The case for a ketogenic diet in the management of kidney disease

This article aims to explore the safety aspects of keto gummies to provide consumers with the necessary information to make informed decisions about their consumption. Different symptoms and side effects were also reported, with varying intensities, especially in the first few days of adopting this diet. Only five participants did not notice any change, and two gained weight, possibly because of the quality of the diet practice or maybe they are still in the early stage of their diet. However, diet intervention with exercise can lose more weight than diet intervention alone . Moreover, most of the respondents were either overweight, obese, or morbidly obese, and only 12.4% had a normal body mass index. Furthermore, many young-aged individuals are trying to lose weight because this age group is concerned about body weight, which could affect employment, marriage, or body image. For instance, people at a young age have a higher tendency to gain more weight, eat unhealthy food, and follow unhealthy habits . Different symptoms and side effects occurred with varying intensities, especially in the first few days of adopting this diet. Recently, this diet has been promoted as a lifestyle, making it highly controversial in terms of its practicality as a lifestyle diet and its duration without affecting one’s health or quality of life. The accurate identification of patients who benefit most from nutritional therapy presents a clinical imperative requiring validation by adequately powered clinical studies. This may be of particular relevance for high-risk patients undergoing complex procedures with prolonged CPB duration and an overwhelming release of pro-inflammatory mediators. Pharmaco-nutrition offers a promising approach to enhance the body’s defense mechanisms and to attenuate the deleterious effects of SIRS and improve outcomes. Berger et al. demonstrated that perioperative FO infusions significantly decreased biological and clinical signs of inflammation, in a rather low-risk population of cardiac surgery patients, as reflected by a low mean Euroscore (5), which is routinely used for the preoperative risk stratification in cardiac surgery patients. Similarly, recent results from a non-randomized open-label study indicate a beneficial effect of perioperative sodium selenite supplementation, whereas the supplementation strategy was still insufficient to compensate for a second decrease in selenium levels during the postoperative course.

Potential Cardiovascular Benefits of Ketosis

Overall, GL considers every dietary component as a whole, providing a more real-life picture of how a dish will affect your blood glucose levels. Moreover, studies have also demonstrated that obesity, atherosclerosis, and diabetes will further lead to glucose metabolism disorders, raising the blood glucose level, which forms a vicious circle 4,5. For patients with chronic kidney disease, there is limited evidence on the risks and/or benefits of this diet. This approach seems to provide us with all of the benefits of the keto diet and Mediterranean diet for heart health in one simple diet. One long-term study was also conducted comparing the effects of the Mediterranean keto diet with and without omega-3 supplementation. Similar results were found after six weeks of a Mediterranean ketogenic diet with the addition of herbal extracts. Interestingly enough, research has already been done on this unique hybrid of the two diets to determine its effects on various aspects of health. In this study, high-risk subjects who followed a Mediterranean diet supplemented with extra-virgin olive oil or nuts experienced a slightly reduced incidence of major cardiovascular events compared to a control reduced-fat diet. Although it isn’t explicitly stated, the consensus seems to be in favor of the Mediterranean diet as being the best option for people at high risk for heart disease. If a specific diet is able to improve each one of these factors significantly, then it is reasonable to assume that the diet is a good option for preventing heart disease and reducing the risk of stroke and heart attack. Although the effects that the keto diet has on mental health have yet to be studied directly, it is reasonable to speculate that this dietary change can have a significant impact on the psychological aspects of our lives as well. Mental health has a significant impact on heart disease risk, directly and indirectly. As you may already know, the keto diet is one of the best diets for fat loss. In general, the risk of heart disease-related death and stroke are twice as high in people with diabetes. The first six weeks they ate a low-carbohydrate diet and the next six weeks a low-fat diet. Dr. Rollin Woodyatt noted that under conditions of starvation, acetone, and beta-hydroxybutyric acid appear.5 Woodyatt also uncovered that acetone and beta-hydroxybutyric acid were observed if patients ate a low carbohydrate diet. With the increased interest in this diet, researchers are working to understand the impact of this pattern of eating on patients’ health. By considering these points, individuals can make informed choices about incorporating keto gummies into their diet. In summary, when considering the consumption of keto gummies, it’s important to weigh the potential benefits against the risks and consider individual circumstances. By seeking guidance from healthcare professionals, individuals with specific health conditions can make informed decisions about consuming keto gummies that are in line with their unique circumstances. While keto gummies can be a tempting treat for many individuals, it’s important to consider certain health conditions and circumstances that may require additional precautions. Checking ingredient labels allows you to make informed decisions based on your dietary requirements, ensuring that the gummies align with your health goals. When incorporating keto gummies into your diet, it’s crucial to prioritize quality and choose products from reputable brands. While keto gummies can be a satisfying treat, it’s essential to consume them in appropriate quantities as part of a balanced diet. Some people may experience gastrointestinal discomfort or other side effects when consuming certain types of sweeteners used in keto gummies, such as sugar alcohols like erythritol or xylitol. Studies of the microbiome as a surrogate marker of low-inflammatory, therapeutic diets in PD are required to further understand the optimal design and mechanism in future studies. Elevated glucose uptake is a frequent feature of cancer cells, which is used to produce mediators of lipid, protein, and nucleic acids synthesis . Various mechanisms have been proposed for the inhibitory effects of KD on the growth of tumors and cancer cells. Several studies have demonstrated that there was no significant change in cardiac indexes, including cIMT and elastic properties of the carotid artery, aortic strain, the stiffness index, and distensibility after short- and long-term KD in epileptic children 57,58. BOHB has an anti-inflammatory effect on the heart by suppressing the Nod-like receptor protein 3’s (NLRP3’s) inflammasome expression. In most vascular diseases, atherogenesis is a common underlying cause, and inflammation plays a role in the atherogenesis process. Thus, KD may protect against heart damage by regulating the heart’s energy metabolism and mitochondrial function. It has been suggested that mitochondrial dynamics play an essential role in heart function. Since aging is a CVD risk factor, delaying or preventing it can play a main role in cardiovascular dysfunction. Myocardial blood flow was enhanced by BOHB infusion by about 75% and induced vasodilatation . Another potential mechanism for the beneficial effect of KD on CVD is the relationship between carbohydrate intake and CVD. The effect of dietary intake on the cardiovascular system has been studied more than other physiological functions . In the process of ketogenesis, glucagon accelerates ketogenesis by stimulating HMG CoA synthase 27,28. Considering the number of studies on this topic, there is a clear need to summarize the evidence on the potential therapeutic mechanisms of KD on CVD and cancer. Cardiovascular disease (CVD) and cancer are the first and second leading causes of death worldwide, respectively . In this review, we explained the history of KD, its types, and physiological effects and discussed how it could play a role in CVD and cancer treatment and prevention. However, there is still great debate regarding prescribing KD in patients either with CVD or cancer. However, these conditions are usually regarded as separate events despite the presence of shared risk factors between both conditions, such as metabolic abnormalities and lifestyle. Epidemiological evidence has demonstrated that the incidence of cancer is elevated in patients with CVD and vice versa. Cardiovascular disease (CVD) and cancer are the first and second leading causes of death worldwide, respectively. To separate fact from fiction, it is essential to consult with a healthcare professional and carefully evaluate the available evidence.

• This is a metabolic state which imitates the biological adaptations seen in starvation, without severely limiting caloric intake and a blood ketone level of between 0.5 and 3 mg/dL .
• Ye Tian looked at Tong Fist, with an evil smile on his lips, pointing to the iron arm at his feet, and said, He threatened are keto gummies safe for heart patients npo-uwsua.org my family, so he died.
• Other uraemic toxins that have high plasma levels in renal failure are thiocyanate, asymmetric dimethylarginine and homocysteine.
• Nevertheless, of these limitations, KDs have been demonstrated to grant a clear beneficial impact on body composition and glucose/insulin homeostasis for obese and/or type 2 diabetes mellitus patients.
• Changes in the level of high density lipoprotein (HDL) cholesterol in obese patients during treatment with a ketogenic diet for a period of 24 weeks.
• Statins competitively block the cholesterol synthesis pathway by inhibiting HMG-CoA reductase, thereby increasing the amount of raw materials available for ketone body synthesis and increasing the level of ketone bodies in the body (Tsouli et al., 2008; Clearfield, 2002; von Haehling et al., 2003).

The ability to achieve and maintain weight reduction for individuals with overweight or obesity reduces cardiometabolic risk. They also tend to report decreased hunger and maintain higher metabolism rates than low-fat dieters . It is a high-fat, low-carb, moderate-protein diet that produces metabolic changes similar to those seen in a state of starvation. Abdominal ultrasound showed a mildly heterogenous and echogenic liver, without focal lesions, suggestive of non-alcoholic fatty liver disease. KD might suppress oxidation through increasing mitochondrial biogenesis, exert an anti-inflammatory effect and consequently reduce cancer and CVD risk, and improve various shared risk factors of cancer and CVD (e.g., hypertension, obesity, diabetes mellitus, and dyslipidemia). Given that hyperinsulinemia mediates the adverse effects of diabetes on both cancer and CVD, improving insulin resistance can be an advantageous strategy to prevent their progression. A meta-analysis of RCTs indicated beneficial effects of a KD on glycemic control, with a greater improvement in diabetic patients . Excess body fat, in particular abdominal adiposity, is linked to higher inflammation and oxidative stress, which play a crucial role in the pathogenesis of both cancer and CVD . A KD with an appropriate composition of protein, mono-unsaturated and saturated fatty acids can increase HDL-C and reduce triglycerides, LDL-C, body fat mass, and inflammatory biomarkers 106,140. Dyslipidemia increases cancer and CVD risk through some shared mechanisms, such as their effects on insulin resistance, inflammation, and oxidative stress 154,155,156,157. Summary of studies that assessed shared mechanisms between cancer and cardiovascular diseases 70,115,125,127,130,140,141,142,143. Table 2 shows the summary of studies that assessed the shared mechanisms between cancer and cardiovascular diseases. Gut microbiota, as a “hidden metabolic organ” or a “virtual endocrine organ” , interacts with diet and has an enormous influence on the host metabolic pathways and health status. Despite several studies exploring the effects of KD on oxidative stress, findings are still controversial. In fact, they found that acetoacetate as a ketone metabolite could induce BRAF V600E mutant-dependent mitogen-activated protein kinase 1 (MEK1) activation in melanoma cells, and KD might play a pathogenic effect in this cancer . Vidali et al., in an animal study on 10 CD-1 nu/nu mice models of renal cell carcinoma with features of Stauffer’s syndrome, showed that KD administered for two weeks led to severe weight loss and liver dysfunction . Like the pre-clinical studies, most of the human studies on KD were conducted on patients with brain tumors. In addition, in another clinical study in eleven patients with glioblastoma, it was reported that the overall survival in patients ranged between 9.8 and 19.0 months, which was not a significant improvement. A prospective clinical trial from Japan evaluated the effects of KD with fluorouracil-based chemotherapy compared to a control group among patients with rectal cancer. However, individuals with specific health conditions or dietary restrictions should consult a healthcare professional before incorporating them into their regimen. When it comes to supplementing for ketosis, keto gummies are just one of many options available. The research on keto gummies specifically is still evolving as this product type is relatively new. When considering the safety of a specific brand of keto gummies, scrutinize the ingredient list. While keto gummies offer appealing advantages, it’s crucial to delve into their safety. These added nutrients can support your overall health during your weight loss journey. Keto gummies can help satisfy sweet cravings without compromising your low-carb diet. Unlike traditional keto supplements in powdered form, keto gummies are portable and can be consumed on the go. The primary benefit of keto gummies is their ability to aid in the process of ketosis. To understand the safety and efficacy of keto gummies, it’s essential to examine their key ingredients. Among these, keto gummies have emerged as a convenient and tasty alternative to traditional keto supplements. Results from a subanalysis of the CARDIA prospective study found that progression of CAD measured by coronary artery calcium was more pronounced in people with low-carbohydrate intake, especially when the compensatory calorie intake was from animal sources as compared to plant-based sources. Drugs that can interfere with ketosis include medications for high blood pressure, such as diuretics and beta blockers, as well as those prescribed for mood disorders, such as antipsychotics and mood stabilizers. Before starting a low-carb diet, discuss your current medications and health conditions with your doctor to develop a safe, personalized plan. If you’re considering a keto lifestyle while taking medications, consulting your healthcare provider is essential. Additionally, CG had a significantly lower gumminess and chewiness compared with other two gummies. Research data suggested that gummy format counteracted sugar-induced glucose intolerance in females (Figure 2). The results of OGTT indicated a significantly improved glucose tolerance in males compared to females with respect to glucose intake. Glycemic Index (GI) and Glycemic Load (GL) values and classifications of the three types of gummies. Although the CG is classified as a high-GI food, it was also found to be a low-GL food when taking the carbohydrate quantity into consideration. The Glycemic Index (GI), Glycemic Load (GL), and the classification of the three types of gummies are illustrated in Table 2. However, the blood sugar peak of the sugar-free group appeared at the 45 min mark after food consumption. The OGTT curve was steadier in the P-SG and T-SG groups than in the CG and glucose groups (Figure 1). The curve and area under curve (AUC) of oral glucose tolerance test (OGTT) demonstrated a significantly improved glucose tolerance in all the gummy groups compared to the glucose group. Sugars in total and partial sugar substitutes gummies, T-SG and P-SG, were substituted by erythritol and maltitol, while sucrose-based gummies were used as comparisons (CG). The chewiness and swallowability of gummies have made them popular among consumers due to the versatility of hydrocolloids in forming specific dosage forms . However, aside from available carbohydrates, there are numerous other food factors that can affect GI and GL values, one of which is gelling properties of the food. It is worth noticing that both GI and GL are calculated based on the amount of available carbohydrates. The GL of the food is the product of its GI and its available carbohydrate content, evaluating both the quantity and the quality of carbohydrates. However, the GI only indicates the glycemic response to the carbohydrates in various foods without considering the amount of food consumed. Therefore, instead of a high-GI diet, a low-GI diet has been recommended as a dietary intervention to manage hyperglycemia or obesity . Thus, the GI of glucose is defined as 100, and foods with a GI lower than 55 are considered as low-GI foods, whereas those with a GI between 55 and 70 are medium-GI foods, and those with a GI exceeding 70 are high-GI foods . The glycemic index (GI) and the glycemic load (GL) are two parameters used for evaluating the quality and quantity of carbohydrates-containing food. Carbohydrates are one of the essential nutrients and sources of energy for the human body. However, there are a few subsets of the population may experience a worsening of blood lipid levels after following a high fat, low carb diet. A small subset of the population may not fare well, from a heart health perspective, when they eat a high-fat, low-carb diet. Because of its focus on fat consumption, the keto diet is concerning to many doctors, dieticians, and health advocates. Of eleven these risk factors, studies indicate that we have the most control the ones that have the biggest impact on heart disease. In the long-term, however, this shortsighted solution turns into a bad omen, increasing our risk of heart disease, heart attack, and stroke if we don’t make the appropriate changes to our diet and lifestyle. “If you’re going to try a ketogenic diet, you should do it under physician supervision so they can see what’s happening to your LDL cholesterol,” he says. As far as major study limitations are concerned, Gardner points out that the investigation was based on a single, 24-hour dietary report, and while the research can show increased risks from a keto-like diet, it can’t prove that the diet itself causes these outcomes. The International Food Information Council estimates that as many as 8 percent of Americans were on a ketogenic diet in 2020. “If cholesterol levels are super high, consult with your doctor because there may really need to be careful attention paid to managing the risk of heart disease,” Dr. Brunham adds. Additionally, incorporating healthy oils and fats into your snacks can enhance flavor and provide essential nutrients beneficial for a ketogenic lifestyle. Regular monitoring and evaluation of any side effects after starting keto gummies are vital to guarantee your health remains a priority. These conditions can complicate your use of keto gummies and may interact with medications affecting blood sugar levels. When considering whether keto gummies are safe for seniors, it’s vital to evaluate individual health conditions and dietary needs. If you have diabetes or low blood sugar levels, be cautious, as these gummies can cause significant fluctuations in your blood sugar levels. Ingredients like apple cider vinegar may affect blood sugar levels, posing risks for those on diabetes medications. It’s important to follow the recommended dosage and combine the consumption of keto gummies with regular physical activity, portion control, and a well-rounded diet for sustainable weight loss. When following a keto diet and preparing keto gummies at home, it is essential to monitor the carbohydrate content. Eating keto gummies can have an impact on your state of ketosis, the metabolic process that burns fat for energy instead of carbohydrates. Unlike the clean keto diet, there are few rules regarding the types of foods you should consume to hit your fat goals. The keto diet encourages followers to consume higher-than-average amounts of fat. Choosing a high-fat, low-carb diet has several possible advantages for your health. Instead, it begins burning its own stored fat, converting it into ketones to use as energy. We explain how keto works and the risks you should consider when switching to this diet. Although this alteration in the gut microbiome may be beneficial for individuals with epilepsy, research is lacking on the impact on populations using the diet for weight loss or diabetes management . One way to mitigate the negative effects of the diet on LDL cholesterol is to replace saturated fats from animal sources with polyunsaturated fats found in avocados, nuts, seeds, coconut and olive oil. The amino acids alanine and glutamine can be converted to glucose through gluconeogenesis, thus removing the body from a ketotic state . Often these self-initiated diets are implemented without the guidance of a licensed health care provider. She received counseling to follow a low-fat and low-carbohydrate diet rich in fruits and vegetables. The theory is that ketone bodies are anti-convulsant when they cross the blood-brain barrier . Furthermore, a more stable energy source may be beneficial for fatigue, pain and other “non-motor” symptoms. This supports the plasticity of hypometabolic brain because AD involves 20–40% global reduction of glucose uptake by FDG PET imaging, particularly in the hippocampus where glucose utilization is relatively high. The memory improvement in these cohorts was followed out to 4 months with attenuated reduction in fluorodeoxyglucose (FDG) PET glucose metabolism . Similarly, insulin administration improved memory performance in early disease stages, mildly cognitive impaired, and mild dementia elderly cohorts, particularly in the apolipoprotein epsilon 4 (APOE4) genotype negative subgroup 66–68. Further evidence for cognitive benefit from fatty acid metabolism comes from clinical trials in AD using MCT. Instructions to fast (time-restricted feeding or intermittent) and/or exercise produces episodically elevated ketosis (red arrows) Such a press-pulse approach might be adapted to neurometabolic degenerative diseases including PD (Fig. 1). The theory that NK may slow PD progression is gaining support, since cell death in neurodegenerative disease, including PD, relates to inadequate calcium buffering by dysfunctional mitochondria in specific neuronal populations, leading to mitochondrial permeability pore formation, depolarization, and programmed cell death 41, 42. Given that NADPH is decreased in the putamen at post-mortem in early PD, as defined by the McKeith Lewy Body score , and that oxidative stress is a sequel of complex I inhibition in PD , there appears to be a role for NK to slow disease progression. Another feature of ketosis is increased supply of nicotinamide adenine dinucleotide phosphate (NADPH) by decreased glycolysis and concomitant shuttling of pyruvate via the pentose phosphate pathway (PPP), therefore increasing the supply of reduced glutathione (GSH) available to remove hydrogen peroxide–derived free radicals . One measure, the amplitude of low-frequency (0.01–0.1 Hz) fluctuations (ALFF), is correlated with cerebral blood flow and studied as a possible index of regional network stability over time. Cerebral metabolic rate can be gauged indirectly via functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) signal. One of the key correlates of both aging and insulin resistance is the reduced cerebral metabolic rate of glucose as defined by positron emission tomography (PET) fluorodeoxyglucose tracer . UPDRS is more relevant with clinical trials because of the proven reliability  and correlation to disease progression . The resolution of outcome assessment at 1–2 months does not differentiate between immediate effects such as from an ATP supply to deficient mitochondria in vulnerable striatal-thalamic-cortical neuronal populations and later effects from epigenetic metabolic factors on cell survival, oxidative stress, neurotransmitter, hormonal, paracrine, or autocrine signaling. The investigators followed 7 subjects in the low carbohydrate group and 7 in the high carbohydrate group. Dietary monitoring relied on participants to check off each meal from the plan outlined for the study period. Interpretation of the results is limited due to the drop out of 2 of 7 participants and additional 2 of the 5 remaining participants with reported dietary relapse. These would include epigenetic modifications for antioxidant and pro-survival signaling as well as indirect metabolic effects such as inhibiting the nuclear factor kappa light chain enhancer of activated B cells (NFKappaB) and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome expression. Ketosis has also gained attention for potential therapeutic use in neurodegenerative disease , including Alzheimer’s disease (AD), Parkinson’s disease (PD), and amyotrophic lateral sclerosis (ALS), as a way to potentially slow disease progression by providing greater mitochondrial oxidative phosphorylation with decreased free radical generation. As opposed to the clean keto diet, dirty keto allows those following it to eat more highly processed foods and unhealthy fats to meet their macronutrient goals. Those on the diet tend to struggle with hitting their fiber goals while eating high amounts of saturated fat, both of which contribute to high LDL cholesterol and worsening heart health. Known for its ability to aid weight loss, control blood sugar, and boost energy, keto is a highly popular diet for those wanting to improve their overall well-being. Like any other restrictive dietary plan, the ketogenic diet is often difficult to maintain long-term. Research also suggests that the ketogenic diet improves insulin sensitivity and glycemic control, although the mechanisms are unclear . After three to four days of fasting or following a very low-carbohydrate diet, the body becomes deprived of dietary sugar and starch, and reacts by reducing insulin secretion and switching to primarily burning fat for fuel. The ketogenic diet was originated in the 1920s and 1930s as an alternative to fasting for the reduction of seizure frequency in children with epilepsy . The patient agreed to discontinue the ketogenic diet and follow up with a registered dietician. In September 2018, the patient self-initiated a ketogenic diet, consuming predominantly eggs, cheese, butter, oil, nuts, leafy green vegetables and almond/coconut milk. The ketogenic diet was originally developed for implementation under medical supervision to treat refractory epilepsy in infants and children .

• While CBD is generally considered safe, it can interact with other medications, including blood thinners and beta blockers, which can increase the risk of bleeding and other adverse effects.
• It should be noted that sodium–glucose cotransporter 2 (SGLT2) inhibitors, which are now widely prescribed to CKD patients and often hailed as a breakthrough treatment, work on the same principle as KMT, albeit less effectively .
• While the mechanisms for this response are not entirely clear, preclinical studies from our group and others suggest that the ketone, beta-hydroxybutyrate (βHB), inhibits histone deacetylases which have been shown to preserve muscle in aging rodents .
• The author argues that although many studies show an association between LDL-C and cardiovascular diseases, this is not conclusive of a causal relationship .
• Additionally, your total body water decreases as carbohydrates become depleted on a keto diet, notes Clark.

Keto May Lead to High Cholesterol and an Increased Risk of Heart Disease

Overall, for the optimal management and prevention of diabetes especially for the prevention of DM complications, nutrition therapy plays an integral role . However, the results of the present study indicate the need for further research in this area, utilizing rigorous methodology. Some evidence indicates reduced reliance on diabetes medications. However, its potential for preventing type 2 diabetes mellitus (T2DM) remains largely unexplored. Like histone PTMs, non-coding RNAs (ncRNAs), including various pathways such as microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), play a dominant role in epigenetic regulation and have attracted increasing interest in heart failure due to their ability to regulate gene expression in heart failure (Gomes et al., 2020). It is crucial to note that further research is needed to differentiate the effects of these inhibitors, as they could either directly target epigenetic regulation via histones or indirectly through non-histone targets, such as gene expression modulation and enzyme activity regulation (Jeong et al., 2018; Khan et al., 2018). Research on heart-specific SCOT knockout mice with transverse aortic constriction (TAC) revealed disordered mitochondrial and myofibrillar microstructures in cardiomyocytes, accompanied by increased left ventricular volume and decreased ejection fraction (Schugar et al., 2014). After released into the circulation and import it into cardiomyocytes by the monocarboxylate transporter (MCT), AcAc and β-HB are converted back to acetyl-CoA via cardiomyocyte mitochondrial ketolysis, which can be subsequently metabolized in the tricarboxylic acid cycle to generate ATP. Currently, the main approach for treating heart failure is to improve hemodynamics by regulating the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system (SNS), which includes positive inotropy, diuresis, and vasodilation (Mullens et al., 2017; Wu and Vaseghi, 2020; Tang and Kiang, 2020). Heart failure is an advanced stage of various cardiovascular diseases characterized by abnormal cardiac structure and function, resulting in reduced cardiac output and increased intra-cardiac pressure (Writing Committee and Members, 2022; Mascolo et al., 2022). There are also changes in the LDL subfractions, which are thought to be beneficial for cardiovascular disease prevention. This was likely secondary to fibromyalgia, rather than statin-induced myopathy, as CPK levels were within normal limits. A 56-year-old Hispanic female with a past medical history of hypertension and fibromyalgia presented to the outpatient clinic for the evaluation of fatigue. Conversely, sicker patients who may already have progressive CKD may be more inclined to use medical cannabis for symptom management. Over 60% of dialysis patients receive at least one opioid prescription annually and approximately 20% of them take prescription opioids chronically . Pain attributed to kidney disease occurs from polycystic kidney disease, renal colic from nephrolithiasis, renal osteodystrophy, or uremic neuropathy. The rationale for its use in patients with CKD and ESRD has been previously reviewed by myself and others 71,72,73▪. One-quarter to one-half of patients with CKD experience chronic symptoms such as pain, nausea, anorexia, sleep disturbance, anxiety, and depression , several of which are approved indications for medical cannabis. A study of 84 CBD products sold online found that 42% of products contained more CBD than stated on the label, 26% were overlabeled, whereas only 31% contained the stated amount . THC has a large volume of distribution (Vd) with slow elimination from the body. CBD is metabolized by CYP3A4 and CYP2C19 with a growing body of evidence suggesting it is also a potent inhibitor of these pathways 51,52 including CYP2C9 and CYP2D6 . Cannabinoids are highly lipophilic and bioavailability is increased with high fat intake compared to consumption on an empty stomach . Inexperienced users who do not feel an effect right away may be tempted to overconsume innocuous appearing edible preparations that can lead to drug accumulation and prolonged adverse side effects. After oral consumption, the onset of action may be delayed up to 1–2 h, with peak effects at 2–3 h and half-life of 3–6 h. Whole cannabis contains numerous cannabinoid compounds with different affinities, making the predicted cumulative effect on cannabis receptors, and potential renal effects difficult to predict. It may also be beneficial to replace animal foods with plant-based alternatives, as the latter tend to contain more healthy fats. You could try the pescatarian keto diet, which prioritizes fish over meat as the main source of nutrients. Having large amounts of LDL in the blood can lead to peripheral arterial disease. This means that people often turn to processed foods and animal products, which contain unhealthy saturated and trans fats. As a rough guide, it’s recommended to get 70–80% of your daily calories from fat, 10–20% from protein, and 5–10% from carbs to remain in ketosis. You’re likely to try dirty keto if you want to lose weight but are less concerned with the quality of your food intake. These symptoms are a result of the body’s rapid excretion of sodium and fluids as carbohydrate intake is restricted and glycogen stores are depleted. Depending on an individual’s response to the diet, benefits of improved glycemic control may outweigh potential risks of an elevated LDL. Notably, in rodents, development of nonalcoholic fatty liver disease (NAFLD) and insulin resistance have been described . The resulting overproduction of acetyl-CoA leads to formation of ketones (acetoacetate, acetone and beta-hydroxybutyric acid) in a process known as ketogenesis . Protein is kept high enough to maintain lean body mass, but low enough to preserve ketosis. Individuals with obesity or overweight often implement what they hope to be the next “quick fix” for reversing their increased fat mass. She was counseled to engage in routine aerobic exercise at least three times per week and advised against implementing any diet that promotes rapid weight loss. These findings are highly suggestive of hepatic steatosis, or fatty liver disease. She reported high stress levels, a strong desire to lose weight, and a lack of support in her daily life. In particular, it has the potential to increase blood cholesterol levels and induce elevations in liver enzymes.

• Understanding the potential benefits and risks of these keto supplements guarantees you maximize their effectiveness while minimizing any adverse effects.
• In a recent study on diabetic mice, a ketogenic diet improved mitochondrial function and capacity through its activation of PGC-1ɑ and SIRT1.62 Further, administration of exogenous BHB was found to increase PGC-1ɑ and mitochondrial copy number in rat kidneys.63 Human data on mitochondrial function are lacking, but we obtained skeletal muscle biopsies from physically active adults before and after a 12-week ketogenic diet and demonstrated that mitochondrial function and efficiency shifted towards fat oxidation while improving insulin sensitivity.64
• Prominent healthcare professionals and nutritionists emphasize the importance of understanding the safety considerations before consuming keto gummies.
• So, is Keto a good diet for heart health?
• In particular, it has the potential to increase blood cholesterol levels and induce elevations in liver enzymes.
• At the 90 min mark, the blood glucose levels of the P-SG and the T-SG groups returned to baseline levels (levels at the 0 min mark).
• On the other hand, Mujica-Parodi and colleagues reported that an overnight fast produced a degree of resting state network stability similar to 1 week of a ketogenic diet in healthy volunteers, which they attributed to exhaustion of astrocyte glycogen stores even while 36–48 h of fasting are required for peripheral glycogen total consumption .
• He tried to stabilize his mind, allowing himself to continue to use his Qi as smoothly as possible, and tried to guide the Qi into Murong Beibei s delicate body.
• Her diet consisted of low-carbohydrate vegetables, seafood, avocados, eggs, and coconut oil.

However, one review in 2009 investigating low GI diets for diabetes reveals clinically insignificant reductions in HbA1c (− 0.5%), nevertheless indicting improved glycaemic control. This group of food (high fat and high sugar) can often be linked with a high glycaemic index and glycaemic load (the quantity of carbohydrate) , a deleterious combination that diminishes insulin sensitivity, leads to insulin resistance and subsequently increases the risk of T2D when consumed long term in high quantities according to meta-analyses 57, 58. Health-related quality of life plays a pivotal role in diabetes and its management due to its potential deleterious effects on the physical, social and psychological well-being of patients, all of which can lead to reduced self-care and subsequent glycaemic control . Another study also revealed that 86% of individuals with T2DM who completed a 12-month low carbohydrate diet were able to reduce or completely discontinue insulin use. Further physiological responses to limited carbohydrate availability include lipogenesis (the conversion of glycerol into fatty acids and triglycerides), reduced adipose tissue storage and lipolysis of fat depots is increased as a result of low circulating insulin levels . It is termed ‘ketogenic’ with the overarching aim being to restrict carbohydrate intake enough to induce nutritional ketosis (Table 1). This is a metabolic state which imitates the biological adaptations seen in starvation, without severely limiting caloric intake and a blood ketone level of between 0.5 and 3 mg/dL . There are many variations of carbohydrate limited or restricted diets, ranging from moderate to very low carbohydrate diets, and a strict definition remains to be agreed; however, Feinman provided the most commonly used categories of carbohydrate-focused diets. Despite the evident favourable short-term metabolic effects of a lower carbohydrate diet, SACN reported inconsistent and inconclusive results for long-term therapeutic benefits due to lack of comprehensive long-term data and concluded that a low carbohydrate diet is not superior but also not inferior compared to other dietary patterns. Subsequently, the Scientific Advisory Committee on Nutrition (SACN) in 2021 reviewed existing data on low carbohydrate diets for people with T2D . This ambiguity has led to uncertainty amongst healthcare professionals with ‘prescribing’ a specific dietary type or pattern as a therapeutic approach for diabetes as a consensus has yet to be reached for the ideal dietary distribution for people with diabetes . Interestingly, this advice was also applicable to the 10% of individuals with T2D who are considered to be a healthy weight (BMI 18.5–24.9 kg/m2), in people with T1D and gestational diabetes as weight loss in these cohorts improves glycaemic control . Until recently, both Diabetes UK and American Diabetes Association (ADA) issued broad advice for diabetes management in individuals with T2D with the overarching aim to induce weight loss due to the lack of evidence-based dietary guidelines for diabetes management. At present, UK National Institute for Health and Care Excellence (NICE) guidelines promote (which have not been updated since 2009) ‘general healthy eating’ for T2D management, encouraging high fibre, low-glycaemic index sources of carbohydrates and to limit saturated fat intake; the same advice as for the general population . A database search of PubMed, Scopus and Medline for original research articles was performed using combinations of terms ‘very low carbohydrate’, ‘low carbohydrate’ and ‘ketogenic’ until 01 August 2023. In 2003, John Hopkins Hospital developed a Modified Atkins Diet (MOD) that involved a less restrictive dietary treatment. The following stages gradually add carbohydrate-containing foods into the plan. The induction phase begins with restricting carbohydrate intake to 20g a day. Designed by Dr. Robert Atkins, this diet has several phases that you need to follow in a specific order. However, the benefits were more noticeable in the keto group. Obesity is a major risk factor for insulin resistance. A regular eating pattern involves carbohydrate consumption. When scientists developed antiepileptic medication, this diet's popularity waned quickly. This means your body's ability to respond to insulin may get better. Research¹ suggests that it may also improve insulin sensitivity in some people with diabetes. When trying a new diet, you need to know how it affects your condition. If you have type 2 diabetes, you need to be careful about what you eat. Consent was obtained by all participants in this study This is consistent with the effect seen in individual studies and confirmed in the aggregate effect estimate. However, it has been shown that electrolyte loss only occurs during the first period of the ketogenic diet (first week) and is due to natural adaptations to the state of ketosis 19,194,195. Another study indicated that cardiovascular risk may be increased, but only during the first few days of a very low-carbohydrate diet . The results of Meroni et al.’s work suggest that the ketogenic diet, mediated by the induction of moderate oxidative stress, activates the transcription factor Nrf2. In the context of vascular endothelial ageing, there is also a body of evidence demonstrating the beneficial, protective effects of ketone bodies on this process. The authors concluded that ketone bodies reduce myocardial glucose uptake and increase myocardial blood flow. Gormsen et al. further demonstrated that hyperketonemia induced by Na-3-hydroxybutyrate infusion increased myocardial blood flow by up to 75% and heart rate by approximately 25%. Additionally, in a mouse model of cardiac hypertrophy, the ketogenic diet prevented vasodilation. A 2023 publication indicates that increasing evidence supports an adaptive role for ketone metabolism in heart failure to promote normal heart organ function and mitigate disease progression . One study indicated that patients with HFrEF had elevated levels of acetone and, importantly, these were inversely related to heart function. In addition to the presence of higher β-hydroxybutyrate concentrations in patients with heart failure, this was also manifested by increased amounts of acetone (one of the ketone bodies) in the exhaled air of such individuals. This particular population remains significantly underinvestigated, as unlike individuals with T2D, insulin resistance per se is not the root cause of β cell dysfunction in this cohort and it may be argued whether a ketogenic diet would result in clinically significant improvements in insulin sensitivity. There is even greater uncertainty and ambiguity surrounding the suitability of a ketogenic diet as a prescription for individuals living with T1D. Further reports of significant early changes in bone and calcium metabolism amongst adults and children 70, 71 are observed as a result of ketogenic diet. Ketogenic diets might be considered to be a very restrictive dietary pattern, primarily consisting of high fat, moderate protein, and a very low carbohydrate intake . Supporting evidence has shown that exogenous consumption of a ketone ester drink, concomitant with increased blood ketone levels, resulted in greater reductions in ghrelin and appetite compared to a dextrose drink . This review will explore whether a ketogenic diet has a place within clinical practice by reviewing current evidence and controversies. Finally, patients should be encouraged to examine long-term health goals, and to re-introduce some amount of beneficial whole grains, fruits and/or vegetables in exchange for improved cardiovascular health, while receiving positive feedback for eliminating refined CHOs from their diets. Mortality risk was highest at a CHO intake of (Figure 1), especially when CHO was replaced by animal protein, leading the authors to conclude that "low carbohydrate diets should be discouraged."20 Two other recent analyses have shown similar findings.21,22 However, VLCDs that are too high in protein cannot be ketogenic, as several amino acids are glucogenic and suppress ketogenesis.7 Thus, a true KD limits protein intake to ≤1.5 grams per kilogram (kg) of body weight per day (or 105 grams per day for a 70 kg adult). This review will help you understand and recognize VLCDs, determine whether they are truly ketogenic, and identify potential risks or benefits for individual patients. Keto ACV gummies represent a convenient, albeit potentially risky, way to potentially incorporate ACV and keto-related components into one's diet. The claim that keto ACV gummies contribute to weight loss is supported by anecdotal evidence and the purported benefits of their individual components (ACV, MCTs, exogenous ketones). Keto ACV gummies have surged in popularity as a convenient way to incorporate apple cider vinegar (ACV) and purported ketogenic benefits into one's diet. Along those lines, we have noticed that a low carbohydrate diet in obese patients reduces heartburn events. Jane, a GERD patient who happens to be a nutritionist and ketogenic diet advocate, presented to my office for evaluation of GERD related symptoms of several year duration.

• When taking keto weight loss gummies with other medications, it’s essential to exercise caution and consult with a healthcare professional.
• The connection between gummies and diabetes is a complex one, with many individuals with diabetes wondering if they can safely consume these sweet treats.
• These signaling effects of ketone bodies support using NK in a clinical trial with the goal to slow PD disease progression.
• The ketone monoester (KE), (R)‐3‐hydroxybutyl‐(R)‐3‐hydroxybutyrate, is a drink that, after ingestion, is cleaved by gut esterases into equimolar βHB and (R)‐1,3‐butanediol.
• Overall, CBD gummies are a popular and convenient way to incorporate CBD into your daily routine.

Benefits of Combining Keto with Intermittent Fasting

Laboratory investigation showed elevated creatinine of 4.3 meq/L, hypokalemia of 3.3 meq/L, FeNa was 4% and positive urine ketone. She did not have a history of hypertension, diabetes, or kidney disease in the past. She stated she started a new weight loss journey with diet and exercise. It has proved its effectiveness for weight loss in obese individuals and with decreases in hyperlipidemia and cardiovascular risk factors . We present a case of a 36-year-old female who presented with pre-renal azotemia after starting a keto diet regimen. This diet's most common and easily reversible consequences are constipation, low-grade acidosis, hypoglycemia, kidney stones, and increased lipid in the blood. The standard range of ketones in ketosis is up to 3.00mmol/L, and anything beyond this level can result in serious medical conditions. There was a significant decrease in the level of triglycerides, total cholesterol, LDL cholesterol and glucose, and a significant increase in the level of HDL cholesterol in the patients. In this regard, these two recent studies are comparable with the present study. It has also been found that the risk of breast cancer decreases with increases in total fat intake (16). The relation between a high fat diet and cancer is not conclusive. It has been proven, beyond a doubt, that disrupting the oxidant-antioxidant status of the cell will lead to various diseases of the body (57). One argument against the consumption of a high fat diet is that it causes obesity. Thus, the use of ketone bodies by the brain could be a significant evolutionary development that occurred in parallel with brain development in humans. Until recently, ketosis was viewed with apprehension in the medical world; however, current advances in nutritional research have discounted this apprehension and increased public awareness about its favourable effects. The initial blood glucose level and its level at the eighth, 16th and 24th week were 7.26±0.38 mmol/L, 5.86±0.27 mmol/L, 5.56±0.19 mmol/L and 5.62±0.18 mmol/L, respectively (Figure 7). The body weights at the eighth, 16th and 24th week were 91.10±2.76 kg, 89.39±3.4 kg and 86.67±3.70 kg, respectively (Figure 1). Twelve weeks later, an additional 20 g of carbohydrate were added to the meal of the patients to total 40 g to 50 g of carbohydrate. Polyunsaturated and monounsaturated fats were also included in the diet. In addition, weight and height measurements, and blood pressure were monitored at each visit. A new study looked at more than 6.5 million adults younger than 40 and found that those with mental health conditions were three times more likely to have a heart attack or stroke than those who did not. Finally, heterogeneity was evident in our data and was possibly due to differences in control diets and follow-up durations across the 21 studies. Hall et al. suggested that diets high in carbohydrates were prone to generating obesity as they tended to increase insulin production (51). Obesity, diabetes and dyslipidemia are all risk factors for cardiovascular disease (39–41). Such diets are widely reported as being effective for weight loss and glycemic control (12). Therefore, ketone bodies can be eliminated by the body via urine excretion, taking away energy (10). In view of the popular uptake of the keto diet even among subjects not in need of weight loss, there is some preoccupation with the potential long-term consequences of a wide embrace of this diet by large segments of the population. Unfortunately, very few randomized clinical trials involving diets have addressed the combined question of weight loss and cardiovascular outcomes. At times emphasis has been put on a single new aspect that the previous diets had overlooked and the new one was to embrace in order to improve weight loss and well-being. Especially considering that CAD is such a widespread cause of disability and mortality , a well-planned vegan diet combined with appropriate nutritional supplementation might be considered preventative for patients at high CVD risk. Accordingly, this dietary pattern seems to be a feasible and reliable approach to preventing and treating CVD and its risk factors since it minimizes the risk of hypercholesterolemia, hypertension and CAD, type 2 diabetes, and obesity. At this point, it is crucial to indicate some of the characteristics and potential differences between pure veganism and other diets with regard to cardiovascular effects. In aggregate, KD seem to have positive effects in T2D patients and persist in long-term trials, as illustrated in Fig. Many patients experienced an increase in physical activity in connection with an improvement in energy levels. Some participants noted that, compared to other diets tried in the past, adherence to KD was easier, tastier, and overall more enjoyable . The advent of immediate results and additional health benefits (improvements in cognitive abilities, reduction in chronic pain levels, improvements in energy levels and quality of sleep) help in maintaining the motivation to follow KD . Goldstein et al. suggested that the long-term compliance and effectiveness of KD for obese diabetes patients in a Mediterranean environment is low . Goldstein et al. demonstrated a progressive decrease in the adherence rate to meet the carbohydrate restriction target as documented by absent biological ketosis during 12 months of observation . In many studies, the patients were asked to interrupt or decrease all medications before KD, which hampers the interpretation of the results 21, 30. In a study exclusively including patients on metformin, there were no changes in the dose between the study groups . A reduction in the use of glucose-lowering medications subsequent to KD has been observed by several studies. ↘ weight (ppIn the T2D subgroup and compared to LCD, VLCKD diet group↘ TAG (pppp Adherence was monitored with weekly plasma ketones tests In the last decades, KD have become increasingly popular, the most widely known is the Atkins diet , and some very-low-carbohydrate KD are even more restrictive with a carbohydrate intake 7, 8]. Nutrition therapy guidelines often emphasize a reduction in the excessive amounts of carbohydrates, as well as limiting fat intake to be 20–35% of total calorie intake, with a focus on a decrease in saturated fats 4••. Given that, there is evidence of a link between hyperhomocysteinemia arising from a vegan diet and CVD, such as heart attacks and strokes . Although a plant-based diet and especially a vegan diet is believed to be healthy, it can nonetheless result in a higher level of essential amino acids. One study has found that vegans and vegetarians had a higher risk of ischemic stroke than people who ate animal products (HR, 1.54; 95 percent CI, 0.95–2.48) . The authors discovered a decrease in fasting blood glucose and BMI and an improvement in the lipid profile . Various studies, however, have revealed that polyunsaturated fatty acids (PUFAs) activate several anti-inflammatory pathways. The influence on cholesterol metabolism is another important way that a vegan diet might benefit CV health. Because of its low saturated fatty acid (SFAs) and high fiber content, the vegan diet is characterized by low energy intake. Examples of CVDs include CHD, peripheral artery disease, cerebrovascular disease, rheumatic and congenital heart disease, and venous thromboembolism. Schematic illustration of endothelial damage and initiation of the atherosclerotic process with only higher LDL levels as a risk factor. Endothelial dysfunction contributes significantly to the pathogenesis of atherosclerotic cardiovascular disease (ASCVD), which is a chronic inflammatory disease of the arterial wall mediated mostly by phagocytic (eating) leukocytes (white blood cells) such as monocytes and macrophages. CRP levels were 73% higher in women in the highest quintile of trans fat intake than in the lowest quintile . The relationship to CHD risk can only partially be explained by the unfavorable effect of trans fats on the lipid profile.

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The second patient had severe side effects from the medication used, including an increased frequency of suicidal thoughts. In both cases, there was an improvement in mood stability, and the effects were more significant than those achieved through pharmacotherapy. A non-randomized, interventional pilot study confirmed the feasibility and safety of introducing a KD for three months among individuals with BD . Additionally, a reduction of 1 point on the Clinical Global Impressions–Severity Scale is considered a minimal clinically relevant difference; in the study, the average decreased by 2.8 . Clinical observations are the source of reports that changes in dopamine (DA) levels are present in episodes of BD. Scientists have noted during human and animal studies that neurotransmitter imbalances may contribute to the development of BD. This may be linked to reduced intake of carbohydrates (including refined sugars, which directly affect the functionality of intestinal microbiota); this is synonymous with reduced polysaccharides, from which the bacteria derive their energy . Reduced Na+/K+ ATPase activity and increased intracellular sodium levels have been observed among individuals with BD. Changes in ATP levels affect the timing of neurotransmitter release and the transition of neurons to excitatory or inhibitory states, and may contribute to the manic and depressive states in BD . A growing body of evidence supports the idea that mitochondrial dysfunction may be an underlying feature of BD 88,89,90. The number of registered protocols of studies of the KD in MDD is still increasing. The severity of MDD was described as moderate compared to severe when starting the diet, and the patient did not report suicidal thoughts . To include enough subjects to make meaningful conclusions, the Canadian investigators looked for people following a keto-like diet that includes more than 45 percent of daily calories from fat and no more than 25 percent from carbs. Because this process, called ketosis, burns stored fat, it can help people lose weight. The findings, presented at the American College of Cardiology’s Annual Scientific Session, suggest that a keto-style eating plan could lead to increased levels of LDL (low-density lipoprotein) — also known as “bad” cholesterol — which in turn may heighten the likelihood of cardiovascular disease. To summarize, while keto gummies can offer potential benefits and convenience, their safety largely hinges on understanding their ingredients and your personal health needs. Understanding the potential benefits and risks of these keto supplements guarantees you maximize their effectiveness while minimizing any adverse effects. Consulting with a healthcare provider is vital before you try keto gummies, particularly if you have existing health conditions. Steering through the world of keto gummies can be overwhelming, especially when trying to align them with your health goals. A registered dietitian nutritionist can offer tailored guidance on incorporating keto gummies into your diet safely. It’s important to consult with a healthcare provider, especially if you have pre-existing health conditions like diabetes, high blood pressure, or kidney issues. Additionally, understanding the impact of insulin sensitivity on your overall health can inform your decisions regarding keto gummies. Before trying keto gummies, it’s essential to consult with a healthcare provider to understand how they might interact with your specific health conditions or medications. Consulting with a healthcare provider is essential, especially if you have pre-existing conditions like diabetes or high blood pressure. Furthermore, the consumption of these gummies may impact insulin sensitivity, which is crucial for maintaining stable blood sugar levels. Most importantly, if you have pre-existing kidney issues, the risk of serious health conditions, including ketoacidosis, increases without proper monitoring. Some users report improved athletic performance and increased energy levels thanks to the exogenous ketones in certain formulations. Many keto gummies contain medium-chain triglycerides (MCTs), which serve as a quick energy source and support ketone production, helping you maintain ketosis. Many gummies include medium-chain triglycerides (MCTs), which can boost ketone production and enhance energy during ketosis. Additionally, it’s important to combine the consumption of Keto gummies with regular physical activity, portion control, and a well-rounded diet for sustainable weight loss. “Our skeletal muscles are fueled primarily by glucose, which is a form of sugar derived from the carbohydrates we eat. Some have even come to believe that following this diet can aid in preventing or reversing heart failure. Join healthcare leaders for live online sessions and Q&A — delivering evidence-based strategies to guide patients toward lasting longevity. 10 type 2 diabetes risk factors you may not know about. Top 5 antioxidants that can improve your health and how to test your patient’s levels. Integrative nutrition approaches to managing blood sugar levels. What are ketones? Determine your primary reason for using Keto ACV Gummies—whether it’s weight management, ketosis support, digestion, or energy maintenance. BHB also minimizes keto flu symptoms like fatigue and brain fog, making the transition to ketosis smoother. It also enhances metabolism and improves insulin sensitivity, helping stabilize blood sugar levels and prevent energy fluctuations. ACV’s antimicrobial properties and its positive effects on gut health may enhance immune defenses, contributing to overall wellness. This is particularly beneficial for keto dieters who maintain steady energy throughout the day. ACV may help improve insulin sensitivity and stabilize blood sugar levels, potentially reducing energy fluctuations. This supports a smoother transition into a ketogenic state, enhancing energy and metabolic function. If BHB is included, it can further support appetite control by stabilizing blood sugar levels and enhancing energy, making it easier to manage cravings. ACV may enhance insulin sensitivity, which could help stabilize blood sugar levels and reduce energy crashes. Emerging trends, such as the use of new ingredients and improved manufacturing processes, may enhance the benefits and safety of keto ACV gummies for diabetics. Apple cider vinegar has been used for centuries to promote health and wellness, and its potential benefits for diabetes are well-documented. Additionally, some individuals may experience allergic reactions or digestive issues, such as bloating or diarrhea, when taking keto ACV gummies. Studies have demonstrated that the ketogenic diet can lead to significant improvements in metabolic health, including weight loss, improved blood lipid profiles, and enhanced glucose control. The KETO diet is believed to have beneficial effects for weight loss, blood pressure and sugar levels, all of which can pose risk for heart diseases2. The beneficial effects of ketogenic diets for people with type 2 diabetes are attributable primarily to weight loss, with benefits appearing to wane over time (48, 49). In healthy men, a ketogenic diet (83% fat and 2% carbohydrate) reduced insulin's ability to suppress endogenous glucose production (46). A small study of 11 adults with type 1 diabetes reported that a ketogenic diet improved blood glucose control (34). Although ketogenic diets can improve glycemia in pediatric patients with type 1 diabetes, they are generally not used in this population due to the risk of malnutrition, failure to thrive, reduced bone density, hyperlipidemia, poor sleep, amenorrhea, and hypoglycemia. These results also add to evidence suggesting that the rapid initial weight loss observed on ketogenic diets is due predominantly to loss of fat-free mass (e.g., body water, glycogen, protein, and contents of the gastrointestinal tract) (27). In a 2016 metabolic ward study by Hall et al., 17 overweight or obese men were provided a baseline diet (50% carbohydrate, 35% fat, and 15% protein, as a percent of energy) for 4 weeks, then a ketogenic diet (5% carbohydrate, 80% fat, 15% protein) for 4 weeks. Numerous studies suggest that ketogenic diets are more effective in glycemic control, weight loss and decreasing hypertension than low fat diets 12–14. The apple cider vinegar in keto ACV gummies may help regulate blood sugar levels and improve insulin sensitivity, while the ketogenic diet provides a comprehensive approach to managing type 2 diabetes. In fact, the bulk of research indicates that the ketogenic diet may be slightly more effective than other common weight loss diets in helping you lose weight and shed body fat. The side effects of drugs commonly used for the reduction of body weight in such patients were not observed in patients who were on the ketogenic diet. Decreased levels of blood glucose (expressed as mean ± SEM) in obese patients at eight, 16 and 24 weeks during the administration of a ketogenic diet Although various short-term studies examining the effect of a ketogenic diet in reducing the weight of obese patients have been carried out (10), its long-term effects in obese subjects are not known (15). In contrast, our laboratory has recently shown that a ketogenic diet modified the risk factors for heart disease in obese patients (12). Although various studies have examined the short-term effects of a ketogenic diet in reducing weight in obese patients, its long-term effects on various physical and biochemical parameters are not known. According to the researchers, ketones may also have positive effects on common cardiovascular risk factors, including blood pressure, body weight, blood glucose or blood sugar, and cholesterol, though research is ongoing. This also confirms the beneficial effect of the ketogenic diet on blood pressure values and other indirect CVD risk factors, i.e., reduction in excess body weight. A meta-analysis by Bueno et al. showed that the ketogenic diet may be a more effective option for long-term weight loss (and improvements in some CVD risk factors), compared to low-fat diets . The beneficial above-mentioned effects of ketogenic diets on the values of inflammatory markers and CVD risk factors may also be due to the reduction of the total carbohydrate pool, not simply the elimination of simple sugars. A cuboid shape of gummies (2 cm length × 2 cm width × 1.5 cm height) was applied for test. Participants consumed reference food (glucose solution) twice and each tested food (the three types of gummy candies) once. CG, P-SG, and T-SG with 250 mL of water and glucose solution (10 g of glucose dissolved in 250 mL of water) were consumed within 5 min. Fasting glucose tests were performed twice with a 5 min interval. The authors applied for human ethics approbation to the Chinese Ethics Committee of Registering Clinical Trials for this study. Informed consent was obtained from all the participants before the start of the study. The three types of gummy candies used in the present study are all low-GL foods, which contribute to a reduced postprandial glycemic response when taken within the recommended dosage. Lean body mass in males is usually heavier than in females, and the skeletal muscle is the most important organ of energy metabolism. Therefore, in the future, more participants need to be recruited for the trials to verify the conclusions of this study. Although this study achieved some meaningful and important results, only 17 participants were selected for the trials. As a result, the gummy dosage form with its chewable characteristics is more likely to become a candy dosage form suitable for people with glucose metabolism disorders. Additionally, digested total available carbohydrate was lower in gummy form. Consistent with hypothesis, the in vitro digestion result showed that, in the oral phase, glucose release rate was slower in gummy form than in powder form. Chewing also enhances the secretion of GLP-1, a protein known to enhance glucose-stimulated insulin secretion . Previous studies have shown that more chewing increases the flow rate of saliva, which is positively correlated with the activity of salivary amylase-alpha. Nevertheless, the results delineated that there was no statistically significant difference in terms of glucose tolerance between men and women after ingesting P-SG and T-SG. The aforementioned findings are consistent with this study’s results. Additionally, sex hormones also play a vital role in maintaining glucose homeostasis. In the present study, we proved that the texture properties of P-SG and T-SG, as well as their limited digestive hydrolysis, contribute to the low GI value. Further studies elucidating the molecular mechanisms of a ketogenic diet are in progress in our laboratory. This is a unique study monitoring the effect of a ketogenic diet for 24 weeks. Further studies on the role of a ketogenic diet in antineoplastic therapy are in progress in our laboratory. However, it has been shown that short-term ketogenic diets improve the lipid disorders that are characteristic of atherogenic dyslipidemia (56). In other studies (38–46), it was shown that the risk of dietary glycemic load from refined carbohydrates was independent of other known risk factors for coronary diseases. These studies provide evidence to explain the actions of a ketogenic diet in the brain. In another study (30), it was shown that a ketogenic diet induced gene expression in the brain. Changes in the level of creatinine in obese patients during a 24-week ketogenic diet. Changes in the level of urea in obese patients during a 24-week ketogenic diet. Changes in the level of triglycerides in obese patients during treatment with a ketogenic diet over a period of 24 weeks. Changes in the level of low density lipoprotein (LDL) cholesterol during treatment with a ketogenic diet in obese patients at eight, 16 and 24 weeks. Changes in the level of high density lipoprotein (HDL) cholesterol in obese patients during treatment with a ketogenic diet for a period of 24 weeks. All 83 subjects received the ketogenic diet consisting of 20 g to 30 g of carbohydrate in the form of green vegetables and salad, and 80 g to 100 g of protein in the form of meat, fish, fowl, eggs, shellfish and cheese. It is generally believed that high fat diets may lead to the development of obesity and several other diseases such as coronary artery disease, diabetes and cancer. Thus, a ketogenic diet is a good regulator of the body’s calorie intake and mimics the effect of starvation in the body. A ketogenic diet maintains the body in a state of ketosis, which is characterized by an elevation of D-b-hydroxybutyrate and acetoacetate. Therefore, the present study confirms that it is safe to use a ketogenic diet for a longer period of time than previously demonstrated. 1 long-term study found mean cholesterol of subjects after 6 years on the diet was only slightly high at 201 mg/dL. Blood lipid levels were collected before and after 3 months of KD treatment in a study published in 2019 . It is important to distinguish if a study examining the MCTKD is using the classic (60% MCT) or modified (30% MCT) when assessing side effects. The frequency and severity of adverse effects from the different KDTs appear to increase with the restrictiveness of the diet. In a systematic review of cKD and MCTKD prospective studies, more than 40 categories of adverse effects were identified with gastrointestinal, cardiovascular, renal/genitourinary and skeletal being the most common . GI is calculated from the incremental area under the blood glucose curve after feeding, indexed to ingested glucose which equals 100. Authors reported that over-all efficacy of the 2 diets was comparable except for in subjects aged 1 to 2 years-old. Unfortunately, even with an increased allowance of carbohydrates, families found the diet very restrictive and had difficulty finding recipes suitable for the children. This diet is beneficial for patients who have difficulty tolerating the restrictiveness of the cKD or those with a history of response to cKD but inability to maintain due to restrictiveness. In the traditional MCTKD, MCTs provide 60% of the diet’s energy which can lead to adverse gastrointestinal effects such as vomiting, diarrhea and abdominal pain . However, those who were overweight at diet onset tended to show a mild increase in the z score short term but those remaining on the diet showed a decrease in the z score over the longer term.

Other Functional Ingredients

However, the observed greater benefits in the CPAP + LCKD group may have resulted from the much greater weight loss (on average from 143.6 ± 23.6 kg to 129.7 ± 23.7 kg vs. from an average of 132.7 ± 23 kg to 131.6 ± 22.3 kg in the CPAP group). Another publication showed that the ratio of apolipoprotein B (Apo B) to apolipoprotein AI (Apo A-I) was a much better predictor in assessing cardiovascular risk. A 2023 publication showed that residual cholesterol is an independent (and possibly earlier than LDL) risk factor for atherosclerosis . A 10-year-long cohort study from 2021 showed that there was a significant, linear association of triglyceride concentrations with ischemic stroke. Publications show that it is inversely correlated with CVD mortality , although both too low and too high concentrations of it may be unfavorable, according to some studies 34,35. A 2023 publication showed that the effect of the LDL cholesterol concentration on the risk of sudden cardiac arrest (SCA) followed a “U” shape, i.e., the highest risk occurred at the lowest and highest LDL concentrations . Low-density lipoprotein (LDL) is considered the so-called “bad cholesterol” and an even more significant risk factor than TC 27,28,29. The authors of another publication raised the issue of serious methodological errors (including ignoring contradictory information or using misleading statistics) in studies suggesting higher TC and LDL concentrations as a major cause of CVD . The lowest mortality from cardiovascular diseases was presented in the range of approximately 190–225 mg/dL . However, there are large discrepancies between the results of different studies due to the different methodological selections. The blood lipid profile is most commonly studied in the form of four parameters, i.e., total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG). It is in itself an important element in the prevention and treatment of CVD and, on the other hand, influences indirect risk factors 12,13. Although some risk factors are not firmly established in the scientific evidence, they are still considered to be among the main ones. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available. Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD prevention and therapy. The most common and increasing causes of death worldwide are cardiovascular diseases (CVD). It will be important to determine in future trials whether the improvement in kidney function translates to a sustained long-term reduction, or even reversal, in the progression of kidney disease. Furthermore, in a subgroup analysis of 22 trial participants with an eGFR 2 at baseline who remained in the study for 2 years,72 the mean eGFR progressively increased from 51 mL/min/1.73 m2 to 60, 63, and 68 mL/min/1.73 m2 at 10 weeks, 1 year, and 2 years (unpublished data).

What are the dangers of the keto diet?

In another study, the authors also examined the effect of a carbohydrate-restricted diet on markers of cardiovascular disease for 12 weeks. Forsythe et al., in a randomized controlled trial, compared the effects of a low-carbohydrate diet and a low-fat diet for 12 weeks on markers of inflammation and circulating fatty acid composition. With the above in mind, it can be concluded that this is another factor by which the ketogenic diet has an anti-inflammatory effect, as it eliminates pro-inflammatory simple sugars. The beneficial effect of the ketogenic diet on glycated hemoglobin, triglycerides and HDL cholesterol values was also described in another meta-analysis from 2022 . Another meta-analysis in 2022 showed the effect of the ketogenic diet in lowering HbA1c (by an average of 0.38% HbA1c) and triglycerides (by an average of 0.36 mmol/L) and increasing HDL cholesterol (by an average of 0.28 mmol/L) . Another meta-analysis from 2022 also showed a remarkable benefit of the ketogenic diet in lowering HbA1c. However, the ketogenic diet has been shown to have HbA1c-lowering properties, through which it can also benefit CVD prevention and therapy. The ketogenic diet, however, marginalizes all forms of simple sugars (as they can “kicked out” from the ketosis state particularly easily) to a much greater extent than other nutrition models (which, according to the guidelines, allow, e.g., 5% free sugars in the diet) . In view of this, the body uses ketone bodies, not glucose, as the main energy source for vital processes . Four main factors influencing the anti-inflammatory, cardioprotective potential of the ketogenic diet. There are many potential mechanisms through which the ketogenic diet demonstrates its anti-inflammatory potential. The results of another meta-analysis in 2022 indicated that the ketogenic diet, even over 12 months, was more effective (compared to the control group) in lowering triglycerides and increasing HDL fraction cholesterol . It was shown that the ketogenic diet increased HDL fraction cholesterol concentrations to some extent and lowered triglyceride concentrations. The authors of another RCT also studied the effect of a ketogenic diet in obese children and adolescents. Our body, being a marvel, will always find a way to adapt. The key concept of this diet is to drastically reduce the intake of carbs. Heart disease is a leading cause of death globally. The limited published literature reports an association with weight loss and improved glycemic control and may, over the long-term, lead to reduced macrovascular and microvascular harm. He writes books and articles and gives lectures related to nutrition and health and has received royalties and honoraria from these sources. Longer-term effects can include decreased bone mineral density, nephrolithiasis, cardiomyopathy, anemia, and neuropathy of the optic nerve (82, 121). In the above study, there was no effect measure modification by folic acid supplement use (115). High protein consumption facilitates hyperfiltration, a phenomenon of increased blood flow to the glomerulus, which is thought to lead to long-term damage in those with CKD (112). Other observational studies of animal protein have shown similar findings (109, 110). In the Foster study, the standard deviation for the change in LDL-C was 20.4%, indicating that while LDL-C decreased for some, for many participants, LDL-C rose dramatically (22). In the 2002 study cited above, while the mean LDL-C increase was 18 mg/dL, one participant's LDL-C concentration increased from 123 to 225 mg/dL (91). For comparison, LDL-C dropped by 11.1% during this same time period in participants following a conventional low-calorie diet. It has long been established that weight loss by any means causes a reduction in total cholesterol of about 2 mg/dL per kilogram lost (90). Whether cognitive gains would be maintained upon discontinuation of the diet/supplement remains unknown due to lack of long-term follow-up (85). By 2050, it is projected that 13.8 million people in the U.S. will have Alzheimer's disease (AD) (80). Studies were excluded if performed with children or adolescents, individuals with type 1 diabetes, and pregnant women, or if the diet was not ketogenic. Despite these potentially positive effects, concerns have been raised about long-term adverse effects, particularly lipid metabolism and fatty liver disease, because of the high fat intake; yet recent studies did not corroborate these concerns 15, 16. Of note, the utilization of ketone bodies has shown protective cardiovascular effects in non-diabetic individuals , findings that need to be confirmed in individuals with diabetes mellitus. Certain diets propose to reduce the carbohydrate intake even more drastically, in combination with a higher intake of fats, which become the most important source of calories. The burdensome nature of this diet, coupled with a growing interest to expand its indications, prompted the development of a modified ketogenic diet – otherwise known as the modified Atkins diet – which did not require hospitalization, did not require the weighing of food, and provided no fluid or calorie restrictions. A healthy, balanced diet will help prevent high blood pressure, high blood sugar, excess weight gain and promote overall wellness and health. Another risk is nutrient imbalance—restricting carbohydrates means some heart-healthy foods like whole grains and certain fruits are limited, which can reduce fiber and antioxidant intake. In some clinical trials, participants on keto diets showed favorable changes in LDL particle size, shifting from small, dense particles (which increase risk) to larger, less harmful forms. Initially developed to treat epilepsy, the keto diet has gained popularity for weight loss and metabolic health benefits. They appreciate the ability to satisfy their sweet cravings while staying within their ketogenic dietary guidelines. Consulting a healthcare professional or registered dietitian is advised to ensure the safety of incorporating keto gummies into one’s diet. In addition to the sweeteners, keto gummies are often enriched with healthy fats, such as coconut oil or MCT oil. These alternatives serve as low-carbohydrate options that mimic the taste of sugar without causing a spike in blood glucose levels. Collectively, the opinions of experts highlight the potential of keto diet pills as a supplementary tool for weight loss, particularly when combined with a holistic approach to health. This includes continued adherence to a balanced ketogenic diet and incorporating exercise routines that align with individual preferences and capabilities. The selection criteria for participants prioritize individuals who are committed to following a ketogenic diet, which aligns with the metabolic principles supported by the pills. The most extreme of these, the very-low-CHO-diet/ketogenic diet (VLCD/KD), has been reported to induce weight loss without hunger and, in those with pre-diabetes or T2DM, to markedly improve blood glucose and triglyceride (TG) levels. To assess the pleiotropic effects of ketogenic diets (KD) on glucose control, changes in medication, and weight loss in individuals with type 2 diabetes, and to evaluate its practical feasibility High-fat keto diets encourage inflammation and LDL cholesterol levels to rise in the body, which are both key factors in regulating heart health and disease. The ketogenic diet is a high-fat, moderate-protein, low-carbohydrate diet that can induce weight loss and improvement in glycemic control, but poses a risk of inducing hyperlipidemia, elevation of liver enzymes and onset of fatty liver disease. For example, Woolf et al., in an animal study of 21 mice models of glioma, demonstrated that the administration of a high-fat, low-carbohydrate, adequate protein ketogenic diet led to a significant reduction in blood glucose, both 7- and 14-days post-implantation . Very-low-carbohydrate ketogenic diets have been long been used to reduce seizure frequency and more recently have been promoted for a variety of health conditions, including obesity, diabetes, and liver disease. Because ketogenic diets can significantly change how your body processes drugs, it may be necessary to adjust medication doses to prevent side effects such as low blood sugar levels or low blood pressure. According to a study published in Nutrients, ketogenic diets often lower blood pressure naturally due to weight loss, improved cardiovascular health, and less water retention.2 There is a considerable body of research suggesting that a very low carbohydrate ketogenic diet is safe in individuals with moderately diminished kidney function, even in studies that had higher protein intake than what is recommended for kidney disease and diets that are not plant-based. A recent review discussing the potential negative effect of purported ketogenic diets on kidney health focused on observational studies that compared low protein versus high protein diets that were not ketogenic or low carbohydrate diets,126 and raised concern about the association of albuminuria with high animal fat but only referred to observational studies that assessed high animal fat intake in the context of a Western diet126 negating the relevance of the studies cited for concern. Low carbohydrate and ketogenic diet studies often report a reduction in systolic and diastolic blood pressure71 72 and blood pressure medication requirements.73 However, the current recommendation of sodium intake in a WFKD is based on individuals with normal kidney function.74 Recommendations for sodium and electrolyte intake for patients with CKD following a ketogenic diet should be individualized by a healthcare professional based on the patient’s renal function and electrolyte status. Nutritional ketosis typically results in blood ketone levels ranging from 0.5 to 3.0 mmol/L, achieved through dietary modifications such as ketogenic diets or intermittent fasting. Moreover, the ketogenic diet enhances endothelial function and helps prevent vascular aging, and it has favorable effects on blood pressure and other CVD risk factors, partly due to weight reduction . When undergoing ketogenic diets, starvation, or ketoacidosis, the blood concentration of β-HB increases, which activates GPR190A to reduce lipolysis in adipose tissue, thereby decreasing the entry of nonesterified fatty acids into the liver for ketone synthesis and forming a negative feedback mechanism (Ahmed et al., 2009). Metabolic and Non-Metabolic Effects of Ketone Bodies In addition to energy supplement as alternative substrates, ketone bodies (1–3 mmol/L β-HB) may have beneficial effects on oxidative stress, mitochondrial function, endothelial function, inflammation, cardiac remodeling and other indirect systemic effects, such as body weight, blood pressure, serum glucose and lipids levels. Due to the unpredictable response of LDL-C levels to a ketogenic diet, close monitoring of patients with a high risk of cardiovascular disease should be considered. Previous studies reported a beneficial effect with a short-term ketogenic diet, as well as a long-term ketogenic diet for reducing body weight and body mass index in patients . The study compared the effects of very low carbohydrates ketogenic diet (VLCKD) versus the low-calorie diet in type two diabetes mellitus. This review aims to present the effect of plant-based diets (PBDs), specifically vegan diets, on the cardiovascular system. Reduced intake of low-density lipoprotein (LDL), saturated fat, processed meat, and greater consumption of fiber and phytonutrients may improve cardiovascular health. This dietary approach may be beneficial to one’s health and the environment and is valuable to the immune system. However, it is essential to approach these reviews with caution, as individual results may vary and keto gummies may not be suitable for everyone. It is essential to consult with a healthcare professional before starting any new supplement or diet, particularly if you have a pre-existing medical condition. Keto gummies can also be expensive and may not be covered by insurance, which can be a significant burden for individuals with diabetes. It is crucial to consult with a healthcare professional before starting any new supplement or diet, particularly if you have a pre-existing medical condition. By reducing carbohydrate intake and increasing fat consumption, individuals can improve their glycemic control and reduce their medication needs. Finally, the Biolyfe Keto Gummies are an excellent way to promote fat loss while also increasing your body’s vitality. Apple-flavoured candies are effective keto weight loss remedies. They help you lose weight because they are low in carbs and high in good fats. It increases your body’s ability to burn calories and generate energy, which aids in weight loss. This means that these gummies can help you lose weight while also increasing your metabolism. BioLyfe Keto Gummies chews are weight loss pills that have distinct health benefits. These chews are incredible and aid in fat loss in a healthy and safe manner. Unlike some weight-loss products, Biolyfe Keto Gummies chews have a positive effect on your body. For instance, a dirty Keto diet would be short on potassium (from vegetables) to counter the high sodium load from salty processed meat. In general, the data suggests that Keto may help lower blood pressure. In other words, the average blood pressure went from “elevated” to “normal.” Many studies suggest Keto may help with treating or preventing hypertension. When an obese person loses weight, other metabolic markers tend to improve too. When someone is obese, they tend to have higher levels of chronic inflammation (chronic inflammation refers to unnecessary, damaging immune activity). But even if the mechanisms aren’t entirely clear, hypertension risk factors still exist. Taken together—as in, 120/80—these two numbers indicate a person’s blood pressure status. It’s the pressure of your blood against your blood vessel walls. Most people understand what blood pressure refers to. Before we talk more about Keto and high blood pressure, let’s cover some basics. This doesn’t mean that Keto can improve all instances of high blood pressure. Is Keto good for high blood pressure? Given the intrinsic characteristics of the diet and the common concomitance of different lifestyle interventions in the same subject, the relationship between KD and exercise performance need to be well ascertained. The authors also reported a global benefit on cardiovascular health, including amelioration of lipid-related indicators with an unexpected increase in high-density lipoprotein (HDL) cholesterol . In 2012, a meta-analysis performed on 17 controlled trials involving 1141 obese patients , showed an overall effect of LCDs on BP estimated at −4.81 mm Hg (95% CI −5.33/−4.29) for systolic BP and −3.10 mm Hg (95% CI −3.45/−2.74) for diastolic BP. Different meta-analyses during recent decades have tried to provide some indications to patients. For all these reasons and because of the limited sample size that is common to almost all available studies, the data are not univocal (see Table 1). The few studies available have often been carried out on very select categories of subjects, such as the morbidly obese. Resistance Training is based primarily on short-term, high intensity bouts of exercises often involving weights. Even though it was once considered risky to be vegan throughout infancy, childhood, pregnancy, and lactation, it is now established that well-planned vegan diets may provide appropriate and balanced nutrition. A whole-food plant-based diet (WFPBD) is another sort of vegan diet that has demonstrated substantial advancements in cardiovascular health, diabetes, and cancer types . Experts in the field of diabetes and nutrition have varying opinions on the effectiveness and safety of keto gummies for diabetes management. Additionally, keto gummies may not be suitable for everyone, particularly individuals with certain medical conditions, such as kidney disease or osteoporosis. These gummies promote weight loss, reduce or eliminate emotional eating, and increase metabolism, resulting in more effective fat removal. Green tea extract, raspberry keto extract, apple cider vinegar, and other weight loss supplements have immediate and rapid weight loss effects. This new product will make your life easier while also assisting you in losing body fat and living a healthy lifestyle. Furthermore, it allows you to instantly build lean and fat-free muscles while preventing your body from gaining weight and fatty deposits. It replenishes energy levels by using fat cells instead of glucose. BioLyfe Keto Gummies contain ingredients and compounds that help the body enter the ketogenic state. A diet high in processed carbohydrates and refined sugars leads to arterial inflammation over time, which can cause an elevation in your blood pressure. Keto can be an effective weight loss diet, especially in obese people and people with diabetes. That includes inflammation, cholesterol levels, triglycerides, blood glucose, insulin function, and—relevant here—blood pressure. This pressure is influenced by the pumping action of your heart, the volume of your blood, electrolyte levels, your nervous system, and other factors.

WHAT IS THE SCIENTIFIC RESEARCH AND CLINICAL EXPERIENCE WITH KMT IN CKD?

The processes occurring during the state of ketosis exert a systemic anti-inflammatory effect, which in turn has a direct bearing on cardiovascular diseases. An indispensable element in the development of cardiovascular diseases is the involvement of inflammation, as demonstrated in a number of studies 65,66,67,68,69,70. On the other hand, however, even when it is increased in other studies, the correlation of LDL with cardiovascular diseases does not necessarily imply causality. This is all the more optimistic given that studies suggesting the cholesterol hypothesis in the context of cardiovascular risk do not meet the Bradford Hill criteria for causality . Recent publications confirm that there is no direct relationship between dietary cholesterol intake and serum cholesterol levels . The efficacy and safety of VLCKD in overweight and obese patients was also evaluated by Castellana et al. The author argues that although many studies show an association between LDL-C and cardiovascular diseases, this is not conclusive of a causal relationship . In addition, it could also have been influenced by the composition of the diet itself, in which there was a significant share of unsaturated fatty acids from olive oil, avocado and fish. In comparison, the body weights of participants using SDD did not change (from an average of 77.95 ± 14.76 kg to 77.34 ± 13.28 kg). It is important that despite the assumption of the same calorie consumption in both groups (1500 ± 50 kcal), the body weights of participants using KD decreased on average from 78.32 ± 15.27 to 70.26 ± 14.79 over 12 weeks. As is well known, there is a great deal of controversy about the impact of the amount and type of fat and cholesterol consumed on the blood lipid profile. A report from the Rotterdam study49 indicated that consumption of the bioflavonoids quercetin, kaempferol and myricetin may account for the reduction of myocardial infarction observed with black tea consumption. Green tea lowers blood pressure and LDL cholesterol,47 and improves endothelial function.48 However, there are differences between green tea and black tea. Both green tea and other forms of tea reduce cardiovascular risk. The role of regular consumption of tea or coffee on cardiovascular risk has not been tested in randomised controlled trials. This means that persons with renal impairment, including most elderly patients, should avoid red meat and egg yolk. Other uraemic toxins that have high plasma levels in renal failure are thiocyanate, asymmetric dimethylarginine and homocysteine. Besides TMAO, there are other toxic metabolites produced by the intestinal bacteria from amino acids, including P-cresyl sulfate, hippuric acid, indoxyl sulfate, P-cresyl glucuronide, phenyl acetyl glutamine and phenyl sulfate. TMAO causes atherosclerosis in animal models and markedly increases the risk of stroke, myocardial infarction and cardiovascular mortality, particularly in persons with renal impairment. Patients at risk of stroke should avoid red meat and egg yolk. In 2016, when the new US dietary guideline was released, there were headlines trumpeting ‘It’s OK to eat cholesterol again; the new guideline says so’. Prevalence (unadjusted) estimates for poor, intermediate and ideal cardiovascular health for each of the seven metrics of cardiovascular health in the American Heart Association 2020 goals, US children aged 12–19 years, National Health and Nutrition Examination Survey (NHANES) 2011–2012. Diet is not about the fasting state; it is about the postprandial state.23 24 For ~4 hours after a high-fat/high-cholesterol meal, there is marked oxidative stress, endothelial dysfunction and arterial inflammation.25 Both versions of the Mediterranean diet significantly reduced cardiovascular events; the nut-fortified version reduced stroke by 47% in 5 years. The diet with the best evidence for stroke prevention is the Mediterranean diet from Crete. Recent dietary guidelines tend to recommend a dietary pattern, rather than specifying limits to intake of particular foods or nutrients. Myocardial infarction increased much more steeply than stroke, probably in large part because of changes in diet in China over time with increased prosperity. Undoubtedly strokes due to large artery disease in China will have increased in proportion during that time, the opposite of what was seen in a Canadian stroke clinic population between 2002 and 2012.9 Dietary changes, although difficult to implement, represent an important opportunity to prevent stroke and have the potential to reverse the trend of increased cardiovascular risk in China. The strongest evidence for dietary prevention of stroke and myocardial infarction is with the Mediterranean diet from Crete, a nearly vegetarian diet that is high in beneficial oils, whole grains, fruits, vegetables and legumes. Therefore, twenty‐one participants (14 males and 7 females), aged 45.1 ± 10.8 years, completed the study. Another participant completed 5 weeks of the study but was excluded from the analysis because she was prescribed glucocorticoids during her last week of the intervention. Target glucose range was 3.9–10 mmol/L (70–180 mg/dl), and time in range was obtained from the Abbot's Libre View® interface. Tolerability was assessed with self‐recorded open adverse effects diaries following each of the KE drinks. If an enrolled participant were prescribed a change in their glycaemic treatment during the study, their participation was discontinued, and they were excluded from the analysis. Participants had no documented changes in other hypoglycaemic medications for the 6 months prior to the study. Recruited were 21 patients with T2D aged 18–70 years (inclusive) who had no past or present use of insulin to control glycaemia. This study was conducted in accordance with the guidelines set forth by the International Conference on Harmonization Guidelines for Good Clinical Practice, and the Declaration of Helsinki regarding the treatment of human subjects in a research study. Thus, the KE could help generate insights into disease mechanisms and thereby provide an avenue for developing targeted therapies. First, it provides enantiomerically pure d‐βHB, which is important because the body primarily uses the d form of βHB and not the l enantiomer. Compared to baseline, exogenous ketosis induced a significant decrease in all glycaemic control markers, including fructosamine (335 ± 60 μmol/L to 290 ± 49 μmol/L, p p p p Serum electrolyte concentrations, acid‐base status, and renal function remained normal throughout the study. Serum electrolytes, acid‐base status, and βHB concentrations were measured weekly and cardiovascular risk markers were measured before and after the intervention. An unhealthy diet can alter the structure and function of the gut microbiota and has been linked to increased gut permeability 39,40,41 and epigenetic modifications in the immune system , which can lead to low-grade endotoxemia and systemic chronic inflammation (SCI) of the vessel walls 39,40,41. The standard diet that has become widely embraced in many countries over the past 40 years is rather unhealthy, containing relatively high amounts of alcohol and processed foods , especially those with additives , and only a few fruits and vegetables and other meals rich in fiber and prebiotics 37,38. For instance, in a vegan diet, long-chain ω-3 fatty acids, which are critical for retina, brain, and cell membrane function, can only be consumed as a-linolenic acid (ALA), and it is therefore recommended that vegans take an algae-based DHA dietary supplement in addition to regular dietary intake of ALA sources . Vegan diets are beneficial in terms of fiber, beta-carotene, vitamin C and K, folic acid, magnesium, and potassium consumption, making them high-quality diets . Vegan diets meet protein requirements through nuts, grains, seeds, legumes, green leafy vegetables, pseudo cereals (buckwheat, quinoa), soy, and other derivative products . Vegan diets should be properly designed and should be able to offer appropriate nourishment throughout life 20,21. The effect of a vegan diet on the cardiovascular system is also compared to other diets. For instance, some studies, although not all 15,16, show that vegans may have poorer bone mineral density and a greater fracture risk due to reduced calcium intake. The nutritional sufficiency and quality of plant-based and vegetarian diets should be evaluated individually, not based on how they are labeled, but on the type, amount, and diversity of nutrients ingested . Randomized experiments have indicated that vegetarian and especially vegan diets have a positive influence on a variety of cardiovascular (CV) events . Veganism seems to be the most stringent of all the plant-based diets since it excludes all animal-related substances . There are also pescatarians, or people who eat plant-based diets that include dairy and fish 1,2. Plant-based diets, which include semi-vegetarian and vegetarian diets, emphasize cereals, fruits, vegetables, legumes, and nuts while limiting animal-based foods such as meat, dairy products, and eggs. Additionally, if you have a history of heart disease, high blood pressure, or liver damage, you may need to be cautious when taking keto weight loss gummies. Keto weight loss gummies typically contain a combination of natural ingredients that help support a ketogenic diet and promote weight loss. They can help increase fat burning and energy levels, making it easier to stick to a ketogenic diet. Search terms included the keywords “Diabetes Mellitus” OR “diabetes” AND “Diet, Ketogenic” OR “ketogenic diet” OR “keto diet” OR “ketogenous diet” OR “ketotic diet” OR “very low carb diet” OR “very low carbohydrate diet”. Potential pathophysiological mechanisms and metabolic effects of ketogenic diet in subjects with type 2 diabetes indicated by clinical trials 19–21 and 22–31. Although older patients appear to have gleaned benefits from a ketogenic diet, this study was not intended to generate recommendations to prescribe or to not prescribe such a diet for medical purposes. In summary, this study demonstrates that some older patients are capable of initiating and maintaining a ketogenic diet. In future prospective studies, investigators should consider providing specific information about the type of ketogenic diet prescribed or the type of diet patients had chosen to adopt and how well that diet was adhered to, acknowledging that more recent renditions of the ketogenic diet have vastly improved patient adherence. We do not know how these diets were taught to patients, whether the diet had been formally prescribed, or whether patients had relied on other sources of information to learn how to adhere to a ketogenic diet. Despite such potential selection bias, the findings from this study nonetheless make clear that some older patients are clearly capable of safely adopting and maintaining a ketogenic diet. Although future clinical trials with ketogenic diets will most assuredly incorporate close monitoring, one might conclude that a ketogenic diet appears reasonably well tolerated in older patients. Before starting this dietary pattern, they should consult a health care provider. “Our findings suggest that people who are considering going on an LCHF diet should be aware that doing so could lead to an increase in their levels of LDL cholesterol. In all, 9.8% of participants on an LCHF diet experienced a new cardiac event, compared with 4.3% of those on a standard diet, a doubling of risk for those on an LCHF diet. Compared with participants on a standard diet, those on an LCHF diet had significantly higher levels of both LDL cholesterol and apolipoprotein B (apoB), the protein component that sits on LDL and other atherogenic lipoprotein particles. Those on an LCHF diet had an average body mass index (BMI) of 27.7; those on a standard diet, 26.7. The researchers identified 305 participants whose questionnaire responses indicated that their diet during the 24-hour reporting period met the study’s definition of an LCHF. “To our knowledge, our study is one of the first to examine the association between this type of dietary pattern and cardiovascular outcomes.” There are many common myths and misconceptions surrounding gummies and diabetes, such as the idea that CBD gummies are a cure-all for diabetes. However, some studies suggest that recreational cannabis use may have a negative impact on blood sugar control. The potential effects of recreational cannabis use on glycemic outcomes in individuals with diabetes are not well understood. Some have found that sugar-free gummies have helped to satisfy their sweet cravings without compromising blood sugar control, while others have reported that CBD gummies have helped to reduce inflammation and improve insulin sensitivity. In comparison to omnivorous diets, which are often lower in such products, the vegan diet has been favorably connected with changes in cardiovascular disease (CVD) risk markers such as reduced body mass index (BMI) values, total serum cholesterol, serum glucose, inflammation, and blood pressure. Studies have shown that the ketogenic diet can have a significant impact on blood sugar levels and insulin sensitivity, particularly in individuals with type 2 diabetes. However, it is essential to approach the ketogenic diet with caution, as it can also have potential risks and side effects, particularly for individuals with type 1 diabetes. The relationship between keto gummies and diabetes is complex and multifaceted, requiring a thorough understanding of the ketogenic diet and its effects on diabetes management. Undoubtedly, the improvement in blood pressure values obtained through the diet is largely mediated by the reduction in body weight, fat mass, and by the indirect effects resulting from the improved control of cardiovascular risk factors 52,76; it can therefore be deduced that the greater the ability of a diet to reduce body weight, reduce fat mass, and improve the cardiovascular risk profile of an individual, the greater the potential of the diet to ensure more effective control of blood pressure values. Since essential hypertension is estimated to affect about 40% of the population globally , it is an independent risk factor for heart disease, stroke, and chronic kidney disease and is a main feature of the metabolic syndrome (MS), along with obesity, diabetes, and dyslipidemia, understanding the effects of a specific diet on blood pressure values is extremely important in clinical terms . In this scenario, a ketogenic diet could putatively sustain aerobic pathways by stimulating fat usage and ketone body production, nevertheless no data to date shows significant improvements in exercise performance in subjects following the KD. Notably, ketone bodies, whose production is triggered by the adoption of ketogenic diet, seems to have an increased efficiency in generating metabolic energy compared with glucose and fatty acids . Compared to ketogenic diets, ketone infusions have fewer drawbacks, are more controllable, and can rapidly elevate ketone levels. Numerous studies have shown that ketogenic diets can reshape the gut microbiota in humans and rodents; this ketogenic microbiota is essential for the efficacy of therapeutic ketones (Olson et al., 2018; Spinelli and Blackford, 2018; Hampton, 2018). For patients with type 2 diabetes, it is likely that any weight loss achieved with the ketogenic diet could lower A1c and help reduce the medication burden. A common concern physicians have with the ketogenic diet is its effect on blood lipids and lipoproteins, and more broadly, its effect on cardiovascular disease risk factors. For example, in a review of thermodynamic principles of weight loss, Feinman and Fine explain that low-carbohydrate diets have decreased insulin fluxes causing an increased rate of lipolysis.8 In other words, insulin inhibits lipolysis, and decreased insulin in low-carb diets causes increased fat breakdown.8 This theory is demonstrated in a study that follows 15 subjects for 12 weeks. The article cites several studies that have shown the potential benefits of CBD for heart health, including a study published in the Journal of Cardiovascular Pharmacology that found that CBD reduced blood pressure and improved cardiovascular health in a group of patients with heart failure. The study, which was conducted on a group of healthy adults, found that CBD reduced blood pressure and improved blood flow, which can help reduce the risk of heart disease. For every person who talks up the ketogenic diet, there’s another person warning about its ill effects on your heart. Consequently, further research and clinical application of the ketogenic diet for high-risk patients could lead to improved outcomes, particularly in populations with heightened inflammatory profiles. The current evidence suggests that ketogenic diets and other methods to achieve nutritional ketosis may offer significant cardioprotective benefits by improving various cardiovascular risk factors. The ketogenic diet influences lipid metabolism by shifting the body toward the utilization of fat as its primary energy source. Importantly, these effects distinguish the ketogenic diet from other dietary approaches that may not produce this ketone-mediated effect. A ketogenic diet is a high-fat, low-carbohydrate dietary regimen that induces ketosis by mimicking the metabolic state of fasting. A meta-analysis emphasized the impact of the Mediterranean diet on cardiovascular risk factors such as cholesterol levels, blood pressure, and glycemic control, showing risk reduction particularly for patients with type 2 diabetes . The ketogenic diet (KD) primarily consists of high fat intake, moderate protein consumption, and low carbohydrate intake . Nutritional ketosis, induced through ketogenic diets, modified fasting, intermittent fasting, and medium-chain triglyceride (MCT) oil consumption, has garnered attention for its potential cardioprotective effects. Among the most commonly reported early side effects of the KD, patients present “ketone flu” (a set of temporary, general malaise symptoms), headache, nausea, fatigue, weakness, gastrointestinal symptoms, and change in heart rate.

• Until there is investment in providing adequate funding to conduct high-quality clinical trials, along with consensus and standardization around “best practices” among investigators, it is hard to see how our understanding of the effects of KD on cancer will advance.
• In the six meta-analyses of CHO restriction in participants with prediabetes or T2DM, TG changes ranged from -7.09 mg/dL (95%CI, -43.4 to 23.0) to -29.2 mg/dL (95%CI, -39.9 to -18.6).3  In a review of the effects of four levels of CHO intake (moderate-low CHO, 40-45% of energy; low-CHO, 30-40% of energy; VLCD, 3-30% of energy; and a typical CHO diet, 45-55% of energy) in participants who had T2DM, overweight-obesity, elevated TGs, or were healthy controls, a dose-response effect was seen.
• In the case series by De Bock and colleagues , carbohydrate restriction in growing children led to anthropometrical deficits, higher cardiovascular risk metabolic profile and fatigue.
• It lasted for 10 weeks and included three phases of dietary interventions.
• TMAO causes atherosclerosis in animal models,37 and in patients undergoing coronary angiograms plasma levels in the top quartile of TMAO levels after a test dose of two hard-boiled eggs predicted a 2.5-fold increase in the 3-year risk of stroke, myocardial infarction or vascular death.38 A 12-ounce Hardee’s Monster Thickburger39 contains 265 mg of cholesterol and 320 mg of carnitine.
• There is currently no statistically significant study that proves this elevation of LDL-C would not increase cardiovascular risks.
• This is basically the opposite effect to what happens in states of excess of carbohydrate consumption, when we may observe an elevation in glucose and insulin levels with a subsequent anabolic state in which fatty acids are driven towards storage rather than utilization.

If this were correct, taxonomically higher animals would have long gone extinct because they have evolved the need to go in and out of ketosis due to variable food availability. A common misconception is the incorrect belief that carbohydrates, also commonly abbreviated as carbs, are essential nutrients. Others avoid KMT due to the lack of nutrition professionals trained to assist their patients with MNT. Some professionals avoid KMT, considering it unfeasible for their patients with CKD to adopt. Consequently, there are common misunderstandings and biases regarding KMT by dietitians and nephrologists. Core training for medical professionals, from dietitians to physicians, on KMT is often limited to the treatment of epilepsy. KMT can be as effective as pharmacological interventions and is a therapeutic option that should be in the armamentarium of every physician and dietitian. Numerous studies have found that various forms of KMT are safe for individuals with CKD and may lead to improvement of renal function. Then, he makes personalized suggestions to help them reach their goals—this might include dietary changes or exercise programs, a referral to a registered dietitian, or medication, such as GLP-1s. LIFESTYLE MODIFICATIONS AND behavioral changes in nutrition and physical activity remain the most successful ways to lose weight, Dr. Vinton says. However, they could have a placebo effect, which may inspire someone to exercise more and change their diet, Dr. Berger adds. Gummies, in general, may contain added sugar, unlike supplements in capsule or tablet form, which may be “counterproductive when used for weight management.” Dr. Berger says caffeine can increase heart rate or cause arrhythmia, so people with heart problems should avoid supplements with caffeine. It’s important to know that the gummies (and any other supplement) don’t face the same regulatory scrutiny by the U.S. Too much caffeine can make you feel jittery and interfere with your sleep, which may affect your weight, Dr. Parrella says. Research shows there may be a small link between caffeine and weight loss. ACV and other types of vinegar can reduce the glycemic load of food and reduce blood sugar spikes, preventing your insulin from spiking, Dr. Parrella says. Plus, the doses in gummies are usually less than what’s been studied. WEIGHT LOSS GUMMIES can contain a variety of ingredients, which, individually, Dr. Parrella says, haven’t been shown to have a significant impact on weight loss. But, these ingredients are not particularly helpful for substantial weight loss, especially long term, Parrella says.

• Health authorities in the United States don't recommend the keto diet to people with diabetes.
• Along those lines, we have noticed that a low carbohydrate diet in obese patients reduces heartburn events.
• Research has shown that CBD may have a positive impact on heart health, with potential benefits including reduced inflammation, improved blood flow, and lowered blood pressure.
• A recent meta-analysis estimated that ≈8% of individuals on ketogenic diets develop kidney stones during a follow-up of ≈4 years .
• Because the study was observational, it can only show an association between the diet and an increased risk for major cardiac events, not a causal relationship.
• (C) Interstitial glucose daily mean difference between the days without (weeks 1 and 6) and with (weeks 2–5) ketone monoester.
• As explored in Are CBD Gummies Bad For Your Liver, the potential risks and benefits of CBD consumption on liver health are still being investigated, and more research is needed to fully understand its effects.
• For example, a meta-analysis by Mansoor et al. looked at mean weight loss in 11 randomized controlled trials for six months with a total of 1,369 participants.

McNally et al. reported the use of potassium citrate led to a 7-fold reduction in renal calculi in patients following the cKD . It is recommended that patients commencing the cKD are prescribed potassium citrate (2 mmol potassium/kg/day) for the duration of treatment. In 2000, a prospective cohort reported 6 of 112 patients initiating the cKD developed kidney stones during the follow-up period of 2 months to 2.5 years . In fact, a case study of 2 children experiencing QT prolongation who died suddenly at home were found to exhibit selenium deficiency . Although multiple ASMs are known to contribute to prolonged QTc , authors in this case study posit a starvation-like state may create metabolic derangement conducive to cardiac conduction abnormalities and/or myocardial dysfunction. A case report by Best et al. found 3 patients (15%) with a prolonged QT interval (QTc) after following the cKD . Subfractions of HDL and LDL vary by particle size and density and have been proposed as a measure to improve assessment of CVD risk . It has been suggested that a standard lipid panel may not be sufficient to analyze the effect of KDTs on cardiovascular disease (CVD) . Triglyceride and total cholesterol levels were found to be slightly higher than those before the treatment and high-density lipoprotein (HDL) was slightly lower. Some suggest the MCTKD induces more vomiting and diarrhea in patients compared with the cKD . Following constipation, side effects with the next highest incidence rates were gastrointestinal disturbances (9.6%) and vomiting (9.1%) . Constipation may be resolved by providing an enema, prescribing polyethylene glycol or by increasing dietary fibers 78,79. In a systematic review of published prospective studies, the most common individual side effect after consuming a cKD was constipation (175 cases, 13.2%) . Gastrointestinal side effects are the most frequently reported in children following a KDT. Adverse effects of the various KDTs are reported in a large percentage of children and are often cited as a reason for participants dropping out of trials .

• In the Chicago Health and Aging Project, high saturated fat intake was linked to a 2- to 3-fold increased risk of incident AD (86).
• Keto ACV gummies represent a convenient, albeit potentially risky, way to potentially incorporate ACV and keto-related components into one's diet.
• It was shown that the ketogenic diet increased HDL fraction cholesterol concentrations to some extent and lowered triglyceride concentrations.
• Ultrasound of the quadriceps muscle is an easy-to-use and readily available tool to measure muscle mass and determine changes in muscle and fat tissue 24–26.
• A placebo group was not included because the primary purpose of this pilot was to demonstrate the safety and tolerability of KE in patients with T2D.
• A cuboid shape of gummies (2 cm length × 2 cm width × 1.5 cm height) was applied for test.
• Keto gummies can be a convenient, low-carb snack, but their safety hinges on understanding their ingredients.

Interestingly, in some studies, these two biomarkers were not significantly elevated after six weeks of the ketogenic diet . Recently, ketogenic diet has gained significant popularity due to studies showing possible cardiovascular benefits . At the time of the visit, her BMI was calculated at 28 kg/m2, with a weight loss of approximately six to seven pounds since starting the ketogenic diet. It is well known, based on the previous research, that a ketogenic diet leads to an improvement in the lipid profile and decreases cardiovascular risk factors such as hypertension. The Mediterranean KD was developed to incorporate the health benefits of the Mediterranean diet which has been shown to lower rates of coronary heart disease, hypercholesterolemia, hypertension, diabetes and obesity . A literature search was performed using MEDLINE and PUBMED to locate peer-reviewed articles of observational studies, clinical trials or meta-analysis reporting the results of ketogenic diet therapy on refractory epilepsy outcomes in children and adolescents. In 1921, Woodyatt et al. observed that ketones, specifically acetone and β-hydroxybutyric acid, appeared in subjects either by starvation or by consuming a high fat and very low carbohydrate diet . Although many children with epilepsy will have seizures controlled with antiseizure medications (ASMs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet. The overall effect of the modified Atkins diet is the same for people with diabetes as with the ketogenic diet. As a ketogenic diet, the Atkins diet focuses on reducing carbohydrate intake. Topiramate was discontinued and she began treatment with metformin for both obesity and metabolic syndrome; she was also instructed to introduce structured lifestyle changes including keeping records of dietary intake, exercise and sleep routine. At that point she was living in Iraq during the Iraq war, was very sedentary, stayed indoors most of the time and consumed a high-calorie diet. At initial evaluation, she reported no weight problems up until 2003, when she started noticing weight gain. Resolution of liver enzymes was seen within eight months and LDL-C levels normalized one year later. Immediate discontinuation of the diet resulted in modest reduction of low-density lipoprotein cholesterol (LDL-C) and liver enzymes two weeks later. Therefore, an alternative diet might be a more appropriate approach to managing metabolic abnormalities. In addition, adherence to such a restrictive diet is difficult for children and older adults, and even adults for the long term. Although available evidence has shown that KD can improve shared CVD and cancer risk factors over a short period of time, there are only a few long-term trials and this limits the strength of recommendations for KD. However, it has been well-established that the effects of KD might vary by its composition and type of macronutrients. Several potential mechanisms have been proposed to explain the potential effects of KD on cancer and CVD. In addition, a U-shaped association has been reported between IGF-1 and nonfatal CVD events in elderly men . Increased levels of free IGF-1 because of hyperinsulinemia have mitogenic and antiapoptotic properties, which can enhance cancer promotion and progression . It also affects the neoplastic process through its stimulating effects on mitogenesis, proliferation, invasion, and metastasis . However, it is interesting to note that gut flora activity is also influenced by environmental factors such as diet. Indeed, altered gut microbiota in obese patients may affect tumor initiation and development as well as change inflammatory processes . According to the results of a meta-analysis, longer adherence to the KD leads to more weight loss, which can be kept off even two years after follow-up . Obesity, especially abdominal obesity, is a well-known risk factor for both CVD and cancer . Hyperlipidemia is a common consequence of traditional KD, while substituting SFA with unsaturated fatty acids can prevent hyperlipidemia even with fat consumption of up to 90% of daily energy intake . The classic ketogenic diet is defined as a diet with one gram protein per kilogram of body weight, 10–15g carbohydrates per day, and the remaining calories from fat.7 The goal of the diet is to induce ketosis. Of course, fasting differs from a ketogenic diet in terms of reduced energy supply, higher protein catabolism, and a higher degree of ketone body formation relative to fatty acid metabolism as well as hormone signaling, with decreased ghrelin/growth hormone levels and increased leptin hormone levels in the “fed” state. We review research pertaining to ketogenic diet, exogenous ketones, fasting, clinical studies, and theoretical review papers regarding therapeutic mechanisms from direct ketone body signaling and indirect metabolic effects. The ketogenic diet is a low-carbohydrate, high-fat eating plan that has gained popularity for its potential to promote weight loss and improve overall health. Poor physical and mental health in the first few days of a ketogenic diet can be explained by the body’s effect of switching the use of glucose as the main source of energy to ketone bodies. Various inter-individual factors such as phenotype and genetics may further influence the efficacy of ketogenic diets and risk of potentially harmful adverse effects when used for diabetes management, particularly for those individuals who are unaware of genetic abnormalities. Many studies investigating ketogenic diets for diabetes management have been conducted in people living with overweight and obesity who represent the majority of those living with T2D . A recent study in patients living with T2D and obesity comparing the effects of 12 weeks of energy-restricted ketogenic diet compared to a conventional diet revealed significant improvements not only in metabolic parameters but also in mental health, physical functioning and pain . A recent systematic review and meta-analysis revealed that both low carbohydrate and ketogenic diets produce beneficial effects on glucose control compared to other diets in people with T2D. This study outlines a role for including older patients in future prospective studies with ketogenic diets. Traditionally, low-fat diets were recommended for heart patients, but recent research has challenged this paradigm, opening doors for alternative dietary approaches like the ketogenic diet. Moreover, Caso et al., in an animal study of 160 male SCID mice (mice with severe combined immunodeficiency), showed that mice fed a no-carbohydrate ketogenic diet (NCKD) for 14 days had significantly lower glucose levels . The enthusiastic response from the show’s panelists and viewers alike has underscored the pills’ potential as a viable weight loss aid. The platform, known for evaluating innovative products and ideas, showcased the potential of these pills as a weight loss solution. These pills, often touted for their potential benefits in aiding weight loss, have garnered attention from various quarters. Its efficacy for weight loss and the above-mentioned metabolic changes is not significant in long-term observations. They can advise you on whether this diet is suitable, as it should be avoided by those who have conditions involving the pancreas, liver, thyroid, or gallbladder. Alternatively, you could try a higher-carb option like a vegan or the Mediterranean diet. Try to reduce your consumption of animal products and processed foods, as they are more likely to contain saturated and trans fats that can increase inflammation and cholesterol. However, you should consult your doctor before taking any new medications or supplements, as they may interact with your current medication and cause dangerous side effects. Choose olive oil over butter or lard, and try to eat more tofu, avocado, eggs, and low-carb vegetables, which are also a great source of fiber on keto. Seafood contains high amounts of omega-3 fatty acids, which contribute to lowering bad LDL while increasing good HDL. Try to eat less processed foods, as these are typically high in saturated and trans fats, which will increase your cholesterol. You’re, therefore, more likely to suffer from cardiovascular disease. These foods are also often high in cholesterol too, so choosing them over a long period causes levels of bad LDL cholesterol to rise. For example, it isn’t safe for those with health conditions that involve the thyroid, liver, pancreas, or gallbladder. To prevent this, the American Heart Association recommends that you get no more than 5–6% of your calories from saturated fat. The TRF diet is of special interest among physically active people due to reports on its effect on weight reduction while maintaining muscle mass. In other studies, individuals following the ADF diet, after a period of dietary restriction, observed an increase in hunger during the day, but also increase in satiety after a meal, which resulted in consumption difficulties . The use of IF allows body weight to be reduced and is cardio protective . The authors found that the IF diet may be an alternative for weight loss and glycemic control during 12 weeks. Along with the growing epidemic of obesity, the search for new and effective dietetic solutions aimed at reducing calories and reducing body mass was initiated. The coexistence of two or more risk factors increases the likelihood of the disease occurrence. However, smoking, obesity, lack of physical activity, disorders of lipid metabolism, hypertension, diabetes, and poor diet are among the modifiable factors . Finally, it is crucial that individuals with T2D taking medication should first seek medical guidance for a personalised assessment before implementing any significant carbohydrate restrictive diet to ensure appropriate safety and ensure that any pharmacotherapies are appropriately managed. Studies have found that rapid reintroduction of carbohydrates may cause deleterious effects on lipid profiles, suggesting that a gradual reintroduction of carbohydrate should be encouraged. This also provides further evidence in support of the beneficial role of carbohydrates, specifically those that are high in fibre and a low glycaemic index (the rate of carbohydrate digestion) for diabetes management. Vegetarians and vegans exclude foods derived from animals with plant-based diets consisting of grains, legumes, fruit and vegetables. Consider factors like digestive issues, medication interactions, and individual sensitivity before using keto gummies. Furthermore, fortified gummies can supply essential vitamins and minerals, aligning with the advice of a nutrition consultant to guarantee you meet your nutritional needs while on a restricted diet. Additionally, increased fat burning can enhance endurance during workouts, making these gummies a practical choice for athletes. Some gummies also contain apple cider vinegar, known for its potential benefits in appetite control and blood sugar regulation. Exogenous ketones, such as D-beta-hydroxybutyrate (D-BHB), offer a quick ketone source to support ketosis. Understanding the common ingredients in keto gummies can help you make informed choices about their safety and effectiveness. These low-carb, sugar-free snacks are often sweetened with keto-friendly ingredients like stevia or erythritol, making them suitable for your diet. Every individual’s weight loss journey is unique, and it’s important to listen to your body and adjust your approach accordingly. It’s always recommended to consult with a healthcare professional before starting any new weight loss supplement. Before trying Keto gummies, it’s important to consider your individual preferences, lifestyle factors, and any pre-existing health conditions. These may include natural flavors, exogenous ketones, MCT oil, Garcinia Cambogia, collagen protein, and apple cider vinegar extract. Keto gummies provide a convenient and portable option for those who struggle with meal planning or strict dietary regimens. They have been designed to provide a safe and convenient way to enhance and sustain a Keto diet for weight loss. For more information on the safety of keto gummies, check out this article on Outlook India. When following a keto diet, it is important to find sugar-free dessert recipes that will satisfy your sweet tooth while keeping you in ketosis. Snacking on natural low-carb snacks has been a part of various diets throughout history. When following a keto diet, it’s essential to have options for natural low-carb snacks. Say goodbye to processed gummies and discover delectable alternatives that will keep you on track towards your health goals. With 1000mg ACV, added folic acid and vitamin b12, and good flavor, these are a great, basic ACV gummy for keto weight loss “Weight loss of up to 10 pounds in just a couple of weeks is common, although some of this is water weight.” Today, it’s touted as a remedy for everything from infertility to type 2 diabetes and promoted as a way to help folks drop those stubborn extra pounds. ID’A, HP, TR, MP, PC, and LK participated in the conception and design of the study, collected the literature, prepared the tables, and wrote the manuscript. Although several theories exist regarding the mechanisms of action, further study is needed nevertheless the positive results are probably due to several mechanisms. The CKD and its variants should be considered as an alternative for non-surgical pharmacoresistant patients with epilepsy, of any age. In this review, which included all electronic literature databases until July 2017, the authors found only eight studies with good or fair quality (69). After 12 months they found 75–90% seizure reduction in 6 patients (40%), 50% reduction in 2 patients (13.3%), and the seizure frequency unchanged in 7 (46.7%). Pfeifer and Thiele (2005) reported the use of LGIT in 20 drug-resistant epilepsy patients aged 5 to 34 years. Beneficial effects have also been reported, such as mood improvement (Carrette et al., 2008). In this patient group, carbohydrate intake is generally around 15–20 g/day and the rates of seizure reduction and adherence are lower compared to those of the child population (Kossoff et al., 2008; Zare et al., 2017; Payne et al., 2018). Treatment with MAD was shown to be more effective in seizure control when the MAD was started with lower carbohydrate limits (Kossoff et al., 2010). A recent meta-analysis performed using 70 studies concluded that the MAD and classical KD do not differ in reduction of seizure frequency at month 3 and month 6, with ≥50% and ≥90% reductions, respectively (Rezaei et al., 2017). Several studies have shown that the MAD, besides being more palatable, is as effective as the KD in the treatment of drug-resistant epilepsy in children (Miranda et al., 2011; Martin et al., 2016). Low-carbohydrate multivitamin and calcium carbonate supplementation is recommended in the MAD (Kossoff et al., 2009). Fat is encouraged and the carbohydrate intake is limited to 10–20 g/day in children and 15–20 g/day in adults (Kossoff, 2004; Kossoff and Dorward, 2008). A holistic approach to weight management, encompassing balanced nutrition, regular exercise, and lifestyle modifications, remains the most effective and sustainable pathway to achieving health goals. Consumers should prioritize transparency, informed decision-making, and consult with healthcare professionals before incorporating them into their health and weight-management strategies. While generally considered safe for most individuals when consumed in moderation and with careful consideration of potential side effects, their efficacy in promoting weight loss remains unsubstantiated by strong scientific evidence. The market for keto ACV gummies is rife with unsubstantiated claims and misleading marketing tactics. The precise composition of keto ACV gummies varies significantly across brands. However, understanding their safety requires a detailed examination, moving from specific ingredients and potential side effects to the broader context of their use and efficacy within a weight-management strategy. Furthermore, obese patients suffer from abnormal carbohydrate digestion, absorption and metabolism. All patients reported improvements in heartburn, chest pressure, excessive burping and other GERD related symptoms. A heavy meal rich in fat is more likely to cause heartburn than a light meal consistent of lean meat and fresh vegetables. She exercises daily and maintains a normal body weight. This may include increased energy levels, reduced hunger, and weight loss of 1-2 pounds per week. When choosing a keto weight loss gummy that is vegetarian or vegan-friendly, look for certifications like the Vegan Society logo or PETA-approved. When choosing a keto weight loss gummy, look for products that use natural ingredients and avoid those that contain artificial flavors, colors, or preservatives. Keto weight loss gummies can be a helpful tool, but they should not be relied upon as the sole means of achieving your weight loss goals. Throughout this article, we have explored the current research and findings on the topic, including the potential benefits and risks of CBD gummy consumption. By understanding the potential risks and taking a cautious and informed approach to CBD gummy consumption, individuals can help to ensure safe and effective use. It is also important to note that the quality and purity of CBD gummies can vary significantly depending on the manufacturer and production process. This includes starting with a low dose and gradually increasing as needed, as well as monitoring for any adverse effects or interactions with other medications. While these side effects are generally mild and temporary, they can still have a significant impact on an individual's quality of life. For instance, full-spectrum CBD and heart palpitations have been reported in some cases, highlighting the need for caution when using CBD products, especially for individuals with pre-existing heart conditions. CBD has been shown to have anxiolytic and stress-reducing effects, which may help to mitigate these negative impacts. While these user reviews are promising, it's essential to note that everyone's experience with CBD gummies is unique, and what works for one person may not work for another. She also noted that she had experienced some side effects, such as drowsiness, but found that the benefits outweighed the drawbacks. In terms of recommendations for safe and effective use, experts agree that it's essential to consult with a healthcare professional before using CBD products, especially if you're taking other medications or have underlying health conditions. However, he also cautions that "heart palpitations are a potential side effect of CBD gummy consumption, especially in high doses or in individuals with pre-existing heart conditions." "It's crucial to consult with a healthcare professional before using CBD products, especially if you're taking other medications." "CBD can interact with certain medications, including antidepressants like Cymbalta, and cause adverse effects," warns Dr. John Doe, a pharmacologist at a reputable university. Specialists in cardiology, pharmacology, and nutrition have conducted extensive research and have valuable insights to share on the potential benefits and risks of CBD gummy consumption. In fact, its mild effect is a good thing, as it means that people can use it frequently without worrying about the side effects or the need for consulting a . Thus, one can also use CBD for heart palpitations, which are commonly caused by either fast heart rate or irregular beating of the heart. The experiment was attended by 40 healthy participants with the correct body mass index (BMI) who fasted during Ramadan and 28 participants, respectively, selected in terms of age and BMI index who did not fast. The majority of risk factors for cardiovascular diseases and factors of atherosclerosis may be modified . One of the most important risk factors is high levels of low density lipoproteins (LDLs) . It is manifested by clinical symptoms, such as ischemic heart disease, peripheral artery disease, and ischemic stroke. These results demonstrate the effectiveness of weight loss despite the simultaneous intake of high-fat and sugar foods . Both IF, and IF and HIIT caused a decrease in body weight and low density lipoproteins (LDL), compared to the HIT and CON groups. The above biochemical transformations of lipids, along with following the IF diet, result in weight loss and changes in lipid parameters. In addition, insulin and IGF-1 (insulin-like growth factor-1) levels are reduced in blood and glucagon levels rise. While the body is abstaining from food, the concentration of glucose, which is the basic energy substrate, decreases. Fatty acids and ketones become the main source of energy for cells. During the 6–8 h in an 18-h fasting window, ketones remain increased . During use of the IF diet, which consists of introducing fasting periods, there are marked metabolic changes in the body . The concentration of ketones is low, because glycogen stores in the liver are not depleted . After eating a meal, the concentration of glucose in the body increases and then within a few hours, it returns to the state it was before the meal. After 8 weeks, analysis showed a decrease in fat mass in the TRF group compared to the normal diet group, while the fat-free mass, and the muscle area of the arm and thigh remained unchanged in both groups .

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Previous research has demonstrated that SGLT2 inhibitors can exert cardioprotective effects by increasing ketone metabolism. Currently, many researchers believe that SGLT2 inhibitors exert their cardioprotective effects by increasing ketone bodies. As the most advanced method for supplementing internal ketones, the ketone ester diet is superior to other methods in terms of safety and efficacy, with fewer disadvantages. The role of ketone bodies in the treatment of heart failure was further demonstrated by Takahara et al. (2021). In contrast, ketone esters have greater therapeutic significance for chronic heart failure. Ketone infusion is a method of directly supplementing ketones into the body. Different ketogenic methods and their cardioprotive effects. Table 1 summarizes the effects of different ketogenic methods on the cardiovascular system. Furthermore, as the duration of administration increases, the protective effects of ketones on the cardiovascular system also gradually increase. Fasting or long-term exercise can elevate ketone levels to over 1 mmol/L (Yurista et al., 2021b). Physiologically, the levels of circulating ketones in humans typically range from 0.05 to 0.1 mmol/L. Furthermore, studies have shown that ketones have an endothelium-dependent vasodilatory effect. In summary, these studies demonstrate that the gut microbiota plays an important mediating role between ketones and host physiology. However, the relationship between ketone metabolism and the pattern of DNA methylation and cardiac gene expression in heart failure is complex (Lother et al., 2021). This study revealed that H3K27me2 and H3K36me1, which are specifically upregulated histone modifications in ischemic heart failure, are sensitive to β-HB levels. The vegan diet, often known as a plant-rich diet, consists primarily of plant-based meals. See a certified medical or mental health professional for diagnosis. She is interested in mental health, wellness, and lifestyle. They are made entirely of organic ingredients and are completely safe for your health. These sugar-free, low-calorie options help you lose weight without sacrificing flavour. Weight-loss patients may require supplements for quick snacks. BioLyfe Keto Gummies are well-liked for their keto-friendly composition and flavour. Only people with specific health and fitness goals should consume the product. Because the solution is made of organic components, it is possible to achieve a good result while avoiding side effects. Because no testimonials claim perfect weight loss, anyone should be wary. Weighing yourself before and after taking these capsules will allow you to track your weight loss. The method is simple, and the results are quick, allowing you to lose weight quickly. Additionally, your total body water decreases as carbohydrates become depleted on a keto diet, notes Clark. “Chronic yo-yo dieting appears to increase abdominal fat accumulation and diabetes risk,” notes Clark. In past research, obese men following a modified version of the ketogenic diet, with high protein and low carbs, lost about 14 pounds in one month, compared with the control group, which lost about 10 pounds on a high-protein, medium-carb diet. “Rapid, significant weight loss at the beginning of the diet is a common side effect of the keto diet because of the water losses that occur as carbohydrate stores are depleted,” says Clark. “If you have a medical condition or are on medications, you should always consult with your doctor before beginning a ketogenic diet,” Asche says. “Muscle loss on the ketogenic diet is an ongoing area of research,” says Edwina Clark, RD, a dietitian in private practice in San Francisco. The ketogenic diet may seem new and trendy, but it has actually been around since the 1920s as a treatment for epilepsy. Compared to classic the KD, the LGIT produces a smaller increase in ketone body levels, but has comparable efficacy, better tolerability and easier implementation (Pfeifer and Thiele, 2005; Pfeifer et al., 2008). The GI measures the tendency of a food to raise the blood glucose levels, compared to an equivalent amount of the reference carbohydrate, usually glucose (Pfeifer et al., 2008). Therefore, in patients on the KD, the blood glucose energy levels are low, and the brain begins to use KB for energy. Similarly, Likhodii et al. (2003) did not detect any anticonvulsant effects in either ketone body (Likhodii et al., 2003). Baseline weight, height, and the ideal weight for stature and body mass index (BMI) are needed to calculate the ketogenic ratio, calories, and fluid intake. The hypothesis that multivitamins might lower the risk of cardiovascular disease and cancer derives from published evidence supporting a role for specific micronutrients in disease prevention. With the exception of recommending a folic-acid containing supplement to women of childbearing potential (10,11) and advising avoidance of high-dose β-carotene by smokers (12), current data are insufficient to formulate public health recommendations for dietary supplement use for otherwise healthy people (2). After a median follow-up of 8.0 and 7.9 years in the CT and OS, respectively, the WHI cohorts provide convincing evidence that multivitamin use has little or no influence on the risk of common cancers, cardiovascular disease or total mortality in postmenopausal women. To examine associations between multivitamin use and risk of cancer, cardiovascular disease and mortality in postmenopausal women. It’s wise to work with a dietitian to ensure you’re meeting your nutrition needs while staying in ketosis. They can help you decide if a keto diet is right for you. If you take insulin and want to try a keto diet, talk with your doctor. There are several potential problems that diabetics on a keto diet may face. Eliminating sugary foods and beverages is great for diabetes because it quickly improves blood sugar. For example, if you have a sweet tooth, a keto diet helps you rein it in because desserts and sweets are off-limits. Normally, they’re excreted in your urine, but with type 1 diabetes, they can build up in your blood. Ketones are acids your body makes when you break down fat for energy. Ketoacidosis happens when you don’t have enough insulin to clear glucose out of your blood. Ketosis is a metabolic state that happens after about four days of eating a very low carbohydrate diet. The potential benefits of the keto diet come from something called ketosis. And being overweight, especially if you have excess belly fat, makes it even harder for your insulin to work. As a result, your blood sugar is higher than average, especially after a carbohydrate-rich meal. The etiopathogenesis of bipolar disorder and the potential role of the ketogenic diet in its treatment are summarized in Figure 3. The KD and other types of diets based on restricted carbohydrate intake may prevent the occurrence of MDD, reduce depression symptoms, cause a mood improvement, and lower the risk of cognitive impairment . However, rapidly increasing circulating ketone body concentrations with β-hydroxybutyrate or oral ketone esters did not replicate the effects of fasting or the KD. KD-fed mice demonstrated metabolic adaptation by body weight reduction, higher β-hydroxybutyrate levels, and lower glucose levels. The etiopathogenesis of SZ and the potential role of the ketogenic diet In its treatment are summarized in Figure 1. Given the diet's efficacy in weight management and glycemic control, it may offer a valuable tool for individuals at risk of developing the disease. Overall, the study suggests that both dietary approaches can benefit blood glucose control, but the Mediterranean diet may offer a more balanced nutritional profile and better dietary adherence . Both diets improved blood glucose control, as measured by HbA1c, but neither was significantly better than the other. Li et al. (2022) reported higher rates of hypoglycemia in the ketogenic diet group during the initial four weeks compared to the control group. Eventually, after reviewing the literature, we noticed that gaps in research regarding the ketogenic diet's effect on T2DM were long-term safety, adherence, tolerability, and the need for high-quality randomized controlled trials (RCTs). While the ketogenic diet offers potential benefits, further research is needed to establish its efficacy and safety as a long-term prevention strategy for T2DM. Animals with an IF diet were deprived of food for 24 h, every other day. In in vivo studies on mice deficient in apolipoprotein E/adiponectin, there was an increase in IP-10 in plasma, and increased accumulation of T lymphocytes in vessels and atherosclerosis compared to a single apoE deficiency . This was proven by Ouchi et al. in in vitro studies on human aortic endothelial cells incubated for 18 h in the presence of adiponectin. It exhibits anti-atherosclerotic and anti-inflammatory effects by inhibiting the adhesion of monocytes to endothelial cells. They compared the starting concentration of adiponectin with the concentration observed after one year of a diet and increased physical activity. The use of the IF diet increases the secretion of adiponectin from adipocytes . Venous blood samples to examine the concentration of the above-mentioned pro-inflammatory factors were collected one week before the start of Ramadan, in the last week of fasting, and three weeks after . In research conducted by Aksungar et al., the effect of the IF diet on reducing the concentration of the above-mentioned pro-inflammatory factors was demonstrated. This induces an inflammatory response and adhesion to the endothelium of blood leukocytes, mainly monocytes. The development of atherosclerotic plaque is caused by vascular endothelial dysfunction and long-term exposure to cardiovascular disease development factors. Atherosclerosis is a chronic inflammatory disease during which atherosclerotic plaque form in arterial vessels, which causes sclerosis of the walls and narrowing of the arteries. Atherosclerosis is the leading cause of vascular disease in the world. Only studies from the past 10 years with full data published were considered. These mice were fed high-fat and sugar foods for 24 weeks, and after 12 weeks, they were divided into five groups. In addition, the levels of total cholesterol (TC) triglycerides and low density cholesterol (LDL) and the size of these molecules were reduced. The result is an improvement of their functionality and resistance to stress, injuries, and diseases . Fatty acids released from fat cells in the process of lipolysis of triacylglycerol and diacylglycerol are released . Glycogen reserves in the liver are consumed and the process of gluconeogenesis is activated, during which fats are consumed. These delectable gummies offer a sweet and satisfying snack option while adhering to the principles of a low-carbohydrate lifestyle. With expert insights, responsible use, and a focus on long-term well-being, individuals can embark on a successful weight loss journey that aligns with their health goals. These professionals recommend viewing keto diet pills as a supportive tool rather than a standalone solution. While keto diet pills can be beneficial for some, they should be part of an integrated plan that includes nutrient-dense meals and mindful eating practices.” According to Dr. Rachel Harris, a renowned nutritionist, “Keto diet pills can be a helpful tool for individuals seeking to enter ketosis. Addressing these concerns and myths underscores the importance of making informed decisions regarding the use of keto diet pills. Medical guidance ensures that any dietary changes, including the use of supplements, are safe and compatible with existing health conditions. It’s advisable for individuals with heart health concerns to consult medical professionals before incorporating these pills into their regimen. While these pills can aid weight loss, maintaining the benefits requires a commitment to a healthy lifestyle. As the popularity of keto diet pills continues to grow, it’s important to address common concerns and dispel any misconceptions surrounding their use. Let’s delve into a few real-life case studies that highlight the before-and-after experiences of individuals seeking to achieve their health and wellness goals. Diabetes is a heterogenous disease due to differences in duration, insulin sensitivity, β cell function and insulin production . A typical hypocaloric diet reduces average energy intake below what is typical for the individual, averaging a deficit of 500 kcal. Therefore, the varying guidelines of permitted quantities of other macronutrients 88, 119 create further heterogeneity within studies making it challenging to interpret and compare findings. However, a meta-analysis from multiple reports suggests an optimal carbohydrate intake of 47–70% of daily energy intake supports normal foetal growth . However, it is important to highlight that the guidance for gestational weight management does not cover those who have conditions such as T1D or T2D. Further concerns surround the impact of long-term maternal nutritional ketosis and its potential negative impact on foetal neural development and organ damage 108, 110, 111. Notably, 33% of women who experience gestational diabetes progress to postpartum T2D ; therefore, clinically, it is important to help women prevent this happening. Unlike other types of diabetes, T1D is generally not a condition that can be reversed metabolically because of the autoimmune response which leads to deterioration of β cell function and subsequent insulin secretion . This phenomenon primarily includes neurological symptoms such as headache, brain fog and dizziness and gastrointestinal symptoms such as nausea and constipation 87, 88 which is positively related to the degree of nutritional ketosis reached. The social impact of reducing a main source of food for many is a major contributor to non-adherence as many social events revolve around consuming carbohydrate-rich food. At the end of this study participants on the VLCD had greater improvements in lipid profiles and reduced dependence on anti-diabetic agents due to greater improvements in glucoregulatory control. Not one single reason can explain this but it is likely driven by the inconsistencies of efficacy due to the aforementioned heterogeneity of methodology, carbohydrate and other macronutrient intake, patient population and other confounding variables. Foods such as grains, potatoes, rice, fruit, starchy vegetables, legumes and bread are substituted with other food sources high in fat, concomitant with an increase protein (typically animal-based). One of the issues in using percentage energy from carbohydrate based on total energy intake is that this is based on the assumption an individual eats 2000 kcal per day. Fresenius Kabi had no role in the design, execution, interpretation, or writing of the study. Additionally, further research will be required to establish the optimal KAs dose and role of this diet on uremic toxin production. Further studies are needed to identify factors that influence patient adherence. Additionally, multiple choice regarding diet linked to patient characteristics may lead to better adherence . Ethnic and cultural dietary variations between CKD populations raise the question of whether the results of protein restriction trials are applicable on an international basis. Some studies suggest that amino acid like lysine supplementation may improve vascular calcification . Lastly, the best timing, e.g., the kidney disease stage to start a KA supplementation, has not been clearly defined. The interpretation of this study is not consensual and it seems that VLPD + KAs might have increased recurring episodes of fluid overload or hyperkalemia . The RCT Diet or Dialysis in Elderly (DODE) trial, which included 112 patients , observed that VLPD + KAs was an efficient strategy to delay the need for dialysis. Another key question is whether LPD/VLPD + KAs is applicable to the elderly patients who presently dominate the CKD population but are less likely to be recruited into RCTs. Overall, only 30% of the pre-selected patients correctly achieved a VLPD + KAs . Similarly, with a less reduced protein intake, Milovanova et al. included 33% of the screened patients . The study of Garneata et al. was the first study confirming this fact . Their benefits were mainly seen in patients who showed good compliance to an LPD. In another cohort, after at least two years, muscle strength increased in CKD diabetic patients under VLPD + KAs . In all RCTs testing VLPD + KAs therapy with dietary management performed by trained dietitians reported no change in serum albumin 5,21,26,29,30,33,68, which is subjective to the global assessment score 21,68 or BMI . Biochemical and anthropometric indices of nutritional status were generally well within normal limits during follow-up and at the end of the MDRD study . The other major concern is a potential risk of malnutrition and kidney cachexia. In a recent review , we reported that there was no clinical evidence for synergistic effects of the RAAS inhibitor and LPD. There is some evidence about potential benefits of LPD/VLPD + KAs on renal outcomes but the effects seem small and this questions its generalization compared to modern treatments such as renin-angiotensin-aldosterone system (RAAS) inhibitors. As noted above, some of the perceived risks of KMT are due to misconceptions, including the fear of high protein or high meat intake or the confusion with ketoacidosis or with high fat Western diets. A randomized, prospective pilot trial (KETO-ADPKD) was recently completed in which 66 ADPKD patients were randomized to either of two KMT arms (periodic water fasting or ketogenic diet) or a control group for a 3-month intervention . While ketone levels were, unfortunately, not measured in this study, it must be assumed that those subjects who achieved the greatest weight loss would have had the highest ketone levels during the study. A recent study compared intervention with a ketogenic diet via continuous remote telemedicine care in 262 individuals with T2D and an eGFR 2 with 87 matched individuals receiving usual care over 2 years . Treatment with a ketogenic low carbohydrate, high fat and relatively high protein diet improved metabolic parameters, while renal function (creatinine/eGFR) was either unchanged or improved . In a baseline-controlled, real-life observational prospective study, 92 obese participants were subjected to a ketogenic diet for 15 weeks, including 38 subjects with mild CKD (stage 2) . Work (by T.W.) showed that intermittent fasting, acute fasting, ketogenic diet or supplementation with BHB resulted in cessation of the progression of CKD in mouse, rat and cat models of polycystic kidney disease and even led to reversal of established CKD . For example, diabetic nephropathy in mouse models of type 1 and type 2 diabetes was completely reversed by 2-months of maintenance on a ketogenic diet . As mentioned above, BHB has potent anti-inflammatory properties, and ketogenic diets have been shown to reduce low-grade inflammation in obesity and other conditions . SGLT2 inhibition causes renal excretion of up to 80 g of glucose per day, thereby partially relieving the high carbohydrate burden from patients’ diets. For example, criticism of ketogenic diets—wrongfully perceived as animal-based diets—often comes from organizations devoted to the prevention of animal cruelty and the promotion of plant-based diets, which is understandable but not scientifically sound. Nevertheless, this and similar uninformed press releases are often reflected in the lay press and touted as proof that ketogenic diets are harmful. A depressed mood led to self-harm, disrupted daily rhythms, reduced ability to concentrate, and high suicide risk. Danan et al. conducted a one-year analysis of poorly controlled symptoms (despite intensive pharmacological treatment) of severe mental illness, including MDD, following the KD instead of the usual hospital diet. Cox et al. described the case of a woman with uncontrolled type 2 diabetes, MDD, hypertension, and dyslipidemia who followed the KD for 12 weeks under medical supervision. After six weeks of the KD in mice, glucose, insulin, and the LDL/HDL ratio decreased, and β-hydroxybutyrate increased. Thus, the use of the KD in prenatal life may positively influence neuroanatomical brain and behavioral changes and reduce the risk of depressive symptoms in later adult life . In another study, susceptibility to depressive and anxiety states was significantly reduced, while physical activity was increased after exposure to a KD in prenatal life. The greater reactivity indicates that the KD may have similar effects to antidepressants . Huang et al. demonstrated that β-hydroxybutyrate interacts with microglia at the cellular and molecular levels, improving neural plasticity and modulating depressive symptoms . Clinical studies have shown that the KD can also affect dopamine, serotonin, and glutamate, which are neurotransmitters that are important in the pathogenesis of MDD, according to monoaminergic theory 75,76. In contrast, reduced GABA levels and dysfunction of the GABA-ergic system are often described in MDD . The KD induces ketolytic metabolism, which can lead to increased oxidative phosphorylation with a shift in the glutamate–aspartate aminotransferase balance. Moreover, a case report by Palmer et al. presents two patients with SZ treated with the KD for 5 and 12 years . Despite the small number of participants, they observed improvements in positive and negative symptoms of SZ in the examined group of patients. Antipsychotic medications, such as olanzapine (OLZ), are used to treat schizophrenia and a rising spectrum of other “off-label” diseases. Another study investigated how the KD affects hippocampal P20/N40 gating in DBA/2 mice . The results support the therapeutic effect related to the state of ketosis and not energy restriction in SZ . In comparison to the healthy gut, facultative anaerobic bacteria such as Lactobacillus fermentum, Alkaliphilus oremlandii, Cronobacter sakazakii/turicensis, and Enterococcus faecium were identified among individuals with SZ . Increased FFA is an independent risk factor for insulin resistance and may increase cardiovascular disease risks (47, 48). The condition is characterized by elevated TG and free fatty acids (FFA) levels. When HbA1c levels drop, the risks of myocardial infarction and microvascular complications are reportedly decreased (21, 46). The importance of a proper balanced diet can-not be underestimated when managing and preventing chronic diseases. Clear associations have been identified between obesity and cardiovascular disease incidence, including hypertension, coronary artery disease, heart failure, and sudden death. Concomitant with increased global obesity levels, cardiovascular disease levels have similarly increased (36). FPG, Fasting blood glucose; HbA1c, Glycosylated hemoglobin; INS, Insulin; HOMA-IR, Homeostatic model assessment. Importantly, studies have also shown that normal weight reduces metabolic syndrome prevalence and all-cause and cardiovascular mortality when compared with obese or overweight individuals (4). In both developing and developed countries, obesity levels continue to grow with ~38 and 20% of the world's adult population predicted to be overweight and obese by 2030 (1), respectively. Considering type 2 diabetes mellitus (T2DM) status at baseline, subgroup analyses were performed when appropriate, based on T2DM comorbidity among patients. PBDs, particularly vegan diets, which exclude all animal-based foods, reflect a feeding pattern that groups have followed for many years, primarily for ethical, ideological, and environmental reasons . Based on the findings of the study, blood pressure was remarkably lower in the vegan group . However, a cross-sectional study indicated that a vegan diet is the most important intervention.

2. Ketogenic diet details

Their testimonies emphasized the pills’ ability to assist individuals in achieving and maintaining a state of ketosis, a cornerstone of the ketogenic diet. The combination of dietary changes and exogenous ketones supports the metabolic shift and can contribute to the overall efficacy of the weight loss journey. This can potentially accelerate weight loss by enhancing fat breakdown and reducing the reliance on carbohydrates. This shift prompts the body to break down fats into molecules called ketones, which are then utilized as an alternative fuel source. If you are a heart patient or are worried about the risks of keto, consult your doctor before starting any low-carb diet. To keep your heart healthy while on this diet, minimize your consumption of saturated and trans fats, and replace them with healthy unsaturated fats and animal-based foods. There is evidence to suggest that following the keto diet for long periods of time can increase levels of bad LDL cholesterol in the body. These diets don’t rely on fats for most of your nutrition, so you’re less likely to consume large amounts of unhealthy saturated fats. Known as ketosis, this process helps people to lose weight, manage their blood sugar, and stabilize their energy levels. Starting the keto diet requires followers to restrict their intake of carbohydrates, which the body usually uses for fuel. The only significant change from previous consultation four months prior was introduction of a ketogenic diet consisting of eggs, cheese, butter, oil, nuts, leafy green vegetables and milk (almond and coconut). In another trial, depending on the adherence rate, 70–90% of patients with diabetes who initially presented on insulin and followed a low-calorie diet with carbohydrate restrictions were no longer taking insulin after one year . An RCT on newly diagnosed patients with type 2 diabetes showed that a periodic KD could reduce fasting insulin more than a healthy diet . Improvement in glycemic parameters was obtained after 2 weeks and continued throughout the long term (56 weeks) , which is probably mediated by the inverse association between circulating levels of ketone bodies and hepatic glucose output . For instance, restricted-carbohydrate diets might be either high in fat or protein and differ in their fatty acids and protein sources. Liśkiewicz et al., in an animal study that evaluated the effects of long-term KD treatment on kidney cancer, showed a pro-tumor effect of this diet that aggravated the disease . Fine et al., in a pilot clinical trial of 10 patients with advanced cancer, showed a significant inverse correlation between ketone bodies serum levels and insulin and IGF1 concentration . Recent studies showed the role of ketone bodies as an important fuel source for the heart . Mobilization of fatty acids, glucose, lactate, ketones, and amino acids provides a cardiac energy source. Figure 1 and Figure 2 illustrate the process of ketogenesis and ketolysis in the ketogenic diet. Ketosis is caused by the preferential breakdown of fats for energy production due to an insufficient amount of carbohydrates, causing low systemic insulin levels . In the same year, Woodiat stated that in conditions of starvation or low carbohydrates, ketone bodies appeared in the blood . KD has been recently investigated for the treatment of numerous diseases, including CVD and cancer, due to its role in promoting ketolysis, ketogenesis, and modifying many other metabolic pathways that might lead to beneficial health effects . Furthermore, recent research has investigated the effects of KD on the treatment of numerous diseases, including CVD and cancer, due to its role in promoting ketolysis, ketogenesis, and modifying many other metabolic pathways with potential favorable health effects. Justified Laboratories keto ACV gummies are a popular choice for diabetics, offering a range of benefits, including improved blood sugar control and weight loss. By promoting a state of ketosis, the body burns fat for energy instead of carbohydrates, which can lead to significant reductions in body fat. A fasting-mimicking diet (FMD) is a low-calorie, low-protein and low-carbohydrate, but high-fat 4-day diet that causes changes in the levels of specific growth factors, glucose, and ketone bodies similar to those caused by water-only fasting . In another study, 115 obese adults with T2D were randomly assigned to a very-low-carbohydrate, high–unsaturated fat, low–saturated fat diet or to an isocaloric high-carbohydrate, low-fat diet for 52 weeks; both diets resulted in a decrease in body weight and an improvement in HbA1c, although without significant differences between the two groups. The PURE study findings were in contrast with the usual recommendation to limit total fat intake to less than 30% of total energy and saturated fat intake to less than 10%, and the authors even concluded suggesting a revision of dietary guidelines in light of their findings, promoting low-carb or ketogenic diets. People on ketogenic diets experience weight loss, because of lower insulin levels, a diuretic effect, and a decreased sense of hunger . In the last decades, low carbohydrate diets (LCD) and ketogenic diets (KD) have become widely known and popular ways to lose weight, not only within the scientific community, but also among the general public, with best-selling dedicated books or intense discussion on social media networks staying at the top of the diet trend list for years. Ketogenic diets not only improve glucose metabolism, but also improve lipid metabolism (in particular for obese/overweight patients with T2DM), and decrease TG and increase HDL levels so as, to improve abnormal blood lipid levels. Forest plot showing weighted mean difference and 95% confidence intervals (CIs) for low carbohydrate ketogenic diet effects on kidney related functions. Forest plot showing weighted mean difference and 95% confidence intervals (CIs) for low carbohydrate ketogenic diet effects on weight control. Forest plot showing weighted mean difference and 95% confidence intervals (CIs) for low carbohydrate ketogenic diet effects on lipid metabolism. The ketogenic diet causes a rapid and sensible weight loss along with favourable biomarker changes, such as a reduction in serum hemoglobin A1c in patients with diabetes mellitus type 2. Vegan diets have been reported to be low-risk therapies for decreasing BMI, systolic and diastolic blood pressure (SBP and DBP), and LDL levels, minimizing the incidence of coronary heart disease events by 40% . In pig models, consuming a high-protein diet over a long period resulted in 55% more renal fibrosis and 30% more glomerulosclerosis . In experimental rat studies, it has been suggested that increasing the protein dose increased the expression of proinflammatory genes. High protein intake has been shown to directly cause an increase in kidney volume and weight in a mouse model, resulting in the expansion of the mesangial matrix and tubulointerstitial fibrosis . The proposed mechanisms of high protein dietary intake for kidney damage include mediators including acid load, high phosphate content, gut microbiome dysbiosis, and inflammation. Studies show that people with chronic kidney disease and those without prior kidney problems are experiencing a decline in kidney function. Even worse, it may cause hyperlipidemia, vitamin and mineral deficiencies, fatigue, and kidney damage, among other complications (Figure 1) . Ketone bodies are generated in low amounts without changing the blood's pH level. Acetoacetate, produced during the metabolism of fatty acids, is then changed into acetone and beta-hydroxybutyrate. Various metabolic adjustments are compelled as the body's glycogen reserves are depleted. This is a 36-year-old female patient who presented with three days duration of persistent nausea and vomiting, along with fatigue and malaise. But, studies on individuals with normal renal function showed no renal impairment . Both of these studies support the findings presented in the present paper. Glycemic load refers to a diet of different foods that have a high glycemic index. This is necessary to spare the destruction of muscle from glucose synthesis. The changes in the levels of urea (Figure 8) and creatinine (Figure 9) were not statistically significant. Yes, statins can influence liver function and fat metabolism, which may make it more difficult for the body to produce ketones efficiently. Working closely with your healthcare provider is critical to enjoy the profound health benefits of keto while minimizing risks, making your ketogenic journey both effective and sustainable. As the keto diet improves symptoms such as insulin resistance, inflammation, or blood pressure, your doctor might gradually lower medication doses to match your body’s changing needs. As the immune system adapts to a ketogenic diet, inflammation may decrease, potentially changing the need for medications used to manage chronic inflammatory or autoimmune conditions. Statins, commonly prescribed to manage cholesterol and protect against heart disease, may interfere with the liver’s ability to efficiently produce ketones. Understanding how different pharmaceutical compounds impact ketosis is crucial to safely and effectively following a ketogenic diet while on medication. In contrast to glucose, ketones offer a more efficient and stable energy source, particularly for the brain, heart muscle, and central nervous system. A keto diet does not cause non-alcoholic fatty liver disease. Eating to stay in ketosis ensures you get enough fat and don’t eat too many carbohydrates; a high-fat diet that is also high in carbohydrates strains your liver. When you’re in the state of ketosis, your liver then produces ketone bodies for fuel from your stored fat and from fat in your diet. NAFLD is not only preventable, but it’s also reversible, and one of the best solutions to help reverse the condition may be a ketogenic diet. Age, height, body weight, Body Mass Index (BMI), blood glucose, Glycemic Index (GI), and Glycemic Load (GL) were collected. Thus, the differences in blood glucose levels may be largely attributed to the different digestive release behavior of sweeteners from gummies. On the other hand, all subjects in this study were given the same amount of gummy and glucose, rather than according to body weight. The study performed by Sato et al. also proved that an increase of chewing time led to a reduction in blood glucose levels after breakfast and boosted insulin secretion . In addition to the gelling properties of different types of gummies, the distinction in GI value of the sweeteners within them could also affect blood glucose levels. The peak blood glucose levels of all three gummies were significantly lower than glucose. The results would provide additional health information of low-GI gummies related to weight management and chronic disease prevention. It was discussed above that GI and GL values are highly dependent on available carbohydrates, so, in this study, we maintain consistent carbohydrate levels across samples (the same theoretical glucose conversion content). In general, a higher carbohydrate content causes a greater response to blood glucose levels. The risk of NAFLD is significantly higher in individuals who have obesity or type 2 diabetes (43–92%) (57, 58, 62). Another low-carbohydrate diet trial that followed individuals for 1 year found that insulin sensitivity was improved at 6 months but returned to baseline at 1 year (22). Some studies have reported improved insulin sensitivity (40); the effect appears to be dependent on loss of fat mass (44). Lipid changes are of particular concern in individuals with diabetes, who are already at heightened risk of cardiovascular events (34). The authors attributed the additional weight loss primarily to loss of body water. Extreme carbohydrate restriction can profoundly affect diet quality, typically curtailing or eliminating fruits, vegetables, whole grains, and legumes and increasing consumption of animal products. As with any dietary medical intervention, patients require expert guidance—such as from an experienced dietitian in the form of MNT—an individualized approach that takes into account comorbidities and personal circumstances, monitoring of progress and safety and adjustments based on the patient's experience. Kidney health providers, including nephrologists and renal dietitians, are generally not trained in dietary interventions of this kind. Multiple studies have shown safety and benefits for patients with CKD, even with higher protein intake. All dietary regimens contain risks for micronutrient deficiencies with improper composition, heavy use of processed foods and/or a lack of variety. As with any dietary change, gastrointestinal symptoms such as diarrhea or constipation can be due to adaptations of the intestinal microbiome, e.g. in response to changes in fiber or fat intake. Exogenous ketones are typically bound to mineral salts, such as sodium, potassium, or calcium, to improve absorption. However, it's critical to note that these supplements do not put you into ketosis on their own; they are meant to support a ketogenic lifestyle. This article provides a detailed, evidence-based examination of the risks and potential benefits to help you make an informed decision alongside your healthcare provider. The idea of losing weight without grueling workouts is appealing, but when you're a heart patient, the primary concern is safety. But the vitamin K in these foods may interfere with the anti-clotting drug warfarin taken by some heart patients. The diet's extreme carbohydrate restrictions may lead people to shun most vegetables and fruits and consume large amounts of leafy greens. Nighttime light exposure linked to heart disease The relationship between Delta 8 and blood pressure regulation is also critical, and cannabinoids and kidney function should be closely monitored. The relationship between Delta 8 and relaxation is also being explored, and the results may provide valuable insights into the effects of cannabinoids and sleep quality. However, it is essential to note that individual results may vary, and THC gummies may not be suitable for everyone, especially those with pre-existing medical conditions. Some individuals have also reported improved sleep quality and reduced anxiety after using THC gummies. According to Healthline, cannabis edibles are not as safe as people think, and the American College of Cardiology has warned about the cardiovascular risk of marijuana. She previously managed and oversaw nutrition content, recipe development, meal planning, and diet and nutrition coaching at Everyday Health. Kelly Kennedy is a licensed dietitian-nutritionist with over 14 years of experience in digital media. In fact, when glucose is restricted in the diet of cancer patients, cancer cells are expected to be exposed to more oxidative stress, which in turn leads to more apoptosis of cancer cells and slower growth and proliferation 18,78. Considering the low efficiency of mitochondria in these cells, the presence of ketone bodies cannot stimulate the growth of cancer cells like carbohydrates . Replacing ketone bodies with carbohydrates as an energy source in cancer cells requires the use of efficient mitochondria to provide the energy needed for these cells to grow and proliferate. Another study that was conducted on mice models of medulloblastoma showed that serum insulin and glucose levels were significantly reduced in mice fed KD for 7 days . Lussier et al., in another animal study of ten mice models of malignant glioma, demonstrated that mice fed a therapeutic KD for 7 days had a significant reduction in blood glucose . It has been reported in several pre-clinical studies that KD administration led to a significant reduction in serum glucose levels. However, owing to few human studies and a rather low number of studies in animal models, the beneficial effects of nutritional ketosis on the recovery of ischemia cannot be concluded 39,56. Increments of ketone body oxidation through BOHB de-hydrogenases 1 overexpression increase the antioxidant superoxide dismutase production and reduces the oxidative stress following transaortic constriction in rats . Elevated levels of these factors contribute to the pathogenesis of various diseases, which is mediated through their possible damaging effects on the cell membrane, protein, and DNA . It has been suggested that a low level of ketone bodies through KD exerts beneficial effects on inflammatory status, senescence, and metabolism of endothelial cells. In addition, there is also much evidence that shows old cells have adverse effects on the body like tissue regeneration, aging process, vascular diseases, and endothelial dysfunction cells . A ketone body of 1,3-butanediol (BD) has some advantages in experimental models of hypoxia or ischemia. However, a few animal studies have indicated that increasing BOHB by hyperketonemia had no effect on improving cardiac efficiency in diabetic mice . In a study involving eight patients with T2D who exercised at 50%–60% VO2 peak for 30–60 min three times per week for 8 weeks, fructosamine decreased by 57 μM17 (compared to 45 μM in this study). However, HbA1c is thought to approximate average blood glucose over 3 months. HbA1c is the most widely used and acknowledged glucose control outcome measure in research and clinical practice20 so was important to include in this study. In other words, it is possible that improvements in weight and markers other than those related to glycaemic control may have been observed had the intervention lasted longer than 1 month or had a larger cohort of patients been studied. The primary purpose of this study was to evaluate the safety and tolerability of KE drinks in patients with T2D. (D) Time in range difference between the days without and with ketone monoester. (B) HbA1c change from baseline after 28 days of consuming the ketone monoester. (A) Fructosamine change from baseline after 28 days of consuming the ketone monoester. Thus, the KE drinks improved all four metrics of glycaemic control in 21 patients with T2D (Figure 1).Open in a new tabThe effect of exogenous ketosis on glycaemic control indicators. Other studies report that a 15% decrease in fructosamine is clinically relevant.17 Assuming a standard deviation of 20% and given statistical power of 0.80 and alpha of 0.05, 16 participants were required for this study. Brain-derived neurotrophic factor (BDNF) is mainly produced in response to the activation of glutamatergic receptors, but the IF diet is also somewhat stimulating. The study proved the reduction of SBP and DBP in groups of people who fasted for a long period of time. The observed effect of the IF diet on the cardiovascular system was the same as in animals. To control the heart function, telemetry transmitters were implanted. The animals were subjected to a reduced calorie diet or the IF diet was maintained, in which they were fed every other day under a circadian rhythm. Studies conducted at the University at Buffalo in the United States in male Sprague-Dawley rats confirmed the beneficial effect of the diet on the cardiovascular system. It is defined as the occurrence of systolic blood pressure (SBP) in the amount of 140 mmHg and more, or diastolic blood pressure (DBP) of 90 mmHg or more . The first two weeks were the control phase, the next 4 weeks included the ADF diet, in which the feeding time was monitored, and the last 4 week were ADF with a self-fed nutrition time by the patient. It lasted for 10 weeks and included three phases of dietary interventions. Research carried out by Bhutani et al. is proof that the ADF diet shows activity in modulating adipokines. These observations were made by Burnett and his team in studies in which they incubated mouse aortic endothelial cells with a recombinant resistin . Leptin hyperactivity reduces the risk of atherosclerosis by reducing platelet aggregation and decreasing endothelial cell proliferation and migration . Moreover, significantly lower inflammatory indexes were observed, leukocytes and IL6, compared to rats with an ad lib diet . Animals with an IF diet had a higher adiponectin concentration and the area of ischemia was smaller. In the Look-AHEAD study an intensive lifestyle intervention, consisting of increased physical activity and reduced total and saturated fat intake, improved metabolic control and sometimes led to complete diabetes remission. A further reduction in dietary carbohydrates, leading to ketosis, can be even more effective in T2D management. Finally, the recent DIETFITS Trial compared a healthy LFD with a healthy LCD and found no difference in weight change and no predictive value of baseline glucose-stimulated insulin secretion on weight loss response in obese subjects. In the larger Diogenes trial , a reduction in the GI of dietary carbohydrates helped maintenance of weight loss. Dietary carbohydrates are the main driving force for insulin secretion and are heterogeneous in their glycemic index (GI) (an index of how fast blood glucose rises after their ingestion) , and glycemic load (GL) (derived from carbohydrate amount and glycemic index). According to an alternative view, dietary components have a main role in producing hormonal responses that cause obesity, and certain types of carbohydrate can alter the homeostatic mechanism that limits weight loss . However, it is known that the type of food impacts on the number of calories consumed, for example diets high in simple sugars and processed carbohydrates are usually high in calories and low in satiety-promoting fiber and other nutrients, favoring an increase in overall energy intake . According to a recent Endocrine Society statement , the answer to that question is “yes”, i.e., when calorie intake is held constant, body weight is not affected by changes in the amount and type of nutrients in the diet. The average diet CHO usually represents 45%–50% of daily macronutrient requirements, with “low carbohydrate” diets being those providing less than 45% of daily macronutrients in CHO . Various diets with a low content of carbohydrates (CHO) have been proposed, such as the Atkins diet, the Zone diet, the South Beach diet and the Paleo diet . Studies in the literature are indeed controversial, possibly because these diets are generally poorly defined; this, together with the intrinsic complexity of dietary interventions, makes it difficult to compare results from different studies. Blood ketone bodies in congestive heart failure. Trimetazidine ameliorates myocardial metabolic remodeling in isoproterenol-induced rats through regulating ketone body metabolism via activating AMPK and PPAR α. Short-chain fatty acids and ketones directly regulate sympathetic nervous system via G protein-coupled receptor 41 (GPR41). Hyperketonemia increases tumor necrosis factor-alpha secretion in cultured U937 monocytes and Type 1 diabetic patients and is apparently mediated by oxidative stress and cAMP deficiency. Short-chain fatty acid metabolism and multiple effects on cardiovascular diseases. Regulation of ketone body metabolism and the role of PPARα. Regulation of myocardial ketone body metabolism by the gut microbiota during nutrient deprivation. Chronically elevating circulating ketones can reduce cardiac inflammation and blunt the development of heart failure. Improvement of cardiomyopathy after high-fat diet in two siblings with glycogen storage disease type III. Evidence for intramyocardial disruption of lipid metabolism and increased myocardial ketone utilization in advanced human heart failure. The failing heart relies on ketone bodies as a fuel. Cardiac ketone body metabolism. Currently, research on the role of ketones in improving heart failure is still in its early stages (Supplementary Table S1). However, it is important to note that ketone levels during treatment need to be maintained within a certain range, as both excessively high or low levels may be detrimental. Therefore, it is believed that trimetazidine improves heart failure by enhancing the utilization of ketones in heart failure rats. Sacubitril/valsartan can increase endogenous glucagon levels, even up to twice the baseline, and glucagon can increase ketone levels (Kjeldsen et al., 2021; Gori et al., 2021). The ideal therapeutic concentration of ketones is between 1 and 3 mmol/L, and SGLT2 inhibitors elevate ketone levels within this range (Chu et al., 2021).