Abstract
Dietary interventions such as intermittent fasting and the ketogenic diet have demonstrated neuroprotective effects in various models of neurological insult. However, there has been a lack of evaluation of these interventions from a surgical perspective despite their potential to augment reparative processes that occur following nerve injury. Thus, we sought to analyze the effects of these dietary regimens on nerve regeneration and repair by critical appraisal of the literature. Following PRISMA guidelines, a systematic review was performed to identify studies published between 1950 and 2020 that examined the impact of either the ketogenic diet or intermittent fasting on traumatic injuries to the spinal cord or peripheral nerves. Study characteristics and outcomes were analyzed for each included article. A total of 1,890 articles were reviewed, of which 11 studies met inclusion criteria. Each of these articles was then assessed based on a variety of qualitative parameters, including type of injury, diet composition, timing, duration, and outcome. In total, seven articles examined the ketogenic diet, while four examined intermittent fasting. Only three studies examined peripheral nerves. Neuroprotective effects manifested as either improved histological or functional benefits in most of the included studies. Overall, we conclude that intermittent fasting and the ketogenic diet may promote neuroprotection and facilitate the regeneration and repair of nerve fibers following injury; however, lack of consistency between the studies in terms of animal models, diet compositions, and timing of dietary interventions preclude synthesis of their outcomes as a whole.
Highlights
Wound healing is a biological phenomenon that requires sufficient calories and precursors for unimpeded progression [1, 2]
The association of malnourishment and adverse healing serves as the basis for nutritional optimization, and surgical emphasis is placed on timely recognition of deficiencies and appropriate supplementation [3]
Systematic review of traumatic injuries to the spinal cord and peripheral nervous tissue in a ketogenic milieu can be leveraged to augment the reparative process [4,5,6,7]
Summary
Wound healing is a biological phenomenon that requires sufficient calories and precursors for unimpeded progression [1, 2]. Intermittent episodes of energy restriction (i.e. intermittent fasting) and regimens that promote metabolic switching—namely, ketone oxidation—have shown salutary effects across diverse species and diseases [8,9,10,11,12,13,14,15,16,17,18,19]. These dietary interventions seem to induce novel responses to injury and enhance repair in various tissues [20,21,22,23,24,25,26]. Ketone bodies—by-products of fatty acid oxidation and a vital fuel source for the brain in episodes of nutrient deprivation—have been implicated as key mediators [27]
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