In a recent study published within the Nutrients Journal, researchers summarized the evidence on ketogenic diets (KDs) from the past three a long time.

​​​​​​​Study: The Influence of Ketogenic Eating regimen on Gut Microbiota: Potential Advantages, Risks and Indications. Image Credit: Boontoom Sae-Kor/Shutterstock.com

Background

KD is characterised by minimal intake of carbohydrates, low calories, standard protein levels, and high fat intake. This dietary approach induces biochemical processes that improve disease management.

Nevertheless, KD could cause complications, akin to bone diseases, hypoglycemia, gastrointestinal symptoms, dyslipidemia, growth failure, and nephrolithiasis, that are manageable.

Furthermore, caution is suggested as a consequence of the potential possibility of pancreatitis, vascular changes, and cardiac abnormalities.

The gut microbiota contributes to nutrition, metabolism, and the event of nervous and immune systems and is influenced by the environment, food plan, drugs, prebiotics, and probiotics.

Modifying these aspects could affect disease onset, course, and outcomes, particularly in pediatric populations where the microbiota is more vulnerable to changes. In the current study, researchers reviewed the available evidence on the indications of KD in pediatric populations and its impact on the microbiota.

Indications of KD

KD was widely adopted as an epilepsy treatment within the last century. It remains to be really useful for refractory epilepsy in children. Nevertheless, the mechanisms leading to raised control of seizures with KD are less clear.

Several studies suggest that KD affects the degrees of neurotransmitters involved in seizure onset. As an illustration, gamma-aminobutyric acid (GABA) activity might increase in those following a KD.

It has been proposed that KD enhances glycolytic production of adenosine triphosphate (ATP), and the lower glucose utilization by the brain induces ATP-sensitive potassium channels, elevating epileptic threshold and decreasing seizures.

Furthermore, others postulate that KD can exert neuroprotective actions by calbindin upregulation, inhibition of apoptotic aspects, and increasing kynurenic acid levels.

A study revealed that seizure reduction was above 50% in 92% of pediatric cases following KD; notably, two-thirds of patients didn’t use anti-epileptic medications. Studies have also demonstrated its efficacy in children with Doose syndrome, infantile spasm, tuberous sclerosis complex, or pyruvate dehydrogenase deficiency.

Moreover, several trials have shown the effectiveness of KD in obesity treatment. Meta-analyses have reported the advantages of a low-carbohydrate food plan on weight reduction.

Furthermore, decreasing intake of carbohydrates has been shown to cut back cholesterol, diastolic blood pressure, and triglycerides while increasing high-density lipoprotein.

These advantages might stem from KD-related mechanisms, including appetite suppression by ketones or through reduced appetite as a consequence of increased ghrelin, cholecystokinin, and glucagon-like peptide 1. Moreover, KDs restrict the metabolism of cancer cells by decreasing glucose levels, which cannot process ketone bodies.

Besides, the reduced glucose levels suppress the pyruvate/lactate cycle that blocks neovascularization, angiogenesis, and hypoxia-induced epidermal growth factor activation.

Furthermore, higher ketone body levels could inhibit the NLR family pyrin domain containing 3 (NLRP3) inflammasome, limiting inflammation. Nevertheless, clinical trials assessing the efficacy of KDs in pediatric cancer patients are lacking.

KD, epilepsy, and gut microbiota

Several studies have reported changes within the gut microbiota of people following KD. The modulation of colonic bacteria appears to have a direct role within the anti-seizure effects of KD in pediatric epilepsy cases.

Epileptic children exhibit gut microbiota changes which will potentially result in the event or exacerbation of seizures.

Quite a few studies have examined the connection between gut microbiota and epilepsy, emphasizing the consequences of KD on the gut microbiota. Although still an lively area of research in pediatric epileptic cases, studies point to a big impact of KD on gut microbial composition and performance.

The everyday effects of KD include reductions in BMI, serum glucose levels, and ketosis. These are related to increased levels of useful bacteria, akin to Escherichia coli, Parabacteroides, and Akkermansia muciniphila, within the gut. Meanwhile, pro-inflammatory species, including Proteobacteria and Desulfovibrio, appear to say no with KD.

A trial showed that KD reduced the abundance of Bifidobacterium, which was attributed to increased ketone body production (chiefly, β-hydroxybutyrate), leading to lower T helper 17 (Th17) cells in visceral and intestinal fat.

This is important provided that obesity and insulin resistance are characterised by low-grade inflammation, and lowering Th17 cells may help reverse the method.

Concluding remarks

Together, the study highlighted the potential of KDs and the gut microbiota as a brand new disease prevention and treatment avenue. Notably, the available evidence and long-term effects (of KD) in children are limited.

Besides, it is important to know the potential risks of adhering to a food plan wealthy in fat and proteins but low in carbohydrates.

As KDs gain popularity amongst youth for weight reduction, their effects on the gut microbiota and dietary status warrant additional research for a more sustainable approach to medical nutrition.