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Kumar M, Bhatt B, Gusain C, Mahajan N, Bishnoi M. Sex-specific effects of ketogenic diet on anxiety-like behavior and neuroimmune response in C57Bl/6J mice. J Nutr Biochem 2024; 127:109591. [PMID: 38311044 DOI: 10.1016/j.jnutbio.2024.109591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024]
Abstract
The ketogenic diet (KD) has been shown to reduce anxiety and enhance cognitive functions in neurological diseases. However, the sex-specific effects of KD on anxiety-like behavior in healthy individuals and the underlying molecular mechanisms contributing to these effects, including neuroinflammation, are unelucidated. This study investigated the sex-specific effects of KD on anxiety-like behavior and the neuroimmune response in the prefrontal cortex (PFC) and hippocampus of healthy C57BL/6J male and female mice. Animals were fed either a control diet (CD- 17% fat, 65% carb, 18% protein) or a KD (80% fat, 5% carb, 15% protein) for 4 weeks. KD increased the levels of circulating β-hydroxybutyrate (BHB) both in males and females. However, PFC BHB levels were found to be elevated only in KD males. Moreover, KD did not affect the behavior of females but improved motor abilities and reduced anxiety levels in males. KD suppressed the mRNA expression of the pan microglial markers (Cd68, P2ry12) and induced morphological changes in the male PFC microglia. A sex-specific decrease in IL1β and an increase in IL-10 levels was found in the PFC of KD males. A similar trend was observed in the hippocampus of males where KD reduced the mRNA expression of P2ry12, Il1β, and cFos. Additionally, BHB increased the production of IL-10 whereas it decreased the production of IL1β from human microglia in in-vitro conditions. In summary, these results demonstrate that the anxiolytic and motor function enhancement abilities of KD are male-specific. Reduced pro-inflammatory and improved anti-inflammatory factors in the male PFC and hippocampus may underlie these effects.
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Affiliation(s)
- Mohit Kumar
- Centre for Excellence in Functional Foods, Food & Nutrition Biotechnology Division, National Agri-Food Biotechnology Institute, S.A.S Nagar, Sector 81 (Knowledge City), Punjab, India; Adjunct faculty, Regional Centre for Biotechnology, Faridabad, Haryana, India.
| | - Babita Bhatt
- Centre for Excellence in Functional Foods, Food & Nutrition Biotechnology Division, National Agri-Food Biotechnology Institute, S.A.S Nagar, Sector 81 (Knowledge City), Punjab, India
| | - Chitralekha Gusain
- Centre for Excellence in Functional Foods, Food & Nutrition Biotechnology Division, National Agri-Food Biotechnology Institute, S.A.S Nagar, Sector 81 (Knowledge City), Punjab, India
| | - Nayan Mahajan
- Centre for Excellence in Functional Foods, Food & Nutrition Biotechnology Division, National Agri-Food Biotechnology Institute, S.A.S Nagar, Sector 81 (Knowledge City), Punjab, India
| | - Mahendra Bishnoi
- Centre for Excellence in Functional Foods, Food & Nutrition Biotechnology Division, National Agri-Food Biotechnology Institute, S.A.S Nagar, Sector 81 (Knowledge City), Punjab, India
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Mishra P, Singh SC, Ramadass B. Drug resistant epilepsy and ketogenic diet: A narrative review of mechanisms of action. World Neurosurg X 2024; 22:100328. [PMID: 38444870 PMCID: PMC10914588 DOI: 10.1016/j.wnsx.2024.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
Drug-resistant epilepsy (DRE) poses a significant global challenge, impacting the well-being of patients. Anti-epileptic drugs often fail to effectively control seizures in individuals with DRE. This condition not only leads to persistent seizures but also induces neurochemical imbalances, elevating the risk of sudden unexpected death in epilepsy and comorbidities. Moreover, patients experience mood and personality alterations, educational and vocational setbacks, social isolation, and cognitive impairments. Ketogenic diet has emerged as a valuable therapeutic approach for DRE, having been utilized since 1920. Various types of ketogenic diets have demonstrated efficacy in controlling seizures. By having a multimodal mechanism of action, the ketogenic diet reduces neuronal excitability and the frequency of seizure episodes. In our narrative review, we have initially provided a concise overview of the factors contributing to drug resistance in epilepsy. Subsequently, we have discussed the different available ketogenic diets. We have reviewed the underlying mechanisms through which the ketogenic diet operates. These mechanisms encompass decreased neuronal excitability, enhanced mitochondrial function, alterations in sleep patterns, and modulation of the gut microbiome. Understanding the complex mechanisms by which this diet acts is essential as it is a rigorous diet and requires good compliance. Hence knowledge of the mechanisms may help to advance research on achieving similar therapeutic effects through other less stringent approaches.
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Affiliation(s)
- Priyadarshini Mishra
- Department of Physiology, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
| | - Sajal Clarence Singh
- Department of Physiology, Institute of Medical Sciences & SUM Hospital, Odisha, India
| | - Balamurugan Ramadass
- Department of Biochemistry, All India Institute of Medical Sciences Bhubaneswar, Odisha, India
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Borrego-Ruiz A, Borrego JJ. Human gut microbiome, diet, and mental disorders. Int Microbiol 2024:10.1007/s10123-024-00518-6. [PMID: 38561477 DOI: 10.1007/s10123-024-00518-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
Diet is one of the most important external factor shaping the composition and metabolic activities of the gut microbiome. The gut microbiome plays a crucial role in host health, including immune system development, nutrients metabolism, and the synthesis of bioactive molecules. In addition, the gut microbiome has been described as critical for the development of several mental disorders. Nutritional psychiatry is an emerging field of research that may provide a link between diet, microbial function, and brain health. In this study, we have reviewed the influence of different diet types, such as Western, Mediterranean, vegetarian, and ketogenic, on the gut microbiota composition and function, and their implication in various neuropsychiatric and psychological disorders.
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Affiliation(s)
- Alejandro Borrego-Ruiz
- Departamento de Psicología Social y de las Organizaciones, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | - Juan J Borrego
- Departamento de Microbiología, Universidad de Málaga. Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina BIONAND, Málaga, Spain.
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Iyer SH, Yeh MY, Netzel L, Lindsey MG, Wallace M, Simeone KA, Simeone TA. Dietary and Metabolic Approaches for Treating Autism Spectrum Disorders, Affective Disorders and Cognitive Impairment Comorbid with Epilepsy: A Review of Clinical and Preclinical Evidence. Nutrients 2024; 16:553. [PMID: 38398876 PMCID: PMC10893388 DOI: 10.3390/nu16040553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 02/25/2024] Open
Abstract
Epilepsy often occurs with other neurological disorders, such as autism, affective disorders, and cognitive impairment. Research indicates that many neurological disorders share a common pathophysiology of dysfunctional energy metabolism, neuroinflammation, oxidative stress, and gut dysbiosis. The past decade has witnessed a growing interest in the use of metabolic therapies for these disorders with or without the context of epilepsy. Over one hundred years ago, the high-fat, low-carbohydrate ketogenic diet (KD) was formulated as a treatment for epilepsy. For those who cannot tolerate the KD, other diets have been developed to provide similar seizure control, presumably through similar mechanisms. These include, but are not limited to, the medium-chain triglyceride diet, low glycemic index diet, and calorie restriction. In addition, dietary supplementation with ketone bodies, polyunsaturated fatty acids, or triheptanoin may also be beneficial. The proposed mechanisms through which these diets and supplements work to reduce neuronal hyperexcitability involve normalization of aberrant energy metabolism, dampening of inflammation, promotion of endogenous antioxidants, and reduction of gut dysbiosis. This raises the possibility that these dietary and metabolic therapies may not only exert anti-seizure effects, but also reduce comorbid disorders in people with epilepsy. Here, we explore this possibility and review the clinical and preclinical evidence where available.
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Affiliation(s)
| | | | | | | | | | | | - Timothy A. Simeone
- Department of Pharmacology & Neuroscience, Creighton University School of Medicine, Omaha, NE 68178, USA; (S.H.I.); (K.A.S.)
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Choi J, Kang J, Kim T, Nehs CJ. Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia. Front Psychiatry 2024; 15:1358578. [PMID: 38419903 PMCID: PMC10899493 DOI: 10.3389/fpsyt.2024.1358578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Bipolar disorder and schizophrenia are serious psychiatric conditions that cause a significant reduction in quality of life and shortened life expectancy. Treatments including medications and psychosocial support exist, but many people with these disorders still struggle to participate in society and some are resistant to current therapies. Although the exact pathophysiology of bipolar disorder and schizophrenia remains unclear, increasing evidence supports the role of oxidative stress and redox dysregulation as underlying mechanisms. Oxidative stress is an imbalance between the production of reactive oxygen species generated by metabolic processes and antioxidant systems that can cause damage to lipids, proteins, and DNA. Sleep is a critical regulator of metabolic homeostasis and oxidative stress. Disruption of sleep and circadian rhythms contribute to the onset and progression of bipolar disorder and schizophrenia and these disorders often coexist with sleep disorders. Furthermore, sleep deprivation has been associated with increased oxidative stress and worsening mood symptoms. Dysfunctional brain metabolism can be improved by fatty acid derived ketones as the brain readily uses both ketones and glucose as fuel. Ketones have been helpful in many neurological disorders including epilepsy and Alzheimer's disease. Recent clinical trials using the ketogenic diet suggest positive improvement in symptoms for bipolar disorder and schizophrenia as well. The improvement in psychiatric symptoms from the ketogenic diet is thought to be linked, in part, to restoration of mitochondrial function. These findings encourage further randomized controlled clinical trials, as well as biochemical and mechanistic investigation into the role of metabolism and sleep in psychiatric disorders. This narrative review seeks to clarify the intricate relationship between brain metabolism, sleep, and psychiatric disorders. The review will delve into the initial promising effects of the ketogenic diet on mood stability, examining evidence from both human and animal models of bipolar disorder and schizophrenia. The article concludes with a summary of the current state of affairs and encouragement for future research focused on the role of metabolism and sleep in mood disorders.
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Affiliation(s)
- Jinyoung Choi
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Jiseung Kang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
| | - Tae Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology, Gwangju, Republic of Korea
| | - Christa J. Nehs
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
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6
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Sindler D, Kastovska B, Dostal T, Cipryan L, Elavsky S. The effects of carbohydrate-restricted diet on psychological outcomes: a systematic review of randomized controlled trials. Nutr Rev 2024; 82:228-239. [PMID: 37290430 DOI: 10.1093/nutrit/nuad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
CONTEXT Carbohydrate-restricted diets are widely used as an effective treatment tool for many chronic diseases. The impact of these diets on physical health is well known, but their impact on psychological health is less well described in the scientific literature. This is an important aspect to focus on, especially if the diets are to be sustainable in the long term. OBJECTIVE The objective of this study was to systematically review the scientific literature describing the effect of carbohydrate-restricted diets and ketogenic diets on psychological outcomes, as observed in randomized controlled trials. Additionally, the potential synergistic effect of carbohydrate-restricted diets and exercise or social factors on these outcomes was researched. DATA SOURCES Five databases (Web of Science, PubMed, Scopus, ScienceDirect, and MEDLINE Complete) were searched without restriction of publication date. DATA EXTRACTION The first data extraction was made in October 2020 and the second in May 2022. Abstract screening was performed by 3 independent reviewers. The quality of studies was assessed using the Jadad scale. DATA ANALYSIS Sixteen randomized controlled studies were included in the analysis. Five studies focused on clinical populations, 9 on obese/overweight populations, and 2 on healthy populations; all studies examined adult people. Four psychological outcomes were identified (quality of life, mental health, mood, and fatigue), and they were examined in connection with a very low-carbohydrate or ketogenic diet. CONCLUSION Daily low-carbohydrate intake may not negatively affect psychological well-being, and low-carbohydrate diets and ketogenic diets are no worse than other diets in this respect. An intervention of 12 weeks or longer can bring benefits in psychological well-being. The synergistic effect of diet and exercise or social factors was not reviewed due to lack of evidence.
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Affiliation(s)
- Dominik Sindler
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Barbora Kastovska
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Tomas Dostal
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Lukas Cipryan
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Steriani Elavsky
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
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De Marchi F, Vignaroli F, Mazzini L, Comi C, Tondo G. New Insights into the Relationship between Nutrition and Neuroinflammation in Alzheimer's Disease: Preventive and Therapeutic Perspectives. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2024; 23:614-627. [PMID: 37291780 DOI: 10.2174/1871527322666230608110201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/16/2023] [Accepted: 05/08/2023] [Indexed: 06/10/2023]
Abstract
Neurodegenerative diseases are progressive brain disorders characterized by inexorable synaptic dysfunction and neuronal loss. Since the most consistent risk factor for developing neurodegenerative diseases is aging, the prevalence of these disorders is intended to increase with increasing life expectancy. Alzheimer's disease is the most common cause of neurodegenerative dementia, representing a significant medical, social, and economic burden worldwide. Despite growing research to reach an early diagnosis and optimal patient management, no disease-modifying therapies are currently available. Chronic neuroinflammation has been recognized as a crucial player in sustaining neurodegenerative processes, along with pathological deposition of misfolded proteins, including amyloid-β and tau protein. Modulating neuroinflammatory responses may be a promising therapeutic strategy in future clinical trials. Among factors that are able to regulate neuroinflammatory mechanisms, diet, and nutrients represent easily accessible and modifiable lifestyle components. Mediterranean diet and several nutrients, including polyphenols, vitamins, and omega-3 polyunsaturated fatty acids, can exert antioxidant and anti-inflammatory properties, impacting clinical manifestations, cognitive decline, and dementia. This review aims to provide an updated overview of the relationship between neuroinflammation, nutrition, gut microbiota, and neurodegeneration. We summarize the major studies exploring the effects of diet regimes on cognitive decline, primarily focusing on Alzheimer's disease dementia and the impact of these results on the design of ongoing clinical trials.
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Affiliation(s)
- Fabiola De Marchi
- ALS Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100, Novara, Italy
| | - Francesca Vignaroli
- Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100, Novara, Italy
| | - Letizia Mazzini
- ALS Center, Neurology Unit, Department of Translational Medicine, University of Piemonte Orientale, 28100, Novara, Italy
| | - Cristoforo Comi
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100, Vercelli, Italy
| | - Giacomo Tondo
- Neurology Unit, Department of Translational Medicine, S. Andrea Hospital, University of Piemonte Orientale, 13100, Vercelli, Italy
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Chen W, Xu Y, Li ZH, Si YC, Wang HY, Bian XL, Li L, Guo ZY, Lai XL. Serum metabolic alterations in peritoneal dialysis patients with excessive daytime sleepiness. Ren Fail 2023; 45:2190815. [PMID: 37051665 PMCID: PMC10116928 DOI: 10.1080/0886022x.2023.2190815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Excessive daytime sleepiness (EDS) is associated with quality of life and all-cause mortality in the end-stage renal disease population. This study aims to identify biomarkers and reveal the underlying mechanisms of EDS in peritoneal dialysis (PD) patients. A total of 48 nondiabetic continuous ambulatory peritoneal dialysis patients were assigned to the EDS group and the non-EDS group according to the Epworth Sleepiness Scale (ESS). Ultra-high-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) was used to identify the differential metabolites. Twenty-seven (male/female, 15/12; age, 60.1 ± 16.2 years) PD patients with ESS ≥ 10 were assigned to the EDS group, while twenty-one (male/female, 13/8; age, 57.9 ± 10.1 years) PD patients with ESS < 10 were defined as the non-EDS group. With UHPLC-Q-TOF/MS, 39 metabolites with significant differences between the two groups were found, 9 of which had good correlations with disease severity and were further classified into amino acid, lipid and organic acid metabolism. A total of 103 overlapping target proteins of the differential metabolites and EDS were found. Then, the EDS-metabolite-target network and the protein-protein interaction network were constructed. The metabolomics approach integrated with network pharmacology provides new insights into the early diagnosis and mechanisms of EDS in PD patients.
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Affiliation(s)
- Wei Chen
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Ying Xu
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Zheng-Hao Li
- Institute of Neuroscience and Key Laboratory of Molecular Neurobiology of Military of Education, Naval Medical University, Shanghai, P.R. China
| | - Ya-Chen Si
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Hai-Yan Wang
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Xiao-Lu Bian
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Lu Li
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Zhi-Yong Guo
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
| | - Xue-Li Lai
- Department of Nephrology, Shanghai Changhai Hospital, Shanghai, P.R. China
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Field R, Field T, Pourkazemi F, Rooney K. Low-carbohydrate and ketogenic diets: a scoping review of neurological and inflammatory outcomes in human studies and their relevance to chronic pain. Nutr Res Rev 2023; 36:295-319. [PMID: 35438071 DOI: 10.1017/s0954422422000087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Dietary restriction of carbohydrate has been demonstrated to be beneficial for nervous system dysfunction in animal models and may be beneficial for human chronic pain. The purpose of this review is to assess the impact of a low-carbohydrate/ketogenic diet on the adult nervous system function and inflammatory biomarkers to inform nutritional research for chronic pain. An electronic database search was carried out in May 2021. Publications were screened for prospective research with dietary carbohydrate intake <130 g per day and duration of ≥2 weeks. Studies were categorised into those reporting adult neurological outcomes to be extracted for analysis and those reporting other adult research outcomes. Both groups were screened again for reported inflammatory biomarkers. From 1548 studies, there were 847 studies included. Sixty-four reported neurological outcomes with 83% showing improvement. Five hundred and twenty-three studies had a different research focus (metabolic n = 394, sport/performance n = 51, cancer n = 33, general n = 30, neurological with non-neuro outcomes n = 12, or gastrointestinal n = 4). The second screen identified sixty-three studies reporting on inflammatory biomarkers, with 71% reporting a reduction in inflammation. The overall results suggest a favourable outcome on the nervous system and inflammatory biomarkers from a reduction in dietary carbohydrates. Both nervous system sensitisation and inflammation occur in chronic pain, and the results from this review indicate it may be improved by low-carbohydrate nutritional therapy. More clinical trials within this population are required to build on the few human trials that have been done.
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Affiliation(s)
- Rowena Field
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tara Field
- The New South Wales Ministry of Health (NSW Health), Sydney, Australia
| | | | - Kieron Rooney
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Chinna-Meyyappan A, Gomes FA, Koning E, Fabe J, Breda V, Brietzke E. Effects of the ketogenic diet on cognition: a systematic review. Nutr Neurosci 2023; 26:1258-1278. [PMID: 36354157 DOI: 10.1080/1028415x.2022.2143609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Ketogenic diet (KD) therapy has been used as a dietary intervention in drug-resistant epilepsy for several years. Research currently suggests that KD therapy may carry neuroprotective and cognition enhancing effects for individuals with non-epileptic conditions as well as for healthy individuals. Therefore, KD may have potential as a non-invasive, nutritional treatment approach for difficult to manage conditions such as neurodegenerative illnesses or mood disorders. The aim of this review is to summarize the available evidence on ketogenic interventions and the resulting cognitive outcomes. MATERIALS AND METHODS The paper was based on PRISMA 2020 guidelines. The search was conducted in June 2021 on the following databases: CENTRAL, PubMed, EMBASE, PsycInfo, Web of Science. The search yielded 2014 studies, of which 49 were included. RESULTS There were 22 animal studies assessing murine models and 27 studies on humans. The primary indications in these studies were epileptic conditions, neurodegenerative disorders, cognitive impairment, and healthy populations. DISCUSSION Administration of KD seems to confer cognitive-enhancing effects in areas such as working memory, reference memory and attention. Studies found that KD treatment in animals has the potential to alleviate age-related cognitive decline. Over 80% of the 27 human studies reported a favourable effect of intervention, and none reported a detrimental effect of KD. While these findings suggest that KD may improve the functioning of certain cognitive domains, definitive conclusions were limited by studies with small sample sizes, the absence of controls and randomization, and the lack of objective measures of cognition.
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Affiliation(s)
| | - Fabiano Alves Gomes
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, Canada
| | - Elena Koning
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
| | | | - Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, Kingston, Canada
- Centre for Neuroscience Studies (CNS), Queen's University, Kingston, Canada
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Oliveira JL, Marques-Vidal P. Sweet dreams are not made of this: no association between diet and sleep quality. J Clin Sleep Med 2023; 19:2005-2014. [PMID: 37489534 PMCID: PMC10692931 DOI: 10.5664/jcsm.10738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/21/2023] [Accepted: 07/21/2023] [Indexed: 07/26/2023]
Abstract
STUDY OBJECTIVES Numerous studies have emphasized the significance of nutrition on the quality of sleep, but few have evaluated the effect of various coexisting dietary markers on middle-aged adults. We assessed the association between sleep quality and a large array of dietary markers among middle-aged, community-dwelling participants. METHODS Data from the first, second, and third follow-ups of CoLaus|PsyCoLaus, a population-based study in Lausanne, Switzerland, was used. Sleep quality was assessed by the Pittsburgh Sleep Quality Index. Dietary intake was assessed by a validated food frequency questionnaire. RESULTS Data from 3857 (53% women, 57.2 ± 10.4 years), 2370 (52% women, 60.7 ± 9.5 years), and 1617 (52% women, 63.5 ± 9.0 years) participants from the first, second, and third follow-ups was used. Bivariate correlations showed fish, vegetables, fruit, and cheese intake to be associated with a better sleep quality (lower Pittsburgh Sleep Quality Index), while rusks, sugar, and meat intake were associated with a poorer sleep quality (higher Pittsburgh Sleep Quality Index). After multivariable adjustment, participants reporting poor sleep quality (Pittsburgh Sleep Quality Index > 5) had a lower Mediterranean diet score and a lower likelihood of complying with the meat and fish recommendations, but the results were inconsistent between surveys. No association was found between sleep quality and macro- or micronutrients in the three surveys. CONCLUSIONS No consistent associations were found between a large panel of nutritional markers and sleep quality. Components of the Mediterranean diet such as dairy, fruits, and vegetables might favor good sleep quality, while increased consumption of sugary foods or meat might favor poor sleep quality. CITATION Oliveira JL, Marques-Vidal P. Sweet dreams are not made of this: no association between diet and sleep quality. J Clin Sleep Med. 2023;19(12):2005-2014.
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Affiliation(s)
| | - Pedro Marques-Vidal
- Department of Medicine, Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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12
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Smolensky IV, Zajac-Bakri K, Gass P, Inta D. Ketogenic diet for mood disorders from animal models to clinical application. J Neural Transm (Vienna) 2023; 130:1195-1205. [PMID: 36943505 PMCID: PMC10460725 DOI: 10.1007/s00702-023-02620-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/10/2023] [Indexed: 03/23/2023]
Abstract
Mood disorders such as major depressive disorder (MDD) and bipolar disorder (BD) are often resistant to current pharmacological treatment. Therefore, various alternative therapeutic approaches including diets are, therefore, under investigation. Ketogenic diet (KD) is effective for treatment-resistant epilepsy and metabolic diseases, however, only a few clinical studies suggest its beneficial effect also for mental disorders. Animal models are a useful tool to uncover the underlying mechanisms of therapeutic effects. Women have a twice-higher prevalence of mood disorders but very little is known about sex differences in nutritional psychiatry. In this review, we aim to summarize current knowledge of the sex-specific effects of KD in mood disorders. Ketone bodies improve mitochondrial functions and suppress oxidative stress, inducing neuroprotective and anti-inflammatory effects which are both beneficial for mental health. Limited data also suggest KD-induced improvement of monoaminergic circuits and hypothalamus-pituitary-adrenal axis-the key pathophysiological pathways of mood disorders. Gut microbiome is an important mediator of the beneficial and detrimental effects of diet on brain functioning and mental health. Gut microbiota composition is affected in mood disorders but its role in the therapeutic effects of different diets, including KD, remains poorly understood. Still little is known about sex differences in the effects of KD on mental health as well as on metabolism and body weight. Some animal studies used both sexes but did not find differences in behavior, body weight loss or gut microbiota composition. More studies, both on a preclinical and clinical level, are needed to better understand sex-specific effects of KD on mental health.
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Affiliation(s)
- Ilya V Smolensky
- Department for Community Health, University of Fribourg, Fribourg, Switzerland.
- Department of Biomedicine, University of Basel, Basel, Switzerland.
| | - Kilian Zajac-Bakri
- Department for Community Health, University of Fribourg, Fribourg, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Peter Gass
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Heidelberg, Germany
| | - Dragos Inta
- Department for Community Health, University of Fribourg, Fribourg, Switzerland
- Department of Biomedicine, University of Basel, Basel, Switzerland
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St-Onge MP, Cherta-Murillo A, Darimont C, Mantantzis K, Martin FP, Owen L. The interrelationship between sleep, diet, and glucose metabolism. Sleep Med Rev 2023; 69:101788. [PMID: 37156196 PMCID: PMC10247426 DOI: 10.1016/j.smrv.2023.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/28/2023] [Accepted: 04/23/2023] [Indexed: 05/10/2023]
Abstract
Obesity and type 2 diabetes (T2D) are increasingly common worldwide. While these disorders have increased in prevalence over the past several decades, there has been a concomitant reduction in sleep duration. Short sleep duration has been associated with higher rates of obesity and T2D, and the causality of these associations and their directionality, continue to necessitate evaluation. In this review we consider the evidence that sleep is an intrinsic factor in the development of obesity and chronic metabolic disorders, such as insulin resistance and T2D, while evaluating a potential bi-directional association. We consider the evidence that diet and meal composition, which are known to impact glycemic control, may have both chronic and acute impact upon sleep. Moreover, we consider that postprandial nocturnal metabolism and peripheral glycemia may affect sleep quality. We propose putative mechanisms whereby acute effects of nighttime glucose excursions may lead to increased sleep fragmentation. We conclude that dietary manipulations, particularly with respect to carbohydrate quality, may confer sleep benefits. Future research may seek to evaluate the effectiveness of synergistic nutrient strategies to promote sleep quality, with particular attention to carbohydrate quality, quantity, and availability as well as carbohydrate to protein ratio.
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Affiliation(s)
- Marie-Pierre St-Onge
- Division of General Medicine and Center of Excellence for Sleep & Circadian Research, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | | | - Christian Darimont
- Nestlé Research, Nestlé Institute of Health Sciences, Lausanne, Switzerland
| | | | | | - Lauren Owen
- Nestlé Research, Nestlé Institute of Health Sciences, Lausanne, Switzerland
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14
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Henderson LR, van den Berg M, Shaw DM. The effect of a 2 week ketogenic diet, versus a carbohydrate-based diet, on cognitive performance, mood and subjective sleepiness during 36 h of extended wakefulness in military personnel: An exploratory study. J Sleep Res 2023:e13832. [PMID: 36734405 DOI: 10.1111/jsr.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 12/20/2022] [Accepted: 01/04/2023] [Indexed: 02/04/2023]
Abstract
Extended wakefulness, or sleep deprivation, impairs cognitive performance and brain glucose metabolism. A ketogenic diet (KD) provides an alternative fuel source, ketone bodies, that could elicit a metabolic benefit during sleep deprivation. A randomised, cross-over trial was conducted with seven male military personnel. Participants ingested an iso-energetic ketogenic diet or carbohydrate-based diet for 14 days, immediately followed by 36 h of extended wakefulness and separated by a 12 day washout. Cognitive performance, mood, subjective sleepiness, capillary blood glucose, and D-β-hydroxybutyrate concentrations were measured every 2 h during extended wakefulness. Linear mixed models were used to analyse data. D-β-hydroxybutyrate was higher (p < 0.001) and glucose was lower (p < 0.01) on the KD compared with the carbohydrate-based diet. The KD improved psychomotor vigilance task performance (number of lapses, mean reciprocal response time, mean fastest 10% response time (RT), and mean slowest 10% RT; all p < 0.05), running memory continuous performance test performance (RT and number of correct responses per minute; both p < 0.01), and vigour, fatigue, and sleepiness (all, p ≤ 0.001) compared with the carbohydrate-based diet. In conclusion, a KD demonstrated beneficial effects on cognitive performance, mood, and sleepiness during 36 h of extended wakefulness compared with a carbohydrate-based diet.
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Affiliation(s)
- Lydia Rose Henderson
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand
| | - Margo van den Berg
- Sleep/Wake Research Centre, School of Health Sciences, Massey University, Wellington, New Zealand
| | - David M Shaw
- School of Sport, Exercise and Nutrition, Massey University, Auckland, New Zealand.,Aviation Medicine Unit, Royal New Zealand Air Force Base Auckland, Auckland, New Zealand
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15
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ERTAL E, ÖZKAYA V. Düşük veya Yüksek Karbonhidratlı Diyetlerin Beyin, Beyin-Bağırsak Aksı ve Bilişsel İşlevler Üzerine Etkisi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.38079/igusabder.1140592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
İntestinal mikrobiyota sağlığın korunmasında anahtar bir rol oynamaktadır. Mikrobiyota üzerine önemli etkileri olan beslenme, beyin-bağırsak aksındaki bozuklukları hafifletmek, nöroinflamasyonu ve bilişsel bozulmayı iyileştirmek için büyük önem taşımaktadır. Bağırsak bakterileri, diyetle alınan besin ögelerini kullanarak çeşitli metabolitleri (örn., kısa zincirli yağ asitleri, amino asitler, vitaminler) üretebilme yeteneğine sahiptir. Üretilen bu metabolitler, periferik sinir sistemi, enteroendokrin hücreler ve merkezi sinir sistemine sinyal gönderen immün hücreler aracılığıyla beyin fonksiyonlarını ve bilişsel davranış değişikliğini etkilemektedir. Karbonhidratlar, çoğu durumda intestinal mikrobiyota tarafından substrat olarak kullanılmakta ve fermente edilmektedir. Karbonhidratların bu etkileri kimyasal yapılarına, sindirilmeden kolona ulaşıp ulaşamamalarına ve konağın karbonhidratı enerji kaynağı olarak kullanabilme yeteneğine bağlıdır. Karbonhidratın türü ve miktarı mikrobiyota, beyin bağırsak aksı ve bilişsel işlevlerdeki etkiyi belirleyen ana faktörlerden biridir. Bu derlemede, düşük veya yüksek karbonhidrat içeren diyetlerin beyin-bağırsak aksı ve bilişsel fonksiyonlara olan etkilerinin güncel literatür verileri ışığında değerlendirilmesi amaçlanmıştır.
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Affiliation(s)
- Ezgi ERTAL
- BİRUNİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, BESLENME VE DİYETETİK BÖLÜMÜ
| | - Volkan ÖZKAYA
- İSTANBUL MEDİPOL ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ FAKÜLTESİ, BESLENME VE DİYETETİK BÖLÜMÜ
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16
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Li X, Shi Z, Byanyima J, Morgan PT, van der Veen JW, Zhang R, Deneke E, Wang GJ, Volkow ND, Wiers CE. Brain glutamate and sleep efficiency associations following a ketogenic diet intervention in individuals with Alcohol Use Disorder. DRUG AND ALCOHOL DEPENDENCE REPORTS 2022; 5:100092. [PMID: 36311277 PMCID: PMC9601174 DOI: 10.1016/j.dadr.2022.100092] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background We previously showed that ketogenic diet (KD) was effective in curbing alcohol withdrawal and craving in individuals with alcohol use disorder (AUD). We hypothesized that the clinical benefits were due to improvements in sleep. To test this, we performed a secondary analysis on the KD trial data to (1) examine the effects of KD on total sleep time (TST) and sleep quality and (2) investigate the association between KD-induced alterations in cingulate glutamate concentration and changes in TST and sleep quality. Methods AUD individuals undergoing alcohol detoxification were randomized to receive KD (n=19) or standard American diet (SA; n=14) for three weeks. TST was measured weekly by self-report, GENEActive sleep accelerometer, and X4 Sleep Profiler ambulatory device. Sleep quality was assessed using subjectively ratings of sleep depth and restedness and Sleep Profiler (Sleep Efficiency [%]). Weekly 1H magnetic resonance spectroscopy scans measured cingulate glutamate levels. Results TST was lower in KD than SA and increased with effect of time. Sleep depth, restedness, and Sleep Efficiency improved with time, but exhibited no effect of diet. In KD and SA combined, week 1 cingulate glutamate levels correlated positively with Sleep Efficiency, but not with TST. Conclusions Although cingulate glutamate levels correlated positively with Sleep Efficiency in week 1, KD-induced glutamate elevation did not produce significant sleep improvements. Rather, KD was associated with lower TST than SA. Given the well-established associations between sleep and alcohol relapse, longer follow up assessment of KD's impact on sleep in AUD is warranted.
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Affiliation(s)
- Xinyi Li
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Zhenhao Shi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Juliana Byanyima
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Peter T. Morgan
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
- Department of Psychiatry, Bridgeport Hospital, Bridgeport, CT, 06610, USA
| | | | - Rui Zhang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Erin Deneke
- Caron Treatment Centers, 243N Galen Hall Rd, Wernersville, PA, 19565, USA
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Nora D. Volkow
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
| | - Corinde E. Wiers
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, 20892, USA
- Corresponding author at: 3535 Market St Ste 500, Philadelphia, PA 19104.
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Fadó R, Molins A, Rojas R, Casals N. Feeding the Brain: Effect of Nutrients on Cognition, Synaptic Function, and AMPA Receptors. Nutrients 2022; 14:nu14194137. [PMID: 36235789 PMCID: PMC9572450 DOI: 10.3390/nu14194137] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022] Open
Abstract
In recent decades, traditional eating habits have been replaced by a more globalized diet, rich in saturated fatty acids and simple sugars. Extensive evidence shows that these dietary factors contribute to cognitive health impairment as well as increase the incidence of metabolic diseases such as obesity and diabetes. However, how these nutrients modulate synaptic function and neuroplasticity is poorly understood. We review the Western, ketogenic, and paleolithic diets for their effects on cognition and correlations with synaptic changes, focusing mainly (but not exclusively) on animal model studies aimed at tracing molecular alterations that may contribute to impaired human cognition. We observe that memory and learning deficits mediated by high-fat/high-sugar diets, even over short exposure times, are associated with reduced arborization, widened synaptic cleft, narrowed post-synaptic zone, and decreased activity-dependent synaptic plasticity in the hippocampus, and also observe that these alterations correlate with deregulation of the AMPA-type glutamate ionotropic receptors (AMPARs) that are crucial to neuroplasticity. Furthermore, we explored which diet-mediated mechanisms modulate synaptic AMPARs and whether certain supplements or nutritional interventions could reverse deleterious effects, contributing to improved learning and memory in older people and patients with Alzheimer’s disease.
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Affiliation(s)
- Rut Fadó
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, E-08195 Sant Cugat del Vallès, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, E-28029 Madrid, Spain
- Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, E-08193 Cerdanyola del Vallès, Spain
- Correspondence: ; Tel.: +34-93-504-20-00
| | - Anna Molins
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, E-08195 Sant Cugat del Vallès, Spain
| | - Rocío Rojas
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, E-08195 Sant Cugat del Vallès, Spain
| | - Núria Casals
- Basic Sciences Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, E-08195 Sant Cugat del Vallès, Spain
- Centro de Investigación Biomédica en Red de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN), Instituto de Salud Carlos III, E-28029 Madrid, Spain
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18
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Jiwani R, Robbins R, Neri A, Renero J, Lopez E, Serra MC. Effect of Dietary Intake Through Whole Foods on Cognitive Function: Review of Randomized Controlled Trials. Curr Nutr Rep 2022; 11:146-160. [PMID: 35334104 PMCID: PMC11110908 DOI: 10.1007/s13668-022-00412-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This review evaluated recent randomized controlled trials (RCTs) examining the chronic intake of whole foods associated with the Mediterranean, Dietary Approaches to Stop Hypertension (DASH), Mediterranean-DASH Intervention for Neurogenerative Delay (MIND), and ketogenic (KETO) diets on cognitive function. RECENT FINDINGS We identified RCTs related to olive oil (N = 3), nuts (N = 7), fatty fish (N = 1), lean meats (N = 4), fruits and vegetables (N = 9), legumes (N = 1), and low-fat dairy (N = 4), with 26/29 reporting positive results on at least one measure of cognition. We also identified 6 RCTs related to whole food-induced KETO diets, with half reporting positive effects on cognition. Variations in study design (i.e., generally the studies are < 6 months and include middle-aged and older, cognitively intact participants) and small sample sizes make it difficult to draw conclusions across studies; however, the current evidence from RCTs generally supports individual component intakes of these dietary patterns as an effective, nonpharmacological approach to improve cognitive health in adults.
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Affiliation(s)
- Rozmin Jiwani
- School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA.
| | - Ronna Robbins
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Alfonso Neri
- School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Jose Renero
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Emme Lopez
- Dolph Briscoe, Jr. Library, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Monica C Serra
- Geriatric Research, Education & Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, TX, USA
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19
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Shaw DM, Henderson L, van den Berg M. Cognitive, Sleep, and Autonomic Responses to Induction of a Ketogenic Diet in Military Personnel: A Pilot Study. Aerosp Med Hum Perform 2022; 93:507-516. [DOI: 10.3357/amhp.6015.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: This pilot study examined the effect of a 2-wk ketogenic diet (KD) compared with a carbohydrate (CHO) diet in military personnel on cognitive performance, mood, sleep, and heart rate variability (HRV).METHODS: A randomized-controlled, cross-over trial was
conducted with eight male military personnel (age, 36 ± 7 yr; body mass, 83.7 ± 9.2 kg; BMI, 26.0 ± 2.3 kg · m−2). Subjects ingested their habitual diet for 7 d (baseline), then an iso-energetic KD (∼25 g CHO/d) or CHO diet (∼285 g CHO/d)
for 14 d (adaptation), separated by a 12-d washout. HRV, fasting capillary blood D-βHB, and glucose concentration, mood, and sleep were measured daily. Cognitive performance was measured on the 7th day of baseline and the 7th and 14th days of adaptation.
Data were analyzed using a series of linear mixed models.RESULTS: Mean weekly D-βHB was higher (95% CI, +0.34 to +2.38 mmol · L−1) and glucose was lower (−0.45 to −0.21 mmol · L−1) in the KD compared with the CHO diet.
Cognitive performance (Psychomotor Vigilance Task, 2-choice reaction time, and running memory continuous performance test) and mean weekly fatigue, vigor, and sleep (sleep duration, sleep efficiency, and sleep onset latency) were similar between diets. A diet × week interaction for HRV
approached significance, with exploratory analyses suggesting HRV was lower compared with baseline during week-2 adapt (−27 to +4 ms) in the KD.DISCUSSION: A 2-wk induction to a KD in male military personnel does not appear to affect cognitive performance, mood, or sleep,
but may lower HRV, indicating increased physiological stress.Shaw DM, Henderson L, van den Berg M. Cognitive, sleep, and autonomic responses to induction of a ketogenic diet in military personnel: a pilot study. Aerosp Med Hum Perform. 2022; 93(6):507–516.
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20
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The Influence of Ketone Bodies on Circadian Processes Regarding Appetite, Sleep and Hormone Release: A Systematic Review of the Literature. Nutrients 2022; 14:nu14071410. [PMID: 35406023 PMCID: PMC9002750 DOI: 10.3390/nu14071410] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/10/2022] [Accepted: 03/24/2022] [Indexed: 12/02/2022] Open
Abstract
Chrononutrition is an emerging branch of chronobiology focusing on the profound interactions between biological rhythms and metabolism. This framework suggests that, just like all biological processes, even nutrition follows a circadian pattern. Recent findings elucidated the metabolic roles of circadian clocks in the regulation of both hormone release and the daily feeding–fasting cycle. Apart from serving as energy fuel, ketone bodies play pivotal roles as signaling mediators and drivers of gene transcription, promoting food anticipation and loss of appetite. Herein we provide a comprehensive review of the literature on the effects of the ketogenic diets on biological processes that follow circadian rhythms, among them appetite, sleep, and endocrine function.
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21
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Orlando A, Chimienti G, Notarnicola M, Russo F. The Ketogenic Diet Improves Gut-Brain Axis in a Rat Model of Irritable Bowel Syndrome: Impact on 5-HT and BDNF Systems. Int J Mol Sci 2022; 23:ijms23031098. [PMID: 35163022 PMCID: PMC8835524 DOI: 10.3390/ijms23031098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 02/05/2023] Open
Abstract
Altered gut-brain communication can contribute to intestinal dysfunctions in the intestinal bowel syndrome. The neuroprotective high-fat, adequate-protein, low-carbohydrate ketogenic diet (KD) modulates the levels of different neurotransmitters and neurotrophins. The aim was to evaluate the effects of KD on levels of 5-HT, the receptors 5-HT3B and 5-HT4, the 5-HT transporter SERT, the neurotrophin BDNF, and its receptor TrkB in the colon and brain of a rat model of irritable bowel syndrome (IBS). Samples from Wistar rats exposed to maternal deprivation as newborns and then fed with a standard diet (IBS-Std) or KD (IBS-KD) for ten weeks were analyzed. As controls, unexposed rats (Ctrl-Std and Ctrl-KD) were studied. IBS-Std rats had a disordered enteric serotoninergic signaling shown by increased mucosal 5-HT content and reduced SERT, 5-HT3B, and 5-HT4 levels compared to controls. In the brain, these animals showed up-regulation of the BDNF receptor TrkB as a counteracting response to the stress-induced reduction of the neurotrophin. KD showed a dual effect in improving the altered 5-HT and BDNF systems. It down-regulated the increased mucosal 5-HT without affecting transporter and receptor levels. KD improved brain BDNF levels and established negative feedback, leading to a compensatory downregulation of TrkB to maintain a physiological steady state.
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Affiliation(s)
- Antonella Orlando
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis”, IRCCS Research Hospital, 70013 Castellana Grotte, Italy;
| | - Guglielmina Chimienti
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari Aldo Moro, Via Orabona 4, 70125 Bari, Italy;
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology “S. de Bellis”, IRCCS Research Hospital, 70013 Castellana Grotte, Italy;
| | - Francesco Russo
- Laboratory of Nutritional Pathophysiology, National Institute of Gastroenterology “S. de Bellis”, IRCCS Research Hospital, 70013 Castellana Grotte, Italy;
- Correspondence: ; Tel.: +39-080-4994315
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22
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Tabaie EA, Reddy AJ, Brahmbhatt H. A narrative review on the effects of a ketogenic diet on patients with Alzheimer's disease. AIMS Public Health 2021; 9:185-193. [PMID: 35071677 PMCID: PMC8755961 DOI: 10.3934/publichealth.2022014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/20/2021] [Indexed: 11/18/2022] Open
Abstract
Alzheimer's disease (AD) has been very difficult to prevent and cure using the medicine available today. However, there has been some hope with using a ketogenic diet (KD) to reduce the cognitive and quality of life decline experienced by patients with AD. In this review, the authors discuss the research done on the effect of a KD on AD to provide some potential avenues for future research and to determine a KD that can be best adopted by patients. The authors also go over the effects of KD's and low-carbohydrate diets (LCDs) on the cognitive function of healthy patients and on patients without AD to determine the similar and dissimilar effects of the diets. The authors found that the KD was able to improve the cognitive abilities and quality of life of patients ranging from mild to severe AD. Several types of memory were improved as a result of the diets. Further research needs to be conducted to determine the cause behind these improvements. However, the several studies that were done were mostly in agreement that once ketosis was reached, cognitive improvements were observed in patients ranging from mild to severe AD or mild to moderate cognitive impairment. Through the use of a KD, potential mechanisms can be found to reduce the cognitive decline of patients with AD, and potentially even prevent the damaging effects of cognitive decline from AD altogether.
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Affiliation(s)
- Ethan Ali Tabaie
- Department of Neurobiology, Physiology & Behavior, University of California, Davis, Davis, USA
| | - Akshay Jakkidi Reddy
- Department of Ophthalmology, California Northstate University College of Medicine, Elk Grove, USA
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23
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Barrea L, Pugliese G, Frias-Toral E, Napolitano B, Laudisio D, Aprano S, Ceriani F, Savastano S, Colao A, Muscogiuri G. Is there a relationship between the ketogenic diet and sleep disorders? Int J Food Sci Nutr 2021; 73:285-295. [PMID: 34702129 DOI: 10.1080/09637486.2021.1993154] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Sleep disorders are very often underestimated and, consequently, not treated with due priority. Common sleep disorders include insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. The ketogenic diet (KD) is rich in fat, low in carbohydrates (CHO), and adequate in protein. The KD has shown several applications in treating medical conditions, such as epilepsy, neurodegenerative disorders, obesity with its comorbidities, and sleep disorders, with encouraging results. Therefore, the purpose of this review is to address the primary sleep disorders and their respective standard therapeutic approaches, analyse the effect of ketone bodies (KBs) on sleep homeostasis, and the effects of KD on sleep disorders and in particular on obstructive sleep apnoea (OSA) syndrome. The goal is to summarise the evidence existing up to now on the subject, to provide a starting point for further investigations.
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Affiliation(s)
- Luigi Barrea
- Dipartimento di Scienze Umanistiche, Università Telematica Pegaso, Napoli, Italy.,Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Gabriella Pugliese
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy
| | - Evelyn Frias-Toral
- Clinical Research Associate Professor for Palliative Care Residency from Universidad Católica Santiago de Guayaquil, Av. Pdte. Carlos Julio Arosemena Tola, Guayaquil, Ecuador
| | - Bruno Napolitano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy
| | - Daniela Laudisio
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy
| | - Sara Aprano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy
| | - Florencia Ceriani
- Nutrition School, Universidad de la Republica (UdelaR), Montevideo, Uruguay
| | - Silvia Savastano
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy
| | - Annamaria Colao
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Department of Clinical Medicine and Surgery, Endocrinology Unit, University Medical School of Naples, Naples, Italy.,Dipartimento di Medicina Clinica e Chirurgia, Unit of Endocrinology, Federico II University Medical School of Naples, Naples, Italy.,Cattedra Unesco "Educazione alla salute e allo sviluppo sostenibile", University Federico II, Naples, Italy
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Ricci A, Idzikowski MA, Soares CN, Brietzke E. Exploring the mechanisms of action of the antidepressant effect of the ketogenic diet. Rev Neurosci 2021; 31:637-648. [PMID: 32406387 DOI: 10.1515/revneuro-2019-0073] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022]
Abstract
The ketogenic diet (KD) is characterized by a diet ratio of 4:1 fat to non-fat energy sources. For decades KD has been successfully used to control seizures in epilepsy patients. Investigations into its mechanism of action suggest that it may have an effect on the metabolic, nervous, immune, and digestive systems. In this review, we postulate that KD may also improve depressive symptoms - for that, we highlight the similarities between depression and epilepsy, describe the extent to which body systems involved in both conditions are affected by the KD, and ultimately hypothesize how KD could improve MDD outcomes. Research into animal models and human patients have reported that KD can increase mitochondrial biogenesis and increase cellular resistance to oxidative stress both at the mitochondrial and genetic levels. Its effect on neurotransmitters alters cell-to-cell communication in the brain and may decrease hyperexcitability by increasing Gamma Aminobutyric Acid (GABA) and decreasing excitatory neurotransmitter levels. Its anti-inflammatory effects are mediated by decreasing chemo- and cytokine levels, including TNF-alpha and IL-1 levels. Finally, KD can alter gut microbiota (GM). Certain strains of microbiota predominate in major depressive disorder (MDD) when compared to healthy individuals. Recent evidence points to Bacteroidetes as a potential treatment predictor as it seems to increase in KD treatment responders for epilepsy. Each of these observations contributes to the presumed modulatory effects of KD on mood and supports its potential role as antidepressant.
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Affiliation(s)
- Alessandro Ricci
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, K7L7X3, Kingston, ON, Canada
| | - Maia A Idzikowski
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, K7L7X3, Kingston, ON, Canada
| | - Claudio N Soares
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, K7L7X3, Kingston, ON, Canada.,Providence Care Hospital, Kingston, ON, Canada.,Kingston General Hospital, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, K7L7X3, Kingston, ON, Canada.,Kingston General Hospital, Kingston, ON, Canada.,Centre for Neuroscience Studies (CNS), Queen's University, Kingston, ON, Canada
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25
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Kakoschke N, Zajac IT, Tay J, Luscombe-Marsh ND, Thompson CH, Noakes M, Buckley JD, Wittert G, Brinkworth GD. Effects of very low-carbohydrate vs. high-carbohydrate weight loss diets on psychological health in adults with obesity and type 2 diabetes: a 2-year randomized controlled trial. Eur J Nutr 2021; 60:4251-4262. [PMID: 34018052 DOI: 10.1007/s00394-021-02587-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
AIMS Very low-carbohydrate (LC) diets are popular for type 2 diabetes (T2DM) management; however, long-term effects on psychological health remain largely unknown. This study reports the effects of a LC diet on mood and cognitive function after 2 years and explores the potential predictors of changes in psychological health. METHODS 115 adults (57% males; age: 58.5 ± 7.1 years) with obesity and T2DM were randomized to consume an energy reduced (~ 500 to 1000 kcal/day deficit), LC diet [14% energy as carbohydrate, 28% protein, 58% fat (< 10% saturated fat)] or an isocaloric high unrefined carbohydrate, low-fat diet [HC: 53% carbohydrate, 17% protein, 30% fat (< 10% saturated fat)] for 2 years. Both diets were combined with aerobic/resistance exercise (1 h, 3 days/week). Mood/well-being [Beck Depression Inventory (BDI), Spielberger State Anxiety Inventory (SAI), Profile of Mood States (POMS)], diabetes-related quality of life [Diabetes-39 (D-39)] and distress [Problem Areas in Diabetes (PAID) Questionnaire], and cognitive function were assessed during and post-intervention. RESULTS 61 (LC: 33, HC: 28) participants completed the study. Weight loss was 9.1% after 12 months and 6.7% after 2 years with no difference between diet groups. There were no differences between the groups for the changes in any psychological health outcome (smallest p ≥ 0.19 for all time x diet interactions). Overtime, improvements in BDI, POMS [Total Mood Disturbance (TMD); four subscales], PAID, and D-39 (three subscales) scores occurred (p ≤ 0.05, time). Stepwise regression analysis showed improvements in BDI, POMS (TMD; two subscales), D-39, SAI, and PAID scores were significantly (p < 0.05) correlated with reductions in body weight and glycated hemoglobin. CONCLUSION In adults with obesity and T2DM, energy-restricted LC and HC diets produced comparable long-term improvements on a comprehensive range of psychological health outcomes. The findings suggest both diets can be used as a diabetes management strategy as part of a holistic lifestyle modification program without concern of negative effects on mental well-being or cognition. TRIAL REGISTRATION ACTRN12612000369820, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362168&isReview=true . Data described in the manuscript, code book, and analytic code will not be made available because approval has not been granted by participants.
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Affiliation(s)
- Naomi Kakoschke
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Ian T Zajac
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Jeannie Tay
- A-Star Singapore-Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Natalie D Luscombe-Marsh
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Campbell H Thompson
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Manny Noakes
- Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Adelaide, SA, Australia
| | - Jonathan D Buckley
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Grant D Brinkworth
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia. .,Commonwealth Scientific and Industrial Research Organisation-Health and Biosecurity, Riverside Corporate Park, 11 Julius Avenue, North Ryde, NSW, 2113, Australia.
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26
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Du C, Almotawa J, Feldpausch CE, Folk SYL, Parag H, Tucker RM. Effects of macronutrient intake on sleep duration and quality: A systematic review. Nutr Diet 2021; 79:59-75. [PMID: 33876534 DOI: 10.1111/1747-0080.12671] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
AIM The aim of this systematic review was to characterise and synthesise the literature that explores the effects of macronutrient manipulation on sleep outcomes in order to provide dietary recommendations for sleep improvement. METHODS Intervention studies that evaluated the effects of macronutrient manipulations on sleep were identified using four databases. A study was included if it: (a) delivered a macronutrient-based dietary intervention, regardless of length; (b) included healthy human participants aged 18 and older; and (c) measured some aspect of sleep, for example, duration or quality, in some manner. RESULTS A total of 17 papers and 19 studies met the inclusion criteria. Included studies were organised into acute studies lasting less than 24 hours (n = 4), longer-term (≥24 hours) studies (n = 10), and energy restriction studies (n = 5). The greatest amount of support was observed for longer-term administration of higher carbohydrate diets. These interventions positively influenced rapid eye movement sleep; however, non-rapid eye movement sleep was negatively affected. The overall health outcomes of these changes are difficult to assess. Limited evidence suggests higher protein diets under conditions of energy restriction can improve sleep quality, but these effects might be restricted to individuals with overweight or obesity. Current evidence does not support the effects of acute macronutrient manipulation, defined as less than 24 hours, on sleep outcomes. CONCLUSIONS Manipulating carbohydrate intake for at least 24 hours appears to alter sleep outcomes among healthy individuals. Interventions were highly varied and methodological shortcomings were identified. More work is required to fully understand how macronutrient intake affects sleep outcomes.
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Affiliation(s)
- Chen Du
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Juman Almotawa
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Clare E Feldpausch
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Sara Yi Ling Folk
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Hanah Parag
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
| | - Robin M Tucker
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, Michigan, USA
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27
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Grammatikopoulou MG, Goulis DG, Gkiouras K, Theodoridis X, Gkouskou KK, Evangeliou A, Dardiotis E, Bogdanos DP. To Keto or Not to Keto? A Systematic Review of Randomized Controlled Trials Assessing the Effects of Ketogenic Therapy on Alzheimer Disease. Adv Nutr 2020; 11:1583-1602. [PMID: 32597927 PMCID: PMC7666893 DOI: 10.1093/advances/nmaa073] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/16/2020] [Accepted: 05/27/2020] [Indexed: 12/14/2022] Open
Abstract
Alzheimer disease (AD) is a global health concern with the majority of pharmacotherapy choices consisting of symptomatic treatment. Recently, ketogenic therapies have been tested in randomized controlled trials (RCTs), focusing on delaying disease progression and ameliorating cognitive function. The present systematic review aimed to aggregate the results of trials examining the effects of ketogenic therapy on patients with AD/mild cognitive impairment (MCI). A systematic search was conducted on PubMed, CENTRAL, clinicaltrials.gov, and gray literature for RCTs performed on adults, published in English until 1 April, 2019, assessing the effects of ketogenic therapy on MCI and/or AD compared against placebo, usual diet, or meals lacking ketogenic agents. Two researchers independently extracted data and assessed risk of bias with the Cochrane tool. A total of 10 RCTs were identified, fulfilling the inclusion criteria. Interventions were heterogeneous, acute or long term (45-180 d), including adherence to a ketogenic diet, intake of ready-to-consume drinks, medium-chain triglyceride (MCT) powder for drinks preparation, yoghurt enriched with MCTs, MCT capsules, and ketogenic formulas/meals. The use of ketoneurotherapeutics proved effective in improving general cognition using the Alzheimer's Disease Assessment Scale-Cognitive, in interventions of either duration. In addition, long-term ketogenic therapy improved episodic and secondary memory. Psychological health, executive ability, and attention were not improved. Increases in blood ketone concentrations were unanimous and correlated to the neurocognitive battery based on various tests. Cerebral ketone uptake and utilization were improved, as indicated by the global brain cerebral metabolic rate for ketones and [11C] acetoacetate. Ketone concentrations and cognitive performance differed between APOE ε4(+) and APOE ε4(-) participants, indicating a delayed response among the former and an improved response among the latter. Although research on the subject is still in the early stages and highly heterogeneous in terms of study design, interventions, and outcome measures, ketogenic therapy appears promising in improving both acute and long-term cognition among patients with AD/MCI. This systematic review was registered at www.crd.york.ac.uk/prospero as CRD42019128311.
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Affiliation(s)
- Maria G Grammatikopoulou
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Gkiouras
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Xenophon Theodoridis
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | | | - Athanasios Evangeliou
- 4th Department of Pediatrics, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece
| | - Efthimis Dardiotis
- Department of Neurology, Laboratory of Neurogenetics, Faculty of Medicine, School of Health Sciences, University of Thessaly, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
- Division of Transplantation Immunology and Mucosal Biology, MRC Centre for Transplantation, King's College London Medical School, London, United Kingdom
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28
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Zheng YQ, Jin MF, Suo GH, Wu YJ, Sun YX, Ni H. Proteomics for Studying the Effects of Ketogenic Diet Against Lithium Chloride/Pilocarpine Induced Epilepsy in Rats. Front Neurosci 2020; 14:562853. [PMID: 33132826 PMCID: PMC7550537 DOI: 10.3389/fnins.2020.562853] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
The ketogenic diet (KD) demonstrates antiepileptogenic and neuroprotective efficacy, but the precise mechanisms are unclear. Here we explored the mechanism through systematic proteomics analysis of the lithium chloride-pilocarpine rat model. Sprague-Dawley rats (postnatal day 21, P21) were randomly divided into control (Ctr), seizure (SE), and KD treatment after seizure (SE + KD) groups. Tandem mass tag (TMT) labeling and liquid chromatography-tandem mass spectroscopy (LC-MS/MS) were utilized to assess changes in protein abundance in the hippocampus. A total of 5,564 proteins were identified, of which 110 showed a significant change in abundance between the SE and Ctr groups (18 upregulated and 92 downregulated), 278 between SE + KD and SE groups (218 upregulated and 60 downregulated), and 180 between Ctr and SE + KD groups (121 upregulated and 59 downregulated) (all p < 0.05). Seventy-nine proteins showing a significant change in abundance between SE and Ctr groups were reciprocally regulated in the SD + KD group compared to the SE group (i.e., the seizure-induced change was reversed by KD). Of these, five (dystrobrevin, centromere protein V, oxysterol-binding protein, tetraspanin-2, and progesterone receptor membrane component 2) were verified by parallel reaction monitoring. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis indicated that proteins of the synaptic vesicle cycle pathway were enriched both among proteins differing in abundance between SE and Ctr groups as well as between SE + KD and SE groups. This comprehensive proteomics analyze of KD-treated epilepsy by quantitative proteomics revealed novel molecular mechanisms of KD antiepileptogenic efficacy and potential treatment targets.
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Affiliation(s)
- Yu-Qin Zheng
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China.,Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Mei-Fang Jin
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Gui-Hai Suo
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - You-Jia Wu
- Department of Pediatrics, Affiliated Hospital of Nantong University, Nantong, China
| | - Yu-Xiao Sun
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
| | - Hong Ni
- Division of Brain Science, Institute of Pediatric Research, Children's Hospital of Soochow University, Suzhou, China
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29
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Influence of the Mediterranean and Ketogenic Diets on Cognitive Status and Decline: A Narrative Review. Nutrients 2020; 12:nu12041019. [PMID: 32276339 PMCID: PMC7231139 DOI: 10.3390/nu12041019] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022] Open
Abstract
Alzheimer’s disease (AD) is the most common form of senile dementia, accounting for up to 70% of dementia cases. AD is a slowly progressive disease, which causes global mental deterioration by affecting various cognitive areas. A growing body of evidence has demonstrated that lifestyle habits and nutritional patterns could delay the natural course of the neurodegeneration process. There is no single dietary pattern unequivocally proven to prevent AD. Nevertheless, epidemiological data suggest that by adopting several dietary habits, especially if accompanied with a healthy lifestyle, the negative consequences of AD could potentially be delayed. Alongside with others, two specific eating patterns have been well investigated concerning their potential beneficial effect on cognitive status: the Mediterranean diet (MedDi) and the Ketogenic Diet (KD). Despite the different underlying mechanisms, both of them have demonstrated a fairly profitable role in reducing or delaying cognitive impairment. The aim of the present narrative review is to overview the existing research on the efficacy of MedDi and KD against AD-related cognitive decline, focusing on the proposed protective mechanisms of action. Although the current knowledge on this complex topic does not allow us, at this point, to make exhaustive conclusions, this information could be of help in order to better characterize the possible role of MedDi and KD as nonpharmacological therapies in the treatment of AD and, more generically, of neurodegenerative disorders.
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30
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Smith PJ. Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition. Brain Plast 2019; 5:3-38. [PMID: 31970058 PMCID: PMC6971820 DOI: 10.3233/bpl-190083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.
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Affiliation(s)
- Patrick J. Smith
- Department of Psychiatry and Behavioral Sciences (Primary), Duke University Medical Center, NC, USA
- Department of Medicine (Secondary), Duke University Medical Center, NC, USA
- Department of Population Health Sciences (Secondary), Duke University, NC, USA
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31
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Harvey KL, Holcomb LE, Kolwicz SC. Ketogenic Diets and Exercise Performance. Nutrients 2019; 11:nu11102296. [PMID: 31561520 PMCID: PMC6835497 DOI: 10.3390/nu11102296] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023] Open
Abstract
The ketogenic diet (KD) has gained a resurgence in popularity due to its purported reputation for fighting obesity. The KD has also acquired attention as an alternative and/or supplemental method for producing energy in the form of ketone bodies. Recent scientific evidence highlights the KD as a promising strategy to treat obesity, diabetes, and cardiac dysfunction. In addition, studies support ketone body supplements as a potential method to induce ketosis and supply sustainable fuel sources to promote exercise performance. Despite the acceptance in the mainstream media, the KD remains controversial in the medical and scientific communities. Research suggests that the KD or ketone body supplementation may result in unexpected side effects, including altered blood lipid profiles, abnormal glucose homeostasis, increased adiposity, fatigue, and gastrointestinal distress. The purpose of this review article is to provide an overview of ketone body metabolism and a background on the KD and ketone body supplements in the context of obesity and exercise performance. The effectiveness of these dietary or supplementation strategies as a therapy for weight loss or as an ergogenic aid will be discussed. In addition, the recent evidence that indicates ketone body metabolism is a potential target for cardiac dysfunction will be reviewed.
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Affiliation(s)
- Kristin L Harvey
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA.
| | - Lola E Holcomb
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA.
| | - Stephen C Kolwicz
- Heart and Muscle Metabolism Laboratory, Health and Exercise Physiology, Ursinus College, Collegeville, PA 19426, USA.
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32
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Kirkpatrick CF, Bolick JP, Kris-Etherton PM, Sikand G, Aspry KE, Soffer DE, Willard KE, Maki KC. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force. J Clin Lipidol 2019; 13:689-711.e1. [PMID: 31611148 DOI: 10.1016/j.jacl.2019.08.003] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
Abstract
Historically, low-carbohydrate (CHO) and very-low-CHO diets have been used for weight loss. Recently, these diets have been promoted for type 2 diabetes (T2D) management. This scientific statement provides a comprehensive review of the current evidence base available from recent systematic reviews and meta-analyses on the effects of low-CHO and very-low-CHO diets on body weight, lipoprotein lipids, glycemic control, and other cardiometabolic risk factors. In addition, evidence on emerging risk factors and potential safety concerns of low-CHO and very-low-CHO diets, especially for high-risk individuals, such as those with genetic lipid disorders, was reviewed. Based on the evidence reviewed, low-CHO and very-low-CHO diets are not superior to other dietary approaches for weight loss. These diets may have advantages related to appetite control, triglyceride reduction, and reduction in the use of medication in T2D management. The evidence reviewed showed mixed effects on low-density lipoprotein cholesterol levels with some studies showing an increase. There was no clear evidence for advantages regarding effects on other cardiometabolic risk markers. Minimal data are available regarding long-term (>2 years) efficacy and safety. Clinicians are encouraged to consider the evidence discussed in this scientific statement when counseling patients on the use of low-CHO and very-low-CHO diets.
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Affiliation(s)
- Carol F Kirkpatrick
- Wellness Center, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA.
| | - Julie P Bolick
- Dietitian Nutritionist Specialist II and Clinical Lipid Specialist, Intermountain Health Care, Live Well Center, Salt Lake City, UT, USA
| | - Penny M Kris-Etherton
- Distinguished Professor of Nutrition, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Geeta Sikand
- Associate Clinical Professor of Medicine (Cardiology Division) and Director of Nutrition, University of California Irvine Preventive Cardiology Program, Irvine, CA, USA
| | - Karen E Aspry
- Brown University Alpert Medical School, Lipid and Prevention Program, Lifespan Cardiovascular Institute, East Greenwich, RI, USA
| | - Daniel E Soffer
- University of Pennsylvania, Preventive Cardiology Heart and Vascular Center, Philadelphia, PA, USA
| | - Kaye-Eileen Willard
- Physician Advisor for Patient Quality and Safety, Ascension Wisconsin All Saints, Racine, WI, USA
| | - Kevin C Maki
- Midwest Biomedical Research, Center for Metabolic & Cardiovascular Health, Addison, IL, USA
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