changes in blood pH.
It must be mentioned here that human nutrition begins with a keto diet…Colostrum is 100% keto and serves the needs of the neonate completely.
Impact on central nervous system 🧠
There are studies supporting possible therapeutic utilization of keto in multiple neurological disorders due to its neuroprotective effects.
Keto is considered an established part of an integrative approach, along with drug therapy, in major epilepsy centers worldwide.
The transition from glucose to ketones can metabolically target brain tumors and reduce their energy metabolism to avoid tumor growth.
Impact on heart 🫀
The cardiac muscle is an “omnivore,” which uses diverse substances as sources of fuel, being ketones one of them. Studies have shown an increase in the number of mitochondria, tolerance to ischemia (an inadequate blood supply to an organ or part of the body, especially the heart muscles), and a faster recovery of cardiac function following reperfusion (restoration of blood flow to an organ or tissue after having been blocked) in rats fed with a ketogenic diet*; hence, it is cardioprotective.
*Similar benefits have been observed in human model studies.
Impact on respiratory system 🫁
Studies have shown that keto can help in respiratory problems with limited oxygen supply, which proves beneficial for patients with respiratory insufficiency or failure.
As you can see, keto is gaining interest but is to be performed under strict medical supervision of dieticians/nutritionists and physicians to be effective. With that being said, the understanding of clinical impacts, safety, tolerability, efficacy, duration of treatment, and prognosis after discontinuation of the diet is challenging and requires further studies to understand the disease-specific mechanisms.