Abstract
Several studies link cardiovascular diseases (CVD) with unhealthy lifestyles (unhealthy dietary habits, alcohol consumption, smoking, and low levels of physical activity). Therefore, the strong need for CVD prevention may be pursued through an improved control of CVD risk factors (impaired lipid and glycemic profiles, high blood pressure, and obesity), which is achievable through an overall intervention aimed to favor a healthy lifestyle. Focusing on diet, different recommendations emphasize the need to increase or avoid consumption of entire classes of food, with only partly known and only partly foreseeable consequences on the overall level of health. In recent years, the ketogenic diet (KD) has been proposed to be an effective lifestyle intervention for metabolic syndrome, and although the beneficial effects on weight loss and glucose metabolism seems to be well established, the effects of a prolonged KD on the ability to perform different types of exercise and the influence of KD on blood pressure (BP) levels, both in normotensives and in hypertensives, are not so well understood. The objective of this review is to analyze, on the basis of current evidence, the relationship between KD, regular physical activity, and BP.
Highlights
A ketogenic diet (KD) is a high-fat, adequate protein, low-carbohydrate diet [1]
We have included in this review only systematic reviews, metanalyses, randomized trials, and randomized controlled trials, selecting studies in which the intervention was ketogenic diet or very low carbohydrate ketogenic diet and one of the main objectives was to examine the effects on exercise capacity and/or on blood pressure (BP) levels
[16] The final effect is a better neuronal resistance and adaptive ability to metabolic stress and challenges. [16,25,26]. In view of these premises and of the growing interest that KDs are gaining in an increasingly large audience of potential patients, this review aims to investigate two aspects that we believe are extremely relevant for individuals approaching this type of diet, namely (1) how much the ability to exercise is influenced by the different bioavailability of metabolic substrates seen during the KD, and in particular by the scarcity of glucose, which is the fuel used by the muscle to support many of the physical efforts, especially those of higher intensity and short duration [27], and (2) what kind of benefit we can expect from this type of diet on blood pressure, since pathophysiologically obesity, altered glucose metabolism, and altered blood pressure control are closely interconnected
Summary
A ketogenic diet (KD) is a high-fat (providing a range of 55 to 90% calories as fat), adequate protein (accounts for 30–35% of the daily caloric requirement supplied; minimum of 1 g/kg of protein), low-carbohydrate diet (only 5–10% of total calories are provided by carbohydrates, less than 50 g/day) [1]. The different availability of substrates supplied to the organism by the diet influences the metabolism and drives it to use different energy substrates according to both quantity and quality of nutrients consumed in the specific dietary regimen This particular type of diet, designed to increase production of ketones by simulating the metabolic changes of starvation [2], has shown increasing interest from both the scientific community and patients since the early 1920’s, when the KD was successfully used as a therapy for intractable childhood epilepsy [3], has its cornerstone on the voluntary deficiency in carbohydrate intake leading the body to a rapid depletion of glycogen reserves; given the persistent unavailability of carbohydrates, the body turns to different metabolic pathways: gluconeogenesis and ketogenesis [1]. Different diet methodologies are offered to patients depending on (i) level of carbohydrate restriction, (ii) protein contribution,
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