A new review explores why it could work, what precautions to take, and the many unknowns left to address.
Word is spreading among patients with heart failure (HF) that going on a ketogenic diet could aid their health, even though the evidence supporting benefit over risk is still in the early stages. A new review article, recently published online in JACC: Heart Failure, is making the case that HF specialists should be aware of what the literature does—and doesn’t—say, and be prepared to guide their patients along the way if they choose to pursue this path.
There are some scientific underpinnings behind the idea that a ketogenic diet, originally created to treat epilepsy but now seen by many as a tool for weight loss and glycemic control, could be beneficial in heart failure.
“The failing heart increases oxidation of ketone bodies to meet its energy demands, so it is conceivable that the ketogenic diet could aid the failing heart by boosting the supply of ketone bodies. Moreover, the ketogenic diet could ameliorate HF by improving overall metabolic health, including body weight, lipid profile, glycemic control, and blood pressure,” the paper notes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors, a mainstay of HF therapy, also increase the liver’s production of ketones, which some say may explain some of their cardioprotective effects.
“Patients and physicians alike really kind of recognize some of these evolving concepts,” senior author W.H. Wilson Tang, MD (Cleveland Clinic, OH), told TCTMD. Their review is meant to clarify how a ketogenic diet might work in heart failure, with an exploration of mechanisms as well as possible pitfalls, he said. “These are the things that patients come and ask us all the time: ‘Doctor, should I be on a ketogenic diet?’”
Some data suggest the eating pattern can increase both LDL cholesterol and adverse cardiovascular events. Still, grocery stores are filled with products labeled as keto, Tang pointed out. On this backdrop, the co-authors thought it was important to dig into whether a ketogenic diet could play a role in HF management.
Indeed, the concept is not without…