Abstract
Background: the ketogenic diet (KD) has become a widely used nutritional approach for weight loss. Some of the KD’s positive effects on metabolism and cardiovascular risk factors are similar to those seen after n-3 polyunsaturated fatty acids (ω-3) supplementation. We hypothesized that a ketogenic Mediterranean diet with phytoextracts combined with ω-3 supplementation may have increased positive effects on cardiovascular risk factors and inflammation. Methods: We analyzed 34 male overweight subjects; aged between 25 and 65 years who were overall healthy apart from overweight. The subjects followed a ketogenic diet protocol for four weeks; with (KDO3) or without (KD) ω-3 supplementation. Results: All subjects experienced a significant loss of body weight and body fat and there was no significant differences between treatment (body weight: KD—4.7 kg, KDO3—4.03 kg, body fat KD—5.41 kg, KDO3—5.86 kg). There were also significant decreases in total cholesterol, LDL-c, and glucose levels. Triglycerides and insulin levels decreased more in KDO3 vs. KD subjects, with a significant difference. All the investigated inflammatory cytokines (IL-1β, IL-6, TNF-α) decreased significantly in KDO3 subjects whilst only TNF-α showed a significant decrease in KD subjects over the 12 month study period. No significant changes were observed in anti-inflammatory cytokines (IL-10 and IL-1Ra), creatinine, urea and uric acid. Adiponectin increased significantly only in the KDO3 group. Conclusions: ω-3 supplementation improved the positive effects of a ketogenic Mediterranean diet with phytoextracts on some cardiovascular/metabolic risk factors and inflammatory state.
Highlights
In recent years there has been an increasing amount of evidence suggesting that a ketogenic diet, apart from its benefits for weight loss [1,2], has a beneficial effect on the symptoms of neurological diseases [3], diabetes [4] and other diseases [5]
Both groups showed a significant decrease in body mass index (BMI), fat mass (FM) with similar results in both KD and KDO3 whilst lean body mass (LBM) showed no significant changes
Both groups showed a decrease in total cholesterol without any significant difference according to treatment, low-density lipoprotein cholesterol (LDL-c) decreased in both groups with a greater decrease, not significant, in the KD group
Summary
In recent years there has been an increasing amount of evidence suggesting that a ketogenic diet, apart from its benefits for weight loss [1,2], has a beneficial effect on the symptoms of neurological diseases [3], diabetes [4] and other diseases [5]. There are still some concerns about its effects on health outcomes on blood lipid profiles and cardiovascular risk factors [8], even though the majority of published studies do not support such concerns [1]. The majority of recent studies clearly demonstrate that the reduction of carbohydrate intake leads to a physiological ketosis (that must be distinguished from the pathological ketosis arising from diabetes, as stated by Hans Krebs in 1966 [9]) that improves blood lipid profiles [10,11,12,13,14,15]. The effects of KDs seem to be more evident on levels of blood triglycerides [16] but they have positive effects on the reduction of total cholesterol and an increase in HDL [17,18].
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