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Ketogenic Diet in Therapy and Rehabilitation
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Ketogenic Diet in Therapy and Rehabilitation

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

Deadline for manuscript submissions: closed (25 November 2024) | Viewed by 8441

Special Issue Editor

Prof. Dr. Antonio Paoli

E-Mail Website
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
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The ketogenic diet, a low-carbohydrate, moderate-protein, and high-fat diet, has garnered significant attention for its therapeutic benefits across diverse domains. From neurological disorders such as epilepsy and Alzheimer's disease to metabolic conditions like diabetes and obesity, the ketogenic diet has demonstrated remarkable efficacy. Moreover, its potential extends beyond these traditional realms, encompassing areas such as cancer therapy, cardiovascular health, and even mental well-being.

This Special Issue seeks to bring together cutting-edge research, clinical insights, and theoretical perspectives to elucidate the mechanisms underlying the therapeutic effects of ketogenic diets. We invite contributions spanning a wide range of disciplines, including but not limited to the following:

  • Clinical trials assessing the efficacy and safety of ketogenic diets in various therapeutic contexts.
  • Molecular and physiological mechanisms underlying the metabolic effects of ketogenic diets.
  • Neurological implications and relevance of ketosis in neurodegenerative disorders.
  • The role of ketogenic diets in managing metabolic syndrome, insulin resistance, and type 2 diabetes.
  • Ketogenic approaches in oncology: exploring metabolic therapies for cancer.
  • Ketogenic interventions in psychiatric disorders and cognitive enhancement.
  • Practical considerations for implementing ketogenic diets in clinical practice, including dietary protocols and patient management strategies.

We welcome original research articles, reviews, meta-analyses, case studies, and perspectives that contribute to our understanding of the therapeutic potential of ketogenic diets. By fostering interdisciplinary dialogue and advancing scientific knowledge in this burgeoning field, we aim to catalyze dialogue and knowledge exchange to innovate healthcare delivery and improve patient outcomes.

Prof. Dr. Antonio Paoli
Guest Editor

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • ketogenic diet
  • ketones
  • very-low-carbohydrate diet
  • modified fasting
  • ketosis

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Published Papers (5 papers)

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Research

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15 pages, 586 KiB  
Article
Effects of a 12 Week Ketogenic Diet Intervention on Obese and Overweight Females with Glucose and Lipid Metabolism Disturbance
by Grzegorz Klonek, Grzegorz Zydek, Robert Roczniok, Mariusz Panek, Adam Zając and Małgorzata Magdalena Michalczyk
Nutrients 2024, 16(23), 4218; https://doi.org/10.3390/nu16234218 - 6 Dec 2024
Viewed by 2199
Abstract
Background/Objectives: We evaluated the effects of a 12-week hypocaloric ketogenic diet (KD) on glucose and lipid metabolism, as well as body mass, in overweight, obese, and healthy-weight females. One hundred adult females completed the study, including 64 obese (97.99 ± 11.48 kg), 23 [...] Read more.
Background/Objectives: We evaluated the effects of a 12-week hypocaloric ketogenic diet (KD) on glucose and lipid metabolism, as well as body mass, in overweight, obese, and healthy-weight females. One hundred adult females completed the study, including 64 obese (97.99 ± 11.48 kg), 23 overweight (75.50 ± 5.12 kg), and 11 with normal body mass (65.93 ± 3.40 kg). All participants followed a KD consisting of less than 30 g of carbohydrates, approximately 60 g of protein, and 140 g of fat per day (80% unsaturated and 20% saturated fat). Methods: Glucose (Gl), insulin (I), glycated haemoglobin (HBA1c), HOMA-IR, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) were measured before and after the intervention. Additionally, body mass (BM), BMI (Body Mass Index), waist circumference (WC), hip circumference (HC), and thigh circumference (TC) were recorded. Results: After 12 weeks of the KD, significant improvements were observed in GL, I, TG, HDL-C, HOMA-IR across all groups. Also BM, BMI, TC, WC, and HC were significantly reduced in all participants. Notably, obese participants showed greater reductions in all variables compared to overweight and healthy-weight females. Conclusions: A 12-week KD led to more pronounced improvements in biochemical markers and body mass in obese females compared to other groups. A KD may be particularly beneficial for obese females with hyperglycaemia, hyperinsulinemia, and lipid profile disturbances. Full article
(This article belongs to the Special Issue Ketogenic Diet in Therapy and Rehabilitation)
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15 pages, 1907 KiB  
Article
Synergistic Effects of Chitosan and Fish Oil on Lipid Metabolism in Rats Fed a High-Fat and Low-Carbohydrate Diet
by Shing-Hwa Liu, Ting-Yu Chang, Shih-Hou Liu and Meng-Tsan Chiang
Nutrients 2024, 16(23), 4080; https://doi.org/10.3390/nu16234080 - 27 Nov 2024
Viewed by 914
Abstract
Background/Objectives: Although high-fat, low-carbohydrate diets are used for weight loss and type 2 diabetes management, their high-fat content may have negative effects. This study examines the effects of replacing cellulose with chitosan and part of the fat with fish oil in a high-fat, [...] Read more.
Background/Objectives: Although high-fat, low-carbohydrate diets are used for weight loss and type 2 diabetes management, their high-fat content may have negative effects. This study examines the effects of replacing cellulose with chitosan and part of the fat with fish oil in a high-fat, low-carbohydrate diet on lipid metabolism in rats. Methods: The experiment involved 35 six-week-old male SD rats, divided into five groups: normal control diet (ND), high-fat diet (HF), high-fat, low-carbohydrate diet (LC), LC with 5% chitosan (LC-CH), and LC with 5% chitosan and 5% fish oil (LC-CHF). Results: After 15 weeks, the HF group had the highest liver weight, and the LC group had the highest adipose tissue weight. The LC-CHF group showed significantly reduced body, liver, and adipose tissue weights, lower ALT, AST, TNF-α, and cholesterol levels, as well as improved liver enzyme activity and fat synthesis regulation. LC-CHF also promoted fat breakdown in adipose tissue, reducing adipocyte size. Conclusions: Our findings suggest the modified high-fat, low-carbohydrate diet with chitosan and fish oil improved obesity and fatty liver outcomes compared to a standard high-fat diet. Full article
(This article belongs to the Special Issue Ketogenic Diet in Therapy and Rehabilitation)
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7 pages, 225 KiB  
Communication
Weight Loss, Pathological Changes, and Inflammatory Effects from a Short-Term Ketogenic Diet in Overweight and Obese Men with Untreated Prostate Cancer on Active Surveillance
by Adeel Kaiser, Mohummad M. Siddiqui, Jason Bosley-Smith, Shu Wang, Joseph Aryankalayil, Mark V. Mishra, Alice S. Ryan and Christopher R. D’Adamo
Nutrients 2024, 16(21), 3716; https://doi.org/10.3390/nu16213716 - 30 Oct 2024
Viewed by 1471
Abstract
Background and Aims: Active Surveillance (AS) is a favored strategy for the management of indolent prostate cancers (PCs). Overweight and obese men harbor an increased risk of cancer progression during AS. We aim to prospectively evaluate the feasibility and outcomes of a ketogenic [...] Read more.
Background and Aims: Active Surveillance (AS) is a favored strategy for the management of indolent prostate cancers (PCs). Overweight and obese men harbor an increased risk of cancer progression during AS. We aim to prospectively evaluate the feasibility and outcomes of a ketogenic diet (KD) weight-loss intervention in overweight men with PC. Materials and Methods: Men with PC and a BMI > 25 kg/m2 undergoing AS were placed on an 8-week ad libitum KD program before a scheduled surveillance biopsy to assess the impact on clinical grade group (CGG). Blood ketone levels were tracked to ensure compliance. BMI, PSA, and inflammatory marker data (TNF-α, TNFR1, TNFR2, sICAM-1, sVCAM-1, IL-6, IL1-RA, CRP, and SAA) were collected before and after the KD intervention. A Shapiro–Wilk test was performed to assess the normality of all continuous study variables. Paired t-tests and Wilcoxon rank sum tests were utilized to compare normally and non-normally distributed study outcomes, respectively. Results: Ten AS patients aged 62.1 (±5.4) years were enrolled with an average BMI of 31.7 kg/m2 (±11.8). Post-KD intervention mean blood ketone levels were 0.32 (±0.12) mmol/L with a mean BMI reduction of 7.4% (p < 0.0003). There were no meaningful changes in PSA or inflammatory biomarkers (p > 0.05). Nine patients completed re-biopsy following a KD with four patients showing no evidence of cancer; one downgraded to a lower CGG; two had unchanged CGG scores; and two had higher CGG scores compared to baseline. Conclusions: Short-term KD interventions for BMI reduction are feasible in men undergoing AS for PC and may result in favorable pathological effects without inflammatory marker changes. Larger studies with longer follow-up are needed to explore whether KD-induced weight loss can improve clinical outcomes with AS in PC. Full article
(This article belongs to the Special Issue Ketogenic Diet in Therapy and Rehabilitation)

Review

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25 pages, 1284 KiB  
Review
Ketogenic Diet as a Nutritional Metabolic Intervention for Obsessive–Compulsive Disorder: A Narrative Review
by Astrid Lounici, Ana Iacob, Katarzyna Hongler, Melina A. Mölling, Maria Drechsler, Luca Hersberger, Shebani Sethi, Undine E. Lang and Timur Liwinski
Nutrients 2025, 17(1), 31; https://doi.org/10.3390/nu17010031 - 25 Dec 2024
Viewed by 3259
Abstract
The substantial evidence supporting the ketogenic diet (KD) in epilepsy management has spurred research into its effects on other neurological and psychiatric conditions. Despite differences in characteristics, symptoms, and underlying mechanisms, these conditions share common pathways that the KD may influence. The KD [...] Read more.
The substantial evidence supporting the ketogenic diet (KD) in epilepsy management has spurred research into its effects on other neurological and psychiatric conditions. Despite differences in characteristics, symptoms, and underlying mechanisms, these conditions share common pathways that the KD may influence. The KD reverses metabolic dysfunction. Moreover, it has been shown to support neuroprotection through mechanisms such as neuronal energy support, inflammation reduction, amelioration of oxidative stress, and reversing mitochondrial dysfunction. The adequate intake of dietary nutrients is essential for maintaining normal brain functions, and strong evidence supports the role of nutrition in the treatment and prevention of many psychiatric and neurological disorders. Obsessive–compulsive disorder (OCD) is a neuropsychiatric condition marked by persistent, distressing thoughts or impulses (obsessions) and repetitive behaviors performed in response to these obsessions (compulsions). Recent studies have increasingly examined the role of nutrition and metabolic disorders in OCD. This narrative review examines current evidence on the potential role of the KD in the treatment of OCD. We explore research on the KD’s effects on psychiatric disorders to assess its potential relevance for OCD treatment. Additionally, we identify key gaps in the preclinical and clinical research that warrant further study in applying the KD as a metabolic therapy for OCD. Full article
(This article belongs to the Special Issue Ketogenic Diet in Therapy and Rehabilitation)
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Other

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12 pages, 740 KiB  
Opinion
Myths and Facts Regarding Low-Carbohydrate Diets
by Nina Teicholz, Steven M. Croft, Ignacio Cuaranta, Mark Cucuzzella, Mariela Glandt, Dina H. Griauzde, Karen Jerome-Zapadka, Tro Kalayjian, Kendrick Murphy, Mark Nelson, Catherine Shanahan, Jodi L. Nishida, Robert C. Oh, Naomi Parrella, Erin M. Saner, Shebani Sethi, Jeff S. Volek, Micalla Williden and Susan Wolver
Nutrients 2025, 17(6), 1047; https://doi.org/10.3390/nu17061047 - 17 Mar 2025
Viewed by 178
Abstract
As the prevalence of chronic diseases persists at epidemic proportions, health practitioners face ongoing challenges in providing effective lifestyle treatments for their patients. Even for those patients on GLP-1 agonists, nutrition counseling remains a crucial strategy for managing these conditions over the long [...] Read more.
As the prevalence of chronic diseases persists at epidemic proportions, health practitioners face ongoing challenges in providing effective lifestyle treatments for their patients. Even for those patients on GLP-1 agonists, nutrition counseling remains a crucial strategy for managing these conditions over the long term. This paper aims to address the concerns of patients and practitioners who are interested in a low-carbohydrate or ketogenic diet, but who have concerns about its efficacy, safety, and long-term viability. The authors of this paper are practitioners who have used this approach and researchers engaged in its study. The paper reflects our opinion and is not meant to review low-carbohydrate diets systematically. In addressing common concerns, we hope to show that this approach has been well researched and can no longer be seen as a “fad diet” with adverse health effects such as impaired renal function or increased risk of heart disease. We also address persistent questions about patient adherence, affordability, and environmental sustainability. This paper reflects our perspective as clinicians and researchers engaged in the study and application of low-carbohydrate dietary interventions. While the paper is not a systematic review, all factual claims are substantiated with citations from the peer-reviewed literature and the most rigorous and recent science. To our knowledge, this paper is the first to address potential misconceptions about low-carbohydrate and ketogenic diets comprehensively. Full article
(This article belongs to the Special Issue Ketogenic Diet in Therapy and Rehabilitation)
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