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The Effects of Ketogenic Diet on Human Health and Disease

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: 15 May 2026 | Viewed by 102711

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Special Issue Editors

Dr. Giuseppe Cerullo

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Guest Editor

Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
Interests: sport nutrition; ketogenic diet; body composition; exercise physiology

Prof. Dr. Antonio Paoli

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Guest Editor

Department of Biomedical Sciences, University of Padova, 35131 Padova, Italy
Interests: resistance training; metabolism; fat loss; skeletal muscle physiology; fitness; muscle hypertrophy; fasting; ketogenic diet; time-restricted eating; ketones; low carbohydrate diet
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Dear Colleagues,

The ketogenic diet was originally used for treatment of refractory epilepsy. After several decades, the ketogenic diet is now considered a popular strategy for losing weight and improving metabolic disorders as well. However, beyond “simple” weight loss, many other applications are emerging, including neurodegenerative disorders, fatigue, and cancer. At the same time, although it is considered generally safe, more research should explore the relationship between the keto diet and blood pressure, kidney stones, and increased risk of heart disease. Furthermore, several symptoms, such as an upset stomach, dizziness, decreased energy, and mood swings caused by your body adapting to ketosis, are also common.

Thus, the aim of this Special Issue is to gather high-quality evidence on the potential role played by ketone bodies and their impact on health and medical conditions.

Original research as well as literature reviews and meta-analyses are welcome. Based on this, the primary goal of the work should be to explore the effects of a ketogenic diet and, consequently, ketosis (achieved through a ketogenic diet or exogenous ketones) on various aspects of human health, ranging from athletic performance to aging, and medical conditions such as obesity, diabetes, palliative care, autoimmune conditions, neurodegenerative disease, and cancer, among others.

Dr. Giuseppe Cerullo
Prof. Dr. Antonio Paoli
Guest Editors

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Keywords

nutritional ketosis
obesity
fatigue
exogenous ketosis
metabolic syndrome
body composition

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Published Papers (5 papers)

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Research

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14 pages, 558 KB

Open AccessArticle

Alteration in Amino Acid Metabolism After Isocaloric, Energy-Restricted Ketogenic Diet in Women with Overweight and Obesity: Randomized KETO-MINOX Trial

by Natalia Drabińska-Fois, Anna Majcher, Paweł Jagielski, Sebastian Borowicz-Skoneczny and Jerzy Romaszko

Nutrients 2026, 18(2), 300; https://doi.org/10.3390/nu18020300 - 18 Jan 2026

Viewed by 979

Abstract

Background/Objectives: Circulating amino acid concentrations and their excretion can provide insights into dietary protein intake and metabolism. Alterations in amino acid homeostasis occur in various disorders due to nutritional imbalances or metabolic changes, including obesity. A ketogenic diet (KD) has gained popularity for weight management; however, its metabolic effects are not fully known. Therefore, the aim of this study was to evaluate the effect of an eight-week, energy-restricted Mediterranean-type KD on the amino acid metabolism in women with overweight and class I obesity. Methods: A randomized, single-center, controlled trial was conducted with 80 women with a BMI of 25.5–35 in age between 18 and 45 years, without any chronic diseases. Randomly divided women received food catering with approximately 1750 kcal daily for eight weeks, containing KD or standard diet (STD), respectively. The concentration of amino acids was assessed by gas chromatography-mass spectrometry after the derivatization with chloroformate in serum and urine collected at the baseline, after 4 weeks, and at the end of the intervention. Results: The results collected from 66 participants were included in the final analyses. Independent of diet type, weight reduction was associated with increased circulating α-aminobutyric acid and decreased proline, glutamate, and tyrosine. The KD led to lower concentrations of alanine, methionine, threonine, and tryptophan, alongside higher levels of branched-chain amino acids (BCAA) and α-aminobutyric acid compared to the STD. Urinary amino acid excretion decreased after weight reduction. KD was associated with higher urinary excretion of BCAA and β-aminoisobutyric acid. Conclusions: In summary, both weight reduction and KD significantly affect the amino acid metabolism, which might have implications for inflammation, oxidative stress, and cardiometabolic risk. Full article

(This article belongs to the Special Issue The Effects of Ketogenic Diet on Human Health and Disease)

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22 pages, 1469 KB

Open AccessArticle

Impact of a Fish-Based Restrictive Ketogenic Diet on Body Composition and Strength Capacity: A Pre–Post Study

by Katarzyna Siedzik, Kamil Góral, Ewa Rodziewicz-Flis, Robert A. Olek and Wiesław Ziółkowski

Nutrients 2025, 17(8), 1297; https://doi.org/10.3390/nu17081297 - 8 Apr 2025

Cited by 1 | Viewed by 3327

Abstract

Background: The ketogenic diet (KD) is becoming a popular nutritional model for athletes. One limitation of this diet is the use of animal-meat products, which may be unacceptable to some people. Moreover, the relationship between this diet’s use, body composition, and strength capacity has not been thoroughly investigated. This study aimed to assess the effects of a two-week fish-based restrictive KD on body composition, strength capacity (isometric muscle strength), and somatic disorders in healthy adults. Methods: Participants were recruited through advertisements, posters displayed at the university, and information shared among colleagues. Ultimately, 14 individuals qualified for this study. For two weeks, they followed a designated ketogenic diet enriched with fish and omega-3 fatty acids, with a calorie reduction of −500 kcal/day. The study was designed and conducted as a single-group pre–post study. Before and after completing the diet, participants’ body composition (body mass, body fat, fat-free mass, and visceral fat) and strength capacity (knee extensor peak torque [KEPT] and knee flexor peak torque [KFPT]) were measured. The survey also analyzed participants’ somatic disorders such as nausea, vomiting, energy level, diarrhea, constipation, drowsiness, sleep problems, hunger, thirst, and bad breath. The average results of both trials obtained before and after the diet were compared using the paired Student’s t-test or non-parametric test. The significance level was set at 0.05. Results: After two weeks of a fish-based restrictive KD, significant increases in ketone bodies were observed in both the blood (pre: 0.21 mmol/L ± 0.15 vs. post: 2.20 ± 1.19, p < 0.001) and urine (pre: 0.00 mmol/L ± 0.00 vs. post: 4.64 mmol/L ± 3.24, p < 0.001). Body composition changes included significant reductions in total body mass (pre: 76.66 kg ± 11.06 vs. post: 73.77 kg ± 10.76, p < 0.001), fat mass (pre: 21.34 kg ± 7.36 vs. post: 19.73 kg ± 7.20, p < 0.001), and visceral fat (pre: 708.50 g ± 627.67 vs. post: 603.21 g ± 567.82, p = 0.0012). Skeletal muscle mass decreased by 2% (pre: 27.75 kg ± 5.80 vs. post: 27.03 kg ± 5.47, p = 0.01), though no significant changes were seen in muscle strength when adjusting for body mass or skeletal muscle mass. No major adverse effects were noted in relation to somatic disorders, although some participants reported increased thirst and bad breath. Conclusions: After 14 days of a fish-based restrictive KD, a significant reduction in body mass and changes in body composition were observed, with no loss of muscle strength. This type of diet may serve as an effective method for rapid body mass reduction in sports with weight categories, while preserving muscle strength, which is crucial for athletes. It could also be an alternative means for individuals to eliminate animal meat from their diet. Full article

(This article belongs to the Special Issue The Effects of Ketogenic Diet on Human Health and Disease)

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Review

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14 pages, 455 KB

Open AccessReview

The Role of Ketogenic Diet and β-Hydroxybutyrate in the Prevention of Muscle Catabolism and Sarcopenia in Aging Populations: Mechanisms, Evidence, and Clinical Perspectives

by Claudia Venturini, Giulia Matacchione, Lucia Mancinelli, Sara Caccese, Michele Alfieri, Fabrizia Lattanzio, Fabiola Olivieri and Roberto Antonicelli

Nutrients 2026, 18(5), 761; https://doi.org/10.3390/nu18050761 - 26 Feb 2026

Viewed by 802

Abstract

Sarcopenia, characterized by the progressive loss of skeletal muscle mass, strength, and function, represents a growing public health challenge in aging populations. Emerging mechanistic evidence suggests that ketogenic diets (KDs) and elevated circulating β-hydroxybutyrate (βOHB) levels may offer selective and context-dependent nutritional strategies to support muscle health during aging. This review summarizes current evidence on the effects of ketogenic diets and ketone body metabolism on muscle mass and function, with a focus on underlying molecular mechanisms and clinical relevance in older adults. βOHB acts not only as an alternative energy substrate but also as a signaling molecule, notably through histone deacetylase inhibition and modulation of inflammatory pathways. Nutritional ketosis in humans typically results in circulating βOHB concentrations of approximately 0.5–3.0 mM, which may be sufficient to engage some of these signaling pathways, although the extent of these effects in human tissues remains incompletely defined. Preclinical studies indicate that long-term ketogenic diets preserve muscle mass, strength, and mitochondrial function in aging models. Limited clinical evidence, largely derived from populations with sarcopenic obesity or metabolic comorbidities, suggests that protein-adequate ketogenic diets, when implemented as an adjunct to physical exercise, may help preserve fat-free mass and improve functional outcomes, while exogenous ketones show potential to augment post-exercise anabolic signaling. Overall, the integration of mechanistic and preliminary clinical data provides a supplementary and exploratory framework suggesting that ketogenic diets may represent a promising adjunctive strategy for sarcopenia prevention, although well-designed long-term randomized controlled trials are required to define their efficacy, safety, and optimal clinical application. Full article

(This article belongs to the Special Issue The Effects of Ketogenic Diet on Human Health and Disease)

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31 pages, 868 KB

Open AccessReview

DASH Diet and Preeclampsia Prevention: A Literature Review

by Dimitris Baroutis, Eleni Katsianou, Diamantis Athanasiou, Aikaterini-Gavriela Giannakaki, Panagiotis Antsaklis, Marianna Theodora, George Daskalakis and Makarios Eleftheriades

Nutrients 2025, 17(12), 2025; https://doi.org/10.3390/nu17122025 - 17 Jun 2025

Viewed by 8170

Abstract

The Dietary Approaches to Stop Hypertension (DASH) diet, characterized by high consumption of fruits, vegetables, whole grains, low-fat dairy products, and limited intake of saturated fats, cholesterol, and refined sugars, has been suggested to reduce the risk of preeclampsia. This narrative review aimed to summarize and synthesize the evidence regarding the role of the DASH diet in preeclampsia prevention. PubMed/MEDLINE, Embase, Google Scholar, ScienceDirect, Scopus, and Web of Science databases were searched to identify relevant studies. Multiple observational and intervention studies examining DASH diet adherence and preeclampsia outcomes were included. Higher adherence to the DASH diet was associated with an approximately 35–45% reduced risk of preeclampsia in observational studies. Intervention trials in high-risk populations demonstrated improved blood pressure control and potential reductions in preeclampsia incidence. The DASH diet appears to exert protective effects through multiple mechanisms, including improved blood pressure regulation, enhanced antioxidant defense, reduced inflammation, and improved endothelial function. The heterogeneity in study designs, DASH diet assessment methods, and intervention protocols limited the strength of conclusions. Evidence for the effects of greater adherence to the DASH diet on preeclampsia prevention is promising but requires confirmation through larger randomized controlled trials. Future research should focus on standardized DASH diet assessment methods, optimal timing and duration of dietary intervention, and exploration of potential synergies with other preventive strategies. Full article

(This article belongs to the Special Issue The Effects of Ketogenic Diet on Human Health and Disease)

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40 pages, 5510 KB

Open AccessReview

Ketogenic Diets for Body Weight Loss: A Comparison with Other Diets

by Damian Dyńka, Łukasz Rodzeń, Mateusz Rodzeń, Anna Pacholak-Klimas, Georgia Ede, Shebani Sethi, Dorota Łojko, Karolina Bartoń, Ken Berry, Adam Deptuła, Żaneta Grzywacz, Peter Martin, Jen Unwin and David Unwin

Nutrients 2025, 17(6), 965; https://doi.org/10.3390/nu17060965 - 10 Mar 2025

Cited by 19 | Viewed by 87342

Abstract

With the prevalence of obesity and overweight increasing at an alarming rate, more and more researchers are focused on identifying effective weight loss strategies. The ketogenic diet (KD), used as a treatment in epilepsy management for over 100 years, is additionally gaining popularity as a weight loss method. Although its efficacy in weight loss is well documented, the areas where it may be beneficial to other dietary approaches need to be carefully examined. The objective of this paper is to identify the potential benefits of the KD over alternative dietary weight loss strategies based on a comprehensive literature review. It has been shown that the KD may be more bioenergetically efficient than other dietary strategies, inter alia owing to its effect on curtailing hunger, improving satiety and decreasing appetite (influence on hunger and satiety hormones and the sensation of hunger), inducing faster initial weight loss (associated with lower glycogen levels and reduced water retention), and controlling glycaemia and insulinemia (directly attributable to the low-carbohydrate nature of KD and indirectly to the other areas described). These effects are accompanied by improved insulin sensitivity, reduced inflammation (through ketone bodies and avoidance of pro-inflammatory sugars), reduced need for pharmacological obesity control (the diet’s mechanisms are similar to those of medication but without the side effects), and positive impacts on psychological factors and food addiction. Based on the authors’ review of the latest research, it is reasonable to conclude that, due to these many additional health benefits, the KD may be advantageous to other diet-based weight loss strategies. This important hypothesis deserves further exploration, which could be achieved by including outcome measures other than weight loss in future clinical trials, especially when comparing different diets of equal caloric value. Full article

(This article belongs to the Special Issue The Effects of Ketogenic Diet on Human Health and Disease)

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