Metabolic Componant

This section reflects other conditions that appear to have a metabolic component. The conditions listed in the contents are emergent in terms of the evidence – they may have features of metabolic dysregulation that respond to therapeutic carbohydrate restriction.


This section should be considered as emergent in terms of the evidence and the role of diet as supportive.

Background and reviews

  1. Lane J, Brown NI, Williams S, Plaisance EP, Fontaine KR. Ketogenic Diet for Cancer: Critical Assessment and Research Recommendations. Nutrients. 2021;13(10):3562. doi:10.3390/nu13103562
  2. Amanollahi, A. et al. (2022) ‘Effect of Ketogenic Diets on Cardio-Metabolic Outcomes in Cancer Patients: A Systematic Review and Meta-Analysis of Controlled Clinical Trials’, Nutrition and Cancer, 75(1), pp. 95–111. Available at:
  3. Shingler E, Perry R, Mitchell A, et al. Dietary restriction during the treatment of cancer: results of a systematic scoping review. BMC Cancer. 2019;19(1):811. doi:10.1186/s12885-019-5931-7
  4. Römer M, Dörfler J, Huebner J. The use of ketogenic diets in cancer patients: a systematic review. Clin Exp Med. Published online April 3, 2021. doi:10.1007/s10238-021-00710-2
  5. Talib WH, Mahmod AI, Kamal A, et al. Ketogenic Diet in Cancer Prevention and Therapy: Molecular Targets and Therapeutic Opportunities. Current Issues in Molecular Biology. 2021;43(2):558-589. doi:10.3390/cimb43020042
  6. Neha and Chaudhary, R. (2024) ‘Ketogenic Diet as a Treatment and Prevention Strategy for Cancer: A Therapeutic Alternative’, Nutrition, p. 112427. Available at:
  7. Mittelman SD. The Role of Diet in Cancer Prevention and Chemotherapy Efficacy. Annu Rev Nutr. Published online June 16, 2020. doi:10.1146/annurev-nutr-013120-041149  PDF
  8. Klement RJ. Addressing the controversial role of ketogenic diets in cancer treatment. Expert Review of Anticancer Therapy. 2020;0(0):1-4. doi:10.1080/14737140.2020.1747438
  9. Weber DD, Aminzadeh-Gohari S, Tulipan J, Catalano L, Feichtinger RG, Kofler B. Ketogenic diet in the treatment of cancer – Where do we stand? Molecular Metabolism. July 2019. doi:10.1016/j.molmet.2019.06.026
  10. Chung H-Y, Park YK. Rationale, Feasibility and Acceptability of Ketogenic Diet for Cancer Treatment. J Cancer Prev. 2017;22(3):127-134. doi:10.15430/JCP.2017.22.3.127 
  11. O’Flanagan CH, Smith LA, McDonell SB, Hursting SD. When less may be more: calorie restriction and response to cancer therapy. BMC Medicine. 2017;15. doi:10.1186/s12916-017-0873-x 
  12. Modified Atkins diet in advanced malignancies – final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System. 2016. doi:10.1186/s12986-016-0113-y 
  13. Klement RJ. Wilhelm Brünings’ forgotten contribution to the metabolic treatment of cancer utilizing hypoglycemia and a very low carbohydrate (ketogenic) diet. Journal of Traditional and Complementary Medicine. 2019;9(3):192-200. doi:10.1016/j.jtcme.2018.06.002
  14. Tulipan J, Kofler B. Implementation of a Low-Carbohydrate Diet Improves the Quality of Life of Cancer Patients – An Online Survey. Front Nutr. 2021;8:661253. doi:10.3389/fnut.2021.661253
  15. Cortez NE, Mackenzie GG. Ketogenic Diets in Pancreatic Cancer and Associated Cachexia: Cellular Mechanisms and Clinical Perspectives. Nutrients. 2021;13(9):3202. doi:10.3390/nu13093202
  16. Shen, S., Iyengar, N.M., 2022. Insulin-Lowering Diets in Metastatic Cancer. Nutrients 14, 3542.


  1. Lin C-J, Chang Y-C, Cheng T-Y, Lo K, Liu S-J, Yeh TL. The association between metabolically healthy obesity and risk of cancer: A systematic review and meta-analysis of prospective cohort studies. Obesity Reviews. n/a(n/a). doi:10.1111/obr.13049 ABSTRACT
  2. Christensen RAG, Kirkham AA. Time-Restricted Eating: A Novel and Simple Dietary Intervention for Primary and Secondary Prevention of Breast Cancer and Cardiovascular Disease. Nutrients. 2021;13(10):3476. doi:10.3390/nu13103476
  3. Klement, R.J., Kämmerer, U. Is there a role for carbohydrate restriction in the treatment and prevention of cancer?. Nutr Metab (Lond) 8, 75 (2011). 
  4. Srinivasan, M. et al. (2022) ‘A Systematic Review: Does Insulin Resistance Affect the Risk and Survival Outcome of Breast Cancer in Women?’, Cureus, 14(1). doi:10.7759/cureus.21712.
  5. Rubinstein MM, Brown KA, Iyengar NM. Targeting obesity-related dysfunction in hormonally driven cancers. British Journal of Cancer. Published online April 28, 2021:1-15. doi:10.1038/s41416-021-01393-y
  6. Soldati L, Di Renzo L, Jirillo E, Ascierto PA, Marincola FM, De Lorenzo A. The influence of diet on anti-cancer immune responsiveness. J Transl Med. 2018;16. doi:10.1186/s12967-018-1448-0 
  7. Koo D-H, Han K-D, Park C-Y. The Incremental Risk of Pancreatic Cancer According to Fasting Glucose Levels: Nationwide Population-Based Cohort Study. None. 2019;104(10):4594-4599. doi:10.1210/jc.2019-00033
  8. Augustin LSA, Taborelli M, Montella M, et al. Associations of dietary carbohydrates, glycaemic index and glycaemic load with risk of bladder cancer: a case-control study. Br J Nutr. 2017;118(9):722-729. doi:10.1017/S0007114517002574 PDF 
  9. Sun B, Karin M. Obesity, inflammation, and liver cancer. Journal of Hepatology.2012; vol.56: 704–713 PDF 
  10. Sadeghi A, Sadeghian M, Nasiri M, et al. Carbohydrate quantity and quality affect the risk of endometrial cancer: A systematic review and dose-response meta-analysis. Clinical Nutrition. August 2019. doi:10.1016/j.clnu.2019.08.001

Brain/CNS Malignancies

  1. Winter SF, Loebel F, Dietrich J. Role of ketogenic metabolic therapy in malignant glioma: A systematic review. Crit Rev Oncol Hematol. 2017;112:41-58. doi:10.1016/j.critrevonc.2017.02.016 ABSTRACT
  2. Amaral, L. et al. (2023) ‘The ketogenic diet plus standard of care for adults with recently diagnosed glioblastoma: Results from a phase 1 trial.’, Journal of Clinical Oncology, 41(16_suppl), pp. 2076–2076. Available at: ABSTRACT
  3. Voss M, Wenger KJ, von Mettenheim N, et al. Short-term fasting in glioma patients: analysis of diet diaries and metabolic parameters of the ERGO2 trial. Eur J Nutr. Published online September 6, 2021. doi:10.1007/s00394-021-02666-1
  4. Smith, K.A., Hendricks, B.K., DiDomenico, J.D., Conway, B.N., Smith, T.L., Azadi, A., Fonkem, E., n.d. Ketogenic Metabolic Therapy for Glioma. Cureus 14, e26457.
  5. Panhans CM, Gresham G, Amaral JL, Hu J. Exploring the Feasibility and Effects of a Ketogenic Diet in Patients With CNS Malignancies: A Retrospective Case Series. Front Neurosci. 2020;14. doi:10.3389/fnins.2020.00390
  6. Woodhouse C, Ward T, Gaskill-Shipley M, Chaudhary R. Feasibility of a modified Atkins diet in glioma patients during radiation and its effect on radiation sensitization. Current Oncology. 2019;26(4). doi:10.3747/co.26.4889
  7. Santos J G, Faria G, Da Cruz Souza Da Cruz W, Fontes C A, Schönthal A H, Quirico-Santos T, da Fonseca C O. Adjuvant effect of low-carbohydrate diet on outcomes of patients with recurrent glioblastoma under intranasal perillyl alcohol therapy. 11-Nov-2020;11:389. doi:10.25259/SNI_445_2020
  8. Schwartz KA, Noel M, Nikolai M, Chang HT. Investigating the Ketogenic Diet As Treatment for Primary Aggressive Brain Cancer: Challenges and Lessons Learned. Front Nutr. 2018;5. doi:10.3389/fnut.2018.00011
  9. Elsakka AMA, Bary MA, Abdelzaher E, et al. Management of Glioblastoma Multiforme in a Patient Treated With Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up. Front Nutr. 2018;5. doi:10.3389/fnut.2018.00020
  10. Woolf EC, Syed N, Scheck AC. Tumor Metabolism, the Ketogenic Diet and β-Hydroxybutyrate: Novel Approaches to Adjuvant Brain Tumor Therapy. Front Mol Neurosci. 2016;9:122. doi:10.3389/fnmol.2016.00122
  11. Varshneya K, Carico C, Ortega A, Patil CG. The Efficacy of Ketogenic Diet and Associated Hypoglycemia as an Adjuvant Therapy for High-Grade Gliomas: A Review of the Literature. Cureus. 2015;7(2). doi:10.7759/cureus.251 
  12. Abdelwahab MG, Fenton KE, Preul MC, et al. The Ketogenic Diet Is an Effective Adjuvant to Radiation Therapy for the Treatment of Malignant Glioma. PLOS ONE. 2012;7(5):e36197. doi:10.1371/journal.pone.0036197
  13. Rieger J, Bähr O, Maurer GD, et al. ERGO: A pilot study of ketogenic diet in recurrent glioblastoma.  INTERNATIONAL JOURNAL OF ONCOLOGY 44:  1843-1852, 201. doi: 10.3892/ijo.2014.2382 PDF
  14. van der Louw EJTM, Olieman JF, van den Bemt PMLA, et al. Ketogenic diet treatment as adjuvant to standard treatment of glioblastoma multiforme: a feasibility and safety study. Ther Adv Med Oncol. 2019;11:1758835919853958. doi:10.1177/1758835919853958  
  15. Seyfried TN, Marsh J, Shelton LM, Huysentruyt LC, Mukherjee P. Is the restricted ketogenic diet a viable alternative to the standard of care for managing malignant brain cancer? 2012;100(3):310-326. doi:10.1016/j.eplepsyres.2011.06.017   PDF
  16. Meidenbaueret al. The glucose ketone index calculator: a simple tool to monitor therapeutic efficacy for metabolic management of brain cancer. Nutrition & Metabolism (2015) 12:12 doi:10.1186/s12986-015-0009-2 

Case Reports

  1. Phillips, M. et al. (2024) ‘Ketogenic metabolic therapy in conjunction with standard treatment for glioblastoma: A case report’, Oncology Letters, 27. Available at:
  2. Seyfried TN, Shivane AG, Kalamian M, Maroon JC, Mukherjee P, Zuccoli G. Ketogenic Metabolic Therapy, Without Chemo or Radiation, for the Long-Term Management of IDH1-Mutant Glioblastoma: An 80-Month Follow-Up Case Report. Front Nutr. 2021;8. doi:10.3389/fnut.2021.682243
  3. Tóth C, Dabóczi A, Chanrai M, Schimmer M, Horváth K, Clemens Z. 4-Year Long Progression-Free and Symptom-Free Survival of a Patient with Recurrent Glioblastoma Multiforme: A Case Report of the Paleolithic Ketogenic Diet (PKD) Used as a Stand-Alone Treatment After Failed Standard Oncotherapy. Published online November 9, 2020. doi:10.20944/preprints201912.0264.v2   (Alternative version with additional details)
  4. Tóth C, Dabóczi A, Chanrai M, Schimmer M, Clemens Z. 38-Month Long Progression-Free and Symptom-Free Survival of a Patient with Recurrent Glioblastoma Multiforme: A Case Report of the Paleolithic Ketogenic Diet (PKD) Used as a Stand-Alone Treatment after Failed Standard Oncotherapy.; 2019. doi:10.13140/RG.2.2.29464.55047
  5. Schwartz K, Chang HT, Nikolai M, et al. Treatment of glioma patients with ketogenic diets: report of two cases treated with an IRB-approved energy-restricted ketogenic diet protocol and review of the literature. Cancer & Metabolism. 2015;3(1):3. doi:10.1186/s40170-015-0129-1 
  6. Zuccoli G, Marcello N, Pisanello A, et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report. Nutr Metab (Lond). 2010;7:33. doi:10.1186/1743-7075-7-33

Cancer - Women

  1. Urzì, A.G. et al. (2023) ‘Ketogenic Diet and Breast Cancer: Recent Findings and Therapeutic Approaches’, Nutrients, 15(20), p. 4357. Available at:
  2. Jemal, M., Molla, T.S. and Dejenie, T.A. (2021) ‘Ketogenic Diets and their Therapeutic Potential on Breast Cancer: A Systemic Review’, Cancer Management and Research, 13, pp. 9147–9155. doi:10.2147/CMAR.S339970.
  3. Cohen CW, Fontaine KR, Arend RC, Gower BA. A Ketogenic Diet Is Acceptable in Women with Ovarian and Endometrial Cancer and Has No Adverse Effects on Blood Lipids: a Randomized, Controlled Trial. Nutrition and Cancer. 2019;0(0):1-11. doi:10.1080/01635581.2019.1645864
  4. Cohen CW, Fontaine KR, Arend RC, Soleymani T, Gower BA. Favorable Effects of a Ketogenic Diet on Physical Function, Perceived Energy, and Food Cravings in Women with Ovarian or Endometrial Cancer: A Randomized, Controlled Trial. Nutrients. 2018;10(9). doi:10.3390/nu10091187 
  5. Kämmerer U, Klement RJ, Joos FT, Sütterlin M, Reuss-Borst M. Low Carb and Ketogenic Diets Increase Quality of Life, Physical Performance, Body Composition, and Metabolic Health of Women with Breast Cancer. Nutrients. 2021;13(3):1029. doi:10.3390/nu13031029
  6. Klement RJ, Champ CE, Kämmerer U, et al. Impact of a ketogenic diet intervention during radiotherapy on body composition: III—final results of the KETOCOMP study for breast cancer patients. Breast Cancer Research. 2020;22(1):94. doi:10.1186/s13058-020-01331-5
  7. Buga, A. et al. (2024) ‘Feasibility and metabolic outcomes of a well-formulated ketogenic diet as an adjuvant therapeutic intervention for women with stage IV metastatic breast cancer: The Keto-CARE trial’, PLOS ONE, 19(1), p. e0296523. Available at:
  8. Khodabakhshi A, Akbari ME, Mirzaei HR, Mehrad-Majd H, Kalamian M, Davoodi SH. Feasibility, Safety, and Beneficial Effects of MCT-Based Ketogenic Diet for Breast Cancer Treatment: A Randomized Controlled Trial Study. Nutr Cancer. September 2019:1-8. doi:10.1080/01635581.2019.1650942  (see review by Römer et al.  for suggested limitations of findings)
  9. Buono G, Crispo A, Giuliano M, et al. Metabolic syndrome and early stage breast cancer outcome: results from a prospective observational study. Breast Cancer Res Treat. Published online June 4, 2020. doi:10.1007/s10549-020-05701-7
  10. de Groot S, Lugtenberg RT, Cohen D, et al. Fasting mimicking diet as an adjunct to neoadjuvant chemotherapy for breast cancer in the multicentre randomized phase 2 DIRECT trial. Nature Communications. 2020;11(1):3083. doi:10.1038/s41467-020-16138-3
  11. Omar, E.M., Omran, G.A., Mustafa, M.F., El-Khodary, N.M., 2022. Intermittent fasting during adjuvant chemotherapy may promote differential stress resistance in breast cancer patients. Journal of the Egyptian National Cancer Institute 34, 38.
  12. İyikesici MS, Slocum AK, Winters N, Kalamian M, Seyfried TN. Metabolically Supported Chemotherapy for Managing End-Stage Breast Cancer: A Complete and Durable Response. Cureus. 13(4). doi:10.7759/cureus.14686
  13. İyikesici MS, Slocum AK, Slocum A, Berkarda FB, Kalamian M, Seyfried TN. Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer. Cureus. 2017;9(7). doi:10.7759/cureus.1445
  14. Ahn HR, Kang SY, Youn HJ, Jung SH. Hyperglycemia during Adjuvant Chemotherapy as a Prognostic Factor in Breast Cancer Patients without Diabetes. Journal of Breast Cancer. 2020;23(4):398-409. doi:10.4048/jbc.2020.23.e44
  15. Tóth C, Schimmer M, Clemens Z. Complete Cessation of Recurrent Cervical Intraepithelial Neoplasia (CIN) by the Paleolithic Ketogenic Diet: A Case Report. Journal of Cancer Research and Treatment. 2018;6:1-5. doi:10.12691/jcrt-6-1-1
  16. Branca JJV, Pacini S, Ruggiero M. Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer. Anticancer Res. 2015;35(10):5525-5532. PDF
  17. Klement RJ, Weigel MM, Sweeney RA. A ketogenic diet consumed during radiotherapy improves several aspects of quality of life and metabolic health in women with breast cancer. Clinical Nutrition. Published online January 27, 2021. doi:10.1016/j.clnu.2021.01.023
  18. Ozveren, A. et al. (2023) ‘The Close Relationship Between Metabolic Syndrome and Hormone Receptor-Positive Early-Stage Breast Cancer’, Integrative Cancer Therapies, 22, p. 15347354231165938. Available at:

Cancer - Paediatric

  1. Almutairi, H. et al. (2023) ‘Safety, feasibility, and effectiveness of ketogenic diet in paediatric patients with brain tumours: A systematic revie’. Available at:
  2. Nebeling LC, Lerner E. Implementing A Ketogenic Diet Based on Medium-chain Triglyceride Oil in Pediatric Patients with Cancer. Journal of the American Dietetic Association. 1995;95(6):693-697. doi:10.1016/S0002-8223(95)00189-1 ABSTRACT
  3. Perez A, Louw E van der, Nathan J, et al. Ketogenic diet treatment in diffuse intrinsic pontine glioma in children: Retrospective analysis of feasibility, safety, and survival data. Cancer Reports. n/a(n/a):e1383. doi:    PDF
  4. Nebeling LC, Miraldi F, Shurin SB, Lerner E. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. Journal of the American College of Nutrition. 1995;14(2):202-208. doi:10.1080/07315724.1995.10718495 ABSTRACT
  5. Diorio C, Kelly KM, Afungchwi GM, Ladas EJ, Marjerrison S. Nutritional traditional and complementary medicine strategies in pediatric cancer: A narrative review. Pediatr Blood Cancer. 2020;67 Suppl 3:e28324. doi:10.1002/pbc.28324

Cancer - Other Trials

  1. Hagihara K, Kajimoto K, Osaga S, et al. Promising Effect of a New Ketogenic Diet Regimen in Patients with Advanced Cancer. Nutrients. 2020;12(5):1473. doi:10.3390/nu12051473
  2. Augustus E, Granderson I, Rocke KD. The Impact of a Ketogenic Dietary Intervention on the Quality of Life of Stage II and III Cancer Patients: A Randomized Controlled Trial in the Caribbean. Nutr Cancer. Published online August 13, 2020:1-11. doi:10.1080/01635581.2020.1803930 ABSTRACT
  3. Iyikesici MS. Long-Term Survival Outcomes of Metabolically Supported Chemotherapy with Gemcitabine-Based or FOLFIRINOX Regimen Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy in Metastatic Pancreatic Cancer. Complement Med Res. September 2019:1-9. doi:10.1159/000502135
  4. Ligorio, F., Fucà, G., Provenzano, L., Lobefaro, R., Zanenga, L., Vingiani, A., Belfiore, A., Lorenzoni, A., Alessi, A., Pruneri, G., de Braud, F., Vernieri, C., 2022. Exceptional tumour responses to fasting-mimicking diet combined with standard anticancer therapies: A sub-analysis of the NCT03340935 trial. Eur J Cancer 172, 300–310.
  5. Iyikesici MS. Feasibility study of metabolically supported chemotherapy with weekly carboplatin/paclitaxel combined with ketogenic diet, hyperthermia and hyperbaric oxygen therapy in metastatic non-small cell lung cancer. Int J Hyperthermia. 2019;36(1):446-455. doi:10.1080/02656736.2019.1589584
  6. Klement RJ, Meyer D, Kanzler S, Sweeney RA. Ketogenic diets consumed during radio-chemotherapy have beneficial effects on quality of life and metabolic health in patients with rectal cancer. Eur J Nutr. Published online June 27, 2021. doi:10.1007/s00394-021-02615-y    PDF
  7. Klement RJ, Schäfer G, Sweeney RA. A ketogenic diet exerts beneficial effects on body composition of cancer patients during radiotherapy: An interim analysis of the KETOCOMP study. Journal of Traditional and Complementary Medicine. March 2019. doi:10.1016/j.jtcme.2019.03.007
  8. Klement RJ, Koebrunner PS, Meyer D, Kanzler S, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: IV. Final results of the KETOCOMP study for rectal cancer patients. Clinical Nutrition. Published online May 31, 2021. doi:10.1016/j.clnu.2021.05.015 ABSTRACT
  9. Iyikesici MS. Survival outcomes of metabolically supported chemotherapy combined with ketogenic diet, hyperthermia, and hyperbaric oxygen therapy in advanced gastric cancer. Niger J Clin Pract. 2020;23(5):734-740. doi:10.4103/njcp.njcp_509_18
  10. Chi J-T, Lin P-H, Tolstikov V, et al. The influence of low-carbohydrate diets on the metabolic response to androgen-deprivation therapy in prostate cancer. Prostate. Published online May 5, 2021. doi:10.1002/pros.24136
  11. Freedland SJ, Allen J, Jarman A, et al. A Randomized Controlled Trial of a 6-Month Low-Carbohydrate Intervention on Disease Progression in Men with Recurrent Prostate Cancer: Carbohydrate and Prostate Study 2 (CAPS2). Clin Cancer Res. 2020;26(12):3035-3043. doi:10.1158/1078-0432.CCR-19-3873
  12. Kaiser A, Haskins C, Siddiqui MM, Hussain A, D’Adamo C. The evolving role of diet in prostate cancer risk and progression. Curr Opin Oncol. 2019;31(3):222-229. doi:10.1097/CCO.0000000000000519 ABSTRACT
  13. Arthur AE, Goss AM, Demark‐Wahnefried W, et al. Higher carbohydrate intake is associated with increased risk of all-cause and disease-specific mortality in head and neck cancer patients: results from a prospective cohort study. International Journal of Cancer. 2018;143(5):1105-1113. doi:10.1002/ijc.31413 ABSTRACT
  14. Furukawa K, Shigematsu K, Katsuragawa H, Tezuka T, Hataji K. Investigating the effect of chemotherapy combined with ketogenic diet on stage IV colon cancer. JCO. 2019;37(15_suppl):e15182-e15182. doi:10.1200/JCO.2019.37.15_suppl.e15182   ABSTRACT
  15. Chi, J.-T. et al. (2022) ‘Serum metabolomic analysis of men on a low-carbohydrate diet for biochemically recurrent prostate cancer reveals the potential role of ketogenesis to slow tumor growth: a secondary analysis of the CAPS2 diet trial’, Prostate Cancer and Prostatic Diseases [Preprint]. doi:10.1038/s41391-022-00525-6.
  16. Lin, P.-H., Howard, L. and Freedland, S.J. (2022) ‘Weight loss via a low-carbohydrate diet improved the intestinal permeability marker, zonulin, in prostate cancer patients’, Annals of Medicine, 54(1), pp. 1221–1225. doi:10.1080/07853890.2022.2069853.

Cancer - Other Case studies

  1. Jansen N, Walach H. The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice. Oncology Letters. 2016;11(1):584-592. doi:10.3892/ol.2015.3923
  2. Schmidt M, Pfetzer N, Schwab M, Strauss I, Kaemmerer U. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: a pilot train. Nutrition & Metabolism. 2011,8:54 PDF  
  3. Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Research Notes. 2016;9(1):143. doi:10.1186/s13104-016-1959-9
  4. Tóth C, Clemens Z. Recurrent tumor of the main bronchus successfully managed with the paleolithic ketogenic diet. 2021. 
  5. Phillips MCL, Murtagh DKJ, Sinha SK, Moon BG. Managing Metastatic Thymoma With Metabolic and Medical Therapy: A Case Report. Front Oncol. 2020;10. doi:10.3389/fonc.2020.00578
  6. Tóth C, Clemens Z. Treatment of Rectal Cancer with the Paleolithic Ketogenic Diet: A 24-months Follow-up. American Journal of Medical Case Reports. 2017;5:205-216. doi:10.12691/ajmcr-5-8-3
  7. Tóth C, Clemens Z. Halted Progression of Soft Palate Cancer in a Patient Treated with the Paleolithic Ketogenic Diet Alone: A 20-months Follow-up. American Journal of Medical Case Reports.:6. 2016 PDF
  8. Klement RJ. Restricting carbohydrates to fight head and neck cancer—is this realistic? Cancer Biology & Medicine. 2014;11(3):145-161-161. doi:10.7497/j.issn.2095-3941.2014.03.001
  9. Evangeliou, A.E., Spilioti, M.G., Vassilakou, D., Goutsaridou, F., Seyfried, T.N., 2022. Restricted Ketogenic Diet Therapy for Primary Lung Cancer With Metastasis to the Brain: A Case Report. Cureus 14.

Fasting and Cancer

  1. de Groot S, Pijl H, van der Hoeven JJM, Kroep JR. Effects of short-term fasting on cancer treatment. J Exp Clin Cancer Res. 2019;38. doi:10.1186/s13046-019-1189-9      
  2. Turbitt WJ, Demark-Wahnefried W, Peterson CM, Norian LA. Targeting Glucose Metabolism to Enhance Immunotherapy: Emerging Evidence on Intermittent Fasting and Calorie Restriction Mimetics. Front Immunol. 2019;10. doi:10.3389/fimmu.2019.01402        
  3. Bauersfeld SP, Kessler CS, Wischnewsky M, et al. The effects of short-term fasting on quality of life and tolerance to chemotherapy in patients with breast and ovarian cancer: a randomized cross-over pilot study. BMC Cancer. 2018;18. doi:10.1186/s12885-018-4353-2     
  4. Wilson RL, Kang D-W, Christopher CN, Crane TE, Dieli-Conwright CM. Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions. Nutrients. 2021;13(10):3421. doi:10.3390/nu13103421
  5. Zhang J, Deng Y, Khoo BL. Fasting to enhance Cancer treatment in models: the next steps. Journal of Biomedical Science. 2020;27(1):58. doi:10.1186/s12929-020-00651-0
  6. Antunes F, Erustes AG, Costa AJ, et al. Autophagy and intermittent fasting: the connection for cancer therapy? Clinics (Sao Paulo). 2018;73. doi:10.6061/clinics/2018/e814s    
  7. Klement RJ. Fasting, Fats, and Physics: Combining Ketogenic and Radiation Therapy against Cancer. CMR. 2018;25(2):102-113. doi:10.1159/000484045    
  8. Fanale D, Maragliano R, Perez A, Russo A. Effects of Dietary Restriction on Cancer Development and Progression. In: Preedy V, Patel VB, eds. Handbook of Famine, Starvation, and Nutrient Deprivation: From Biology to Policy. Cham: Springer International Publishing; 2017:1-19. doi:10.1007/978-3-319-40007-5_72-1    
  9. Marinac CR, Nelson SH, Breen CI, et al. Prolonged Nightly Fasting and Breast Cancer Prognosis. JAMA Oncol. 2016;2(8):1049-1055. doi:10.1001/jamaoncol.2016.0164
  10. Dorff TB, Groshen S, Garcia A, et al. Safety and feasibility of fasting in combination with platinum-based chemotherapy. BMC Cancer. 2016;16. doi:10.1186/s12885-016-2370-6 
  11. de Groot S, Vreeswijk MP, Welters MJ, et al. The effects of short-term fasting on tolerance to (neo) adjuvant chemotherapy in HER2-negative breast cancer patients: a randomized pilot study. BMC Cancer. 2015;15. doi:10.1186/s12885-015-1663-5
  12. Zorn S, Ehret J, Schäuble R, et al. Impact of modified short-term fasting and its combination with a fasting supportive diet during chemotherapy on the incidence and severity of chemotherapy-induced toxicities in cancer patients – a controlled cross-over pilot study. BMC Cancer. 2020;20(1):578. doi:10.1186/s12885-020-07041-7
  13. Gabriel, S. et al. (2024) ‘Prolonged water-only fasting in the management of low-grade follicular lymphoma: a case series’, Journal of Medical Case Reports, 18, p. 302. Available at:  
  14. Raffaghello L, Safdie F, Bianchi G, Dorff T, Fontana L, Longo VD. Fasting and differential chemotherapy protection in patients. Cell Cycle.9,22. 4474-4476. (2010) PDF
  15. Christensen RAG, Kirkham AA. Time-Restricted Eating: A Novel and Simple Dietary Intervention for Primary and Secondary Prevention of Breast Cancer and Cardiovascular Disease. Nutrients. 2021;13(10):3476. doi:10.3390/nu13103476
  16. Kleckner A, Reschke JE, Altman BJ, et al. A 10-hour time-restricted eating intervention to address cancer-related fatigue among cancer survivors. JCO. 2021;39(15_suppl):12109-12109. doi:10.1200/JCO.2021.39.15_suppl.12109 ABSTRACT
  17. Kirkham, A.A. et al. (2021) ‘Abstract 12484: Weekday 16:8 Time-Restricted Eating in Breast Cancer Survivors: Feasibility, Safety, and Effects on Cardiometabolic Health’, Circulation, 144(Suppl_1), pp. A12484–A12484. doi:10.1161/circ.144.suppl_1.12484 ABSTRACT
Media Links
  1. Diet Doctor Podcast – #34 – Dr. Nasha Winters 
  2. Diet Doctor Podcast – #44 – Angela Poff, PhD

Pain and Inflammation

  1. Kazeminasab, F. et al. (2024) ‘Effects of low-carbohydrate diets, with and without caloric restriction, on inflammatory markers in adults: a systematic review and meta-analysis of randomized clinical trials’, European Journal of Clinical Nutrition [Preprint]. Available at: ABSTRACT 
  2. Ji, J. et al. (2024) ‘The effect of a ketogenic diet on inflammation-related markers: a systematic review and meta-analysis of randomized controlled trials’, Nutrition Reviews, p. nuad175. Available at: ABSTRACT
  3. Neudorf, H. and Little, J.P. (2024) ‘Impact of fasting & ketogenic interventions on the NLRP3 inflammasome: A narrative review’, Biomedical Journal, 47(1), p. 100677. Available at:
  4. Gyorkos A, Baker MH, Miutz LN, Lown DA, Jones MA, Houghton-Rahrig LD. Carbohydrate-restricted Diet and High-intensity Interval Training Exercise Improve Cardio-metabolic and Inflammatory Profiles in Metabolic Syndrome: A Randomized Crossover Trial. Cureus. 11(9). doi:10.7759/cureus.5596
  5. Jonasson L, Guldbrand H, Lundberg AK, Nystrom FH. Advice to follow a low-carbohydrate diet has a favourable impact on low-grade inflammation in type 2 diabetes compared with advice to follow a low-fat diet. Ann Med. 2014;46(3):182-187. doi:10.3109/07853890.2014.894286 
  6. Phinney S, Adams R, Athinarayanan S, McKenzie A, Volek J. SAT-LB125 Broad Spectrum Effects of a Ketogenic Diet Delivered by Remote Continuous Care on Inflammation and Immune Modulators in Type 2 Diabetes and Prediabetes. J Endocr Soc. 2020;4(Supplement_1). doi:10.1210/jendso/bvaa046.2319    (5 year data
  7. Monda V, Polito R, Lovino A, et al. Short-Term Physiological Effects of a Very Low-Calorie Ketogenic Diet: Effects on Adiponectin Levels and Inflammatory States. International Journal of Molecular Sciences. 2020;21(9):3228. doi:10.3390/ijms21093228
  8. Ciaffi, J. et al. (2023) ‘Efficacy, safety and tolerability of very low-calorie ketogenic diet in obese women with fibromyalgia: a pilot interventional study’, Frontiers in Nutrition, 10. Available at:
    Kim, E.R. et al. (2022) ‘Short Term Isocaloric Ketogenic Diet Modulates NLRP3 Inflammasome Via B-hydroxybutyrate and Fibroblast Growth Factor 21’, Frontiers in Immunology, 13, p. 843520. doi:10.3389/fimmu.2022.843520.
  9. Ruth MR, Port AM, Shah M, et al. Consuming a hypocaloric high fat low carbohydrate diet for 12 weeks lowers C-reactive protein, and raises serum adiponectin and high density lipoprotein-cholesterol in obese subjects. Metab Clin Exp. 2013;62(12):1779-1787. doi:10.1016/j.metabol.2013.07.006  PDF
  10. Cipryan L, Dostal T, Plews DJ, Hofmann P, Laursen PB. Adiponectin-leptin ratio increases after a 12-week very low-carbohydrate, high-fat diet and exercise training in healthy individuals: A non-randomized, parallel-group study. Nutrition Research. Published online December 10, 2020. doi:10.1016/j.nutres.2020.12.012
  11. Barrea, L. et al. (2022) ‘Phase angle as an easy diagnostic tool for the nutritionist in the evaluation of inflammatory changes during the active stage of a very low-calorie ketogenic diet’, International Journal of Obesity (2005) [Preprint]. doi:10.1038/s41366-022-01152-w.
  12. Rashid T, Wilson C, Ebringer A. The Link between Ankylosing Spondylitis, Crohn’s Disease, Klebsiella, and Starch Consumption. Journal of Immunology Research. doi:10.1155/2013/872632
  13. Phillips MCL, Murtagh DKJ, Ziad F, Johnston SE, Moon BG. Impact of a Ketogenic Diet on Sporadic Inclusion Body Myositis: A Case Study. Front Neurol. 2020;11. doi:10.3389/fneur.2020.582402


  1. Field, R.J. et al. (2021) ‘Experience of participants with chronic pain in a pilot randomized clinical trial using a ketogenic diet’, Pain Management [Preprint]. doi:10.2217/pmt-2021-0084 ABSTRACT
  2. Field R, Pourkazemi F, Rooney K. Effects of a low-carbohydrate ketogenic diet on reported pain, blood biomarkers and quality of life in patients with chronic pain: A pilot randomised clinical trial. Pain Medicine. 2021;(pnab278). doi:10.1093/pm/pnab278 ABSTRACT
  3. Strath LJ, Jones CD, Philip George A, et al. The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis. Pain Med. March 2019. doi:10.1093/pm/pnz022 ABSTRACT
  4. Lyman, K.S. et al. (2022) ‘Continuous care intervention with carbohydrate restriction improves physical function of the knees among patients with type 2 diabetes: a non-randomized study’, BMC Musculoskeletal Disorders, 23(1), p. 297. doi:10.1186/s12891-022-05258-0.
  5. Masino S, Ruskin D. Ketogenic Diets and Pain. Journal of Child Neurology. 2013;28(8):993-1001. doi:10.1177/0883073813487595  PDF 
  6. Masino SA, Ruskin DN. Nutritional Recommendations to Address Pain: Focus on Ketogenic/Low-Carbohydrate Diet. In: Pietramaggiori G, Scherer S, eds. Minimally Invasive Surgery for Chronic Pain Management: An Evidence-Based Approach. Springer International Publishing; 2020:69-71. doi:10.1007/978-3-030-50188-4_8 ABSTRACT
  7. Field, R. et al. (2022) ‘Low-carbohydrate and ketogenic diets: a scoping review of neurological and inflammatory outcomes in human studies and their relevance to chronic pain’, Nutrition Research Reviews, pp. 1–71. doi:10.1017/S0954422422000087.
  8. Cuevas-Cervera, M. et al. (2022) ‘The Effectiveness of Intermittent Fasting, Time Restricted Feeding, Caloric Restriction, a Ketogenic Diet and the Mediterranean Diet as Part of the Treatment Plan to Improve Health and Chronic Musculoskeletal Pain: A Systematic Review’, International Journal of Environmental Research and Public Health, 19(11), p. 6698. Available at:
  9. Klejc, K., Cruz-Almeida, Y. and Sheffler, J.L. (2024) ‘Addressing Pain Using a Mediterranean Ketogenic Nutrition Program in Older Adults with Mild Cognitive Impairment’, Journal of Pain Research, 17, pp. 1867–1880. Available at:
  10. Pappolla MA, Manchikanti L, Candido KD, et al. Insulin Resistance is Associated with Central Pain in Patients with Fibromyalgia. Pain Physician. Published online 2021:10. PDF
  11. Holton, K. et al. (2020) ‘The Low Glutamate Diet Significantly Improves Pain and Other Symptoms in Veterans with Gulf War Illness’, Current Developments in Nutrition, 4(Supplement_2), pp. 1211–1211. doi:10.1093/cdn/nzaa057_027.


  1. Strath LJ, Jones CD, Philip George A, et al. The Effect of Low-Carbohydrate and Low-Fat Diets on Pain in Individuals with Knee Osteoarthritis. Pain Med. March 2019. doi:10.1093/pm/pnz022 ABSTRACT 
  2. Lambadiari, V. et al. (2024) ‘The Effect of a Ketogenic Diet versus Mediterranean Diet on Clinical and Biochemical Markers of Inflammation in Patients with Obesity and Psoriatic Arthritis: A Randomized Crossover Trial’, International Journal of Molecular Sciences, 25(5), p. 2475. Available at:
  3. Schönenberger, K.A. et al. (2021) ‘Effect of Anti-Inflammatory Diets on Pain in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis’, Nutrients, 13(12). doi:10.3390/nu13124221.
  4. Lyman, K.S. et al. (2022) ‘Continuous care intervention with carbohydrate restriction improves physical function of the knees among patients with type 2 diabetes: a non-randomized study’, BMC Musculoskeletal Disorders, 23(1), p. 297. doi:10.1186/s12891-022-05258-0.
  5. Kountouri, A. et al. (2024) ‘The effect of ketogenic diet versus mediterranean diet on clinical and biochemical markers of inflammation in patients with obesity and psoriatic arthritis’, in Endocrine Abstracts. ECE 2024, Bioscientifica. Available at:
  6. Ometto, F. et al. (2024) ‘Ab0444 Very Low-Calorie Ketogenic Diet in Patients with Psoriatic Arthritis: A Proof of Concept Study’, Annals of the Rheumatic Diseases, 83(Suppl 1), pp. 1481–1482. Available at:
  7. Lawford, B. et al. (2023) ‘“The fact that I know I can do it is quite a motivator now”: a qualitative study exploring experiences maintaining weight loss 6 months after completing a weight loss programme for knee osteoarthritis’, BMJ Open, 13(5), p. e068157. Available at:
  8. Lawford BJ, Bennell KL, Jones SE, Keating C, Brown C, Hinman RS. “It’s the single best thing I’ve done in the last 10 years”: a qualitative study exploring patient and dietitian experiences with, and perceptions of, a multi-component dietary weight loss program for knee osteoarthritis. Osteoarthritis Cartilage. Published online January 9, 2021. doi:10.1016/j.joca.2021.01.001
  9. Cooper, I. et al. (2022) ‘An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study’, BMC Musculoskeletal Disorders, 23. doi:10.1186/s12891-022-05003-7.
  10. Hagström, N. et al. (2023) ‘A qualitative evaluation of the specific carbohydrate diet for juvenile idiopathic arthritis based on children’s and parents’ experiences’, Pediatric Rheumatology, 21(1), p. 127. Available at:
  11. Rondanelli, M. et al. (2023) ‘Very low calorie ketogenic diet and common rheumatic disorders: A case report’, World Journal of Clinical Cases, 11(9), pp. 1985–1991. Available at:
  12. Gallagher L, Cregan S, Biniecka M, et al. Insulin Resistant Pathways are associated with Disease Activity in Rheumatoid Arthritis and are Subject to Disease Modification through Metabolic Reprogramming; A Potential Novel Therapeutic Approach. Arthritis & Rheumatology (Hoboken, NJ). Published online December 16, 2019. doi:10.1002/art.41190 ABSTRACT
  13. Babu S, Vaish A, Vaishya R, Agarwal A. Can intermittent fasting be helpful for knee osteoarthritis? Journal of Clinical Orthopaedics & Trauma. 2021;16:70-74. doi:10.1016/j.jcot.2020.12.020 ABSTRACT
  14. Jiang Y, Jarr K, Layton C, et al. Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases. Nutrients. 2021;13(3). doi:10.3390/nu13030890
  15. Ciaffi, J. et al. (2021) ‘The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review’, Frontiers in Medicine, 8. doi: 10.3389/fmed.2021.792846 


  1. Jamnik J, Rehman S, Blanco Mejia S, et al. Fructose intake and risk of gout and hyperuricemia: a systematic review and meta-analysis of prospective cohort studies. BMJ Open. 2016;6(10):e013191. doi:10.1136/bmjopen-2016-013191
  2. Goldberg EL, Asher JL, Molony RD, et al. β-hydroxybutyrate deactivates neutrophil NLRP3 inflammasome to relieve gout flares. Cell Rep. 2017;18(9):2077-2087. doi:10.1016/j.celrep.2017.02.004
  3. Juraschek SP, McAdams-Demarco M, Gelber AC, et al. Effects of Lowering Glycemic Index of Dietary Carbohydrate on Plasma Uric Acid: The OmniCarb Randomized Clinical Trial. Arthritis Rheumatol. 2016;68(5):1281-1289. doi:10.1002/art.39527
  4. Dessein P, Shipton E, Stanwix A, Joffe B, Ramokgadi J. Beneficial effects of weight loss associated with moderate calorie/carbohydrate restriction, and increased proportional intake of protein and unsaturated fat on serum urate and lipoprotein levels in gout: a pilot study. Ann Rheum Dis. 2000;59(7):539-543. doi:10.1136/ard.59.7.539


Microbiome and Carbohydrate Restriction

  1. Sholl J, Mailing LJ, Wood TR. Reframing Nutritional Microbiota Studies To Reflect an Inherent Metabolic Flexibility of the Human Gut: a Narrative Review Focusing on High-Fat Diets. mBio. 2021;12(2). doi:10.1128/mBio.00579-21
  2. Attaye, I. et al. (2022) ‘The Role of the Gut Microbiota on the Beneficial Effects of Ketogenic Diets’, Nutrients, 14(1), p. 191. doi:10.3390/nu14010191
  3. Zhang S, Wu P, Tian Y, et al. Gut Microbiota Serves a Predictable Outcome of Short-Term Low-Carbohydrate Diet (LCD) Intervention for Patients with Obesity. Microbiology Spectrum. 0(0):e00223-21. doi:10.1128/Spectrum.00223-21
  4. Rondanelli M, Gasparri C, Peroni G, et al. The Potential Roles of Very Low Calorie, Very Low Calorie Ketogenic Diets and Very Low Carbohydrate Diets on the Gut Microbiota Composition. Front Endocrinol. 2021;12. doi:10.3389/fendo.2021.662591
  5. Jaagura M, Viiard E, Karu-Lavits K, Adamberg K. Low-carbohydrate high-fat weight reduction diet induces changes in human gut microbiota. MicrobiologyOpen. 2021;10(3):e1194. doi:
  6. Fan Y, Wang H, Liu X, Zhang J, Liu G. Crosstalk between the Ketogenic Diet and Epilepsy: From the Perspective of Gut Microbiota. Mediators Inflamm. 2019;2019:8373060. doi:10.1155/2019/8373060 
  7. Klement RJ, Pazienza V. Impact of Different Types of Diet on Gut Microbiota Profiles and Cancer Prevention and Treatment. Medicina (Kaunas). 2019;55(4). doi:10.3390/medicina55040084
  8. Paoli A, Mancin L, Bianco A, Thomas E, Mota JF, Piccini F. Ketogenic Diet and Microbiota: Friends or Enemies? Genes (Basel). 2019;10(7). doi:10.3390/genes10070534 
  9. Reddel S, Putignani L, Del Chierico F. The Impact of Low-FODMAPs, Gluten-Free, and Ketogenic Diets on Gut Microbiota Modulation in Pathological Conditions. Nutrients. 2019;11(2). doi:10.3390/nu11020373
  10. Sun, S. et al. (2022) ‘Effects of Low-Carbohydrate Diet and Exercise Training on Gut Microbiota’, Frontiers in Nutrition, 9, p. 884550. doi:10.3389/fnut.2022.884550.
  11. Murtaza N, Burke LM, Vlahovich N, et al. Analysis of the Effects of Dietary Pattern on the Oral Microbiome of Elite Endurance Athletes. Nutrients. 2019;11(3). doi:10.3390/nu11030614   
  12. González Olmo BM, Butler MJ, Barrientos RM. Evolution of the Human Diet and Its Impact on Gut Microbiota, Immune Responses, and Brain Health. Nutrients. 2021;13(1):196. doi:10.3390/nu13010196
  13. Alsharairi NA. The Role of Short-Chain Fatty Acids in Mediating Very Low-Calorie Ketogenic Diet-Infant Gut Microbiota Relationships and Its Therapeutic Potential in Obesity. Nutrients. 2021;13(11):3702. doi:10.3390/nu13113702
  14. Tang Y, Wang Q, Liu J. Microbiota-gut-brain axis: A novel potential target of ketogenic diet for epilepsy. Current Opinion in Pharmacology. 2021;61:36-41. doi:10.1016/j.coph.2021.08.018
  15. Gutiérrez-Repiso C, Hernández-García C, García-Almeida JM, et al. Effect of Synbiotic Supplementation in a Very-Low-Calorie Ketogenic Diet on Weight Loss Achievement and Gut Microbiota: A Randomized Controlled Pilot Study. Mol Nutr Food Res. July 2019:e1900167. doi:10.1002/mnfr.201900167 ABSTRACT
  16. Ang QY, Alexander M, Newman JC, et al. Ketogenic Diets Alter the Gut Microbiome Resulting in Decreased Intestinal Th17 Cells. Cell. 2020;0(0). doi:10.1016/j.cell.2020.04.027 ABSTRACT
  17. Donatella P, Aurelio C. KETOGENIC DIET AND GUT MICROBIOTA. :7. Pharmacology Online; Special issue; 2020; vol.3; 175-181. Mini-Review   PDF

Irritable Bowel Syndrome

  1. Nilholm C, Roth B, Ohlsson B. A Dietary Intervention with Reduction of Starch and Sucrose Leads to Reduced Gastrointestinal and Extra-Intestinal Symptoms in IBS Patients. Nutrients. 2019;11(7):1662. doi:10.3390/nu11071662
  2. Nilholm C, Larsson E, Sonestedt E, Roth B, Ohlsson B. Assessment of a 4-Week Starch- and Sucrose-Reduced Diet and Its Effects on Gastrointestinal Symptoms and Inflammatory Parameters among Patients with Irritable Bowel Syndrome. Nutrients. 2021;13(2):416. doi:10.3390/nu13020416
  3. Nilholm C, Larsson E, Roth B, Gustafsson R, Ohlsson B. Irregular Dietary Habits with a High Intake of Cereals and Sweets Are Associated with More Severe Gastrointestinal Symptoms in IBS Patients. Nutrients. 2019;11(6):1279. doi:10.3390/nu11061279
  4. Austin GL, Dalton CB, Hu Y, et al. A Very Low-Carbohydrate Diet Improves Symptoms and Quality of Life in Diarrhea-Predominant Irritable Bowel Syndrome. Clinical Gastroenterology and Hepatology. 2009;7(6):706-708.e1. doi:10.1016/j.cgh.2009.02.023
  5. Algera J, Colomier E, Simrén M. The Dietary Management of Patients with Irritable Bowel Syndrome: A Narrative Review of the Existing and Emerging Evidence. Nutrients. 2019;11(9):2162. doi:10.3390/nu11092162
  6. Chumpitazi BP, Shulman RJ. Dietary Carbohydrates and Childhood Functional Abdominal Pain. Ann Nutr Metab. 2016;68(Suppl 1):8-17. doi:10.1159/000445390
  7. Saidi K, Nilholm C, Roth B, Ohlsson B. A carbohydrate-restricted diet for patients with irritable bowel syndrome led to lower serum levels of C-peptide, insulin, and leptin without any correlation with symptom reduction. Nutrition Research. Published online December 4, 2020. doi:10.1016/j.nutres.2020.12.001
  8. Nilholm C, Larsson E, Roth B, Gustafsson R, Ohlsson B. Irregular Dietary Habits with a High Intake of Cereals and Sweets Are Associated with More Severe Gastrointestinal Symptoms in IBS Patients. Nutrients. 2019;11(6):1279. doi:10.3390/nu11061279
  9. Van den Houte K, Colomier E, Schol J, Carbone F, Tack J. Recent advances in diagnosis and management of irritable bowel syndrome. Curr Opin Psychiatry. 2020;33(5):460-466. doi:10.1097/YCO.0000000000000628 ABSTRACT
  10. Chimienti G, Orlando A, Lezza AMS, et al. The Ketogenic Diet Reduces the Harmful Effects of Stress on Gut Mitochondrial Biogenesis in a Rat Model of Irritable Bowel Syndrome. International Journal of Molecular Sciences. 2021;22(7):3498. doi:10.3390/ijms22073498 (pre-clinical)

Crohn’s Disease and Inflammatory Bowel Disease

  1. Suskind DL, Lee D, Kim Y-M, et al. The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial. Nutrients. 2020;12(12):3749. doi:10.3390/nu12123749
  2. Alsharairi, N.A. (2022) ‘The Therapeutic Role of Short-Chain Fatty Acids Mediated Very Low-Calorie Ketogenic Diet–Gut Microbiota Relationships in Paediatric Inflammatory Bowel Diseases’, Nutrients, 14(19), p. 4113. Available at:
  3. Jiang Y, Jarr K, Layton C, et al. Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases. Nutrients. 2021;13(3). doi:10.3390/nu13030890
  4. Konijeti GG, Kim N, Lewis JD, et al. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017;23(11):2054-2060. doi:10.1097/MIB.0000000000001221
  5. Kakodkar S, Mutlu EA. Diet as a therapeutic option for adult inflammatory bowel disease. Gastroenterol Clin North Am. 2017;46(4):745-767. doi:10.1016/j.gtc.2017.08.016 
  6. Burgis JC, Nguyen K, Park K, Cox K. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease. World J Gastroenterol. 2016;22(6):2111-2117. doi:10.3748/wjg.v22.i6.2111
  7. Tóth C, Dabóczi A, Howard M, J. Miller N, Clemens Z. Crohn’s disease successfully treated with the paleolithic ketogenic diet. International Journal of Case Reports and Images. September 2016. doi:10.5348/ijcri-2016102-CR-10690
  8. Lowery RP, Wilson JM, Sharp MH, Wilson GJ, Wagner R. The effects of exogenous ketones on biomarkers of Crohn’s disease: A case report. Journal of Gastroenterology and Digestive Diseases. 2017;2(3). 
  9. Mehrtash F. Sustained Crohn’s Disease Remission with an Exclusive Elemental and Exclusion Diet: A Case Report. Gastrointestinal Disorders. 2021;3(3):129-137. doi:10.3390/gidisord303001
  10. Rashid T, Wilson C, Ebringer A. The Link between Ankylosing Spondylitis, Crohn’s Disease, Klebsiella, and Starch Consumption. Journal of Immunology Research. doi:10.1155/2013/872632 
  11. Norwitz NG, Loh V. A Standard Lipid Panel Is Insufficient for the Care of a Patient on a High-Fat, Low-Carbohydrate Ketogenic Diet. Front Med. 2020;7. doi:10.3389/fmed.2020.00097 (IBD)
  12. Simon, D. et al. (2023) ‘Food for Thought: Remission of Perianal Pediatric Crohn’s Disease on Specific Carbohydrate Diet Monotherapy’, JPGN Reports, 4(3), p. e343. Available at:


  1. Lakananurak, N. et al. (2024) ‘The Efficacy of Dietary Interventions in Patients with Gastroesophageal Reflux Disease: A Systematic Review and Meta-Analysis of Intervention Studies’, Nutrients, 16(3), p. 464. Available at:
  2. Latorre-Rodríguez, A.R., Munir, S. and Mittal, S.K. (2024) ‘Effect of Ketogenic Diet on Gastroesophageal Reflux Disease: Literature Review and Exploratory Study’, Foregut, p. 26345161241249381. Available at:
  3. Wu K-L, Kuo C-M, Yao C-C, et al. The effect of dietary carbohydrate on gastroesophageal reflux disease. J Formos Med Assoc. 2018;117(11):973-978. doi:10.1016/j.jfma.2017.11.001
  4. Pointer SD, Rickstrew J, Slaughter JC, Vaezi MF, Silver HJ. Dietary carbohydrate intake, insulin resistance and gastro-oesophageal reflux disease: A pilot study in European- and African-American obese women. Aliment Pharmacol Ther. 2016;44(9):976-988. doi:10.1111/apt.13784
  5. Yancy WS, Provenzale D, Westman EC. Improvement of gastroesophageal reflux disease after initiation of a low-carbohydrate diet: Five brief case reports. Altern Ther Health Med. 2001;7(6):120, 116-119. PMID:11712463 PDF
  6. Austin GL, Thiny MT, Westman EC, Yancy WS, Shaheen NJ. A very low-carbohydrate diet improves gastroesophageal reflux and its symptoms. Dig Dis Sci. 2006;51(8):1307-1312. doi:10.1007/s10620-005-9027-7 ABSTRACT

Carbohydrate Malabsorption

  1. Goebel-Stengel M, Stengel A, Schmidtmann M, van der Voort I, Kobelt P, Mönnikes H. Unclear Abdominal Discomfort: Pivotal Role of Carbohydrate Malabsorption. J Neurogastroenterol Motil. 2014;20(2):228-235. doi:10.5056/jnm.2014.20.2.228
  2. Born P. Carbohydrate malabsorption in patients with non-specific abdominal complaints. World J Gastroenterol. 2007;13(43):5687-5691. doi: 10.3748/wjg.v13.i43.5687
  3. Goldstein R, Braverman D, Stankiewicz H. Carbohydrate malabsorption and the effect of dietary restriction on symptoms of irritable bowel syndrome and functional bowel complaints. Isr Med Assoc J. 2000;2(8):583-587. PMID:10979349 ABSTRACT 
  4. Born P, Sekatcheva M, Rösch T, Classen M. Carbohydrate malabsorption in clinical routine: A prospective observational study. Hepatogastroenterology. 2006;53(71):673-677. PMID:17086866 ABSTRACT 
  5. Fernández-Bañares F, Rosinach M, Esteve M, Forné M, Espinós JC, Maria Viver J. Sugar malabsorption in functional abdominal bloating: a pilot study on the long-term effect of dietary treatment. Clin Nutr. 2006;25(5):824-831. doi:10.1016/j.clnu.2005.11.010 ABSTRACT
  6. Hammer HF, Hammer J. Diarrhea Caused By Carbohydrate Malabsorption. Gastroenterology Clinics. 2012;41(3):611-627. doi:10.1016/j.gtc.2012.06.003 ABSTRACT

Small Intestinal Bacterial Overgrowth

  1. Barton, K. (2024) ‘Clinical outcomes of patients with SIBO and adherence to the carnivore diet: An analysis from a functional medicine perspective’. OSF. Available at:
  2. Martin, P., Johansson, M. and Ek, A. (2021) ‘A Zero Carbohydrate, Carnivore Diet can Normalize Hydrogen Positive Small Intestinal Bacterial Overgrowth Lactulose Breath Tests: A Case Repor’. Available at:
  3. O’Dwyer, D. (2021) ‘Homemade Elemental Diet to Treat Intestinal Methanogen Overgrowth: A Case Report’, Integrative Medicine: A Clinician’s Journal, 20(2), pp. 32–41.
  4. Reynolds, K. (2015) ‘Small Intestinal Bacterial Overgrowth: A Case-Based Review’, Journal of Patient-Centered Research and Reviews, 2(4), pp. 165–173. Available at:
  5. Yao, Q. et al. (2023) ‘The role of small intestinal bacterial overgrowth in obesity and its related diseases’, Biochemical Pharmacology, 212, p. 115546. Available at:

Gastrointestinal – General

This section is intended to reflect the general lack of consensus (especially with regard to fibre) regarding best management of various gastrointestinal disorders and supports individual tailoring through elimination protocols. Common themes include whole foods, reduced carbohydrate, FODMAP and low/no/high fibre.

    1. Ünlü C, Daniels L, Vrouenraets BC, Boermeester MA. A systematic review of high-fibre dietary therapy in diverticular disease. Int J Colorectal Dis. 2012;27(4):419-427. doi:10.1007/s00384-011-1308-3
    2. Hsieh M-S, Hsu W-H, Wang J-W, et al. Nutritional and dietary strategy in the clinical care of inflammatory bowel disease. Journal of the Formosan Medical Association. October 2019. doi:10.1016/j.jfma.2019.09.005
    3. Grammatikopoulou MG, Goulis DG, Gkiouras K, et al. Low FODMAP Diet for Functional Gastrointestinal Symptoms in Quiescent Inflammatory Bowel Disease: A Systematic Review of Randomized Controlled Trials. Nutrients. 2020;12(12):3648. doi:10.3390/nu12123648
    4. Roncoroni L, Bascuñán KA, Doneda L, et al. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients. 2018;10(8). doi:10.3390/nu10081023
    5. Caio G, Volta U, Sapone A, et al. Celiac disease: A comprehensive current review. BMC Medicine. 2019;17(1):142. doi:10.1186/s12916-019-1380-z
    6. Vanhauwaert E, Matthys C, Verdonck L, De Preter V. Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management. Adv Nutr. 2015;6(6):820-827. doi:10.3945/an.115.009688
    7. Ho K-S, Tan CYM, Mohd Daud MA, Seow-Choen F. Stopping or reducing dietary fiber intake reduces constipation and its associated symptoms. World J Gastroenterol. 2012;18(33):4593-4596. doi:10.3748/wjg.v18.i33.4593
    8. Tuck CJ, Biesiekierski JR, Schmid-Grendelmeier P, Pohl D. Food Intolerances. Nutrients. 2019;11(7):1684. doi:10.3390/nu11071684
    9. Peery AF, Barrett PR, Park D, et al. A High-Fiber Diet Does Not Protect Against Asymptomatic Diverticulosis. Gastroenterology. 2012;142(2):266-72.e1. doi:10.1053/j.gastro.2011.10.035
    10. Offringa LC, Hartle JC, Rigdon J, Gardner CD. Changes in Quantity and Sources of Dietary Fiber from Adopting Healthy Low-Fat vs. Healthy Low-Carb Weight Loss Diets: Secondary Analysis of DIETFITS Weight Loss Diet Study. Nutrients. 2021;13(10):3625. doi:10.3390/nu13103625


Media Links
  1. Dr. Andrew McIntyre – Low Carb Down Under – YouTube – Implementing Low Carb In Gastroenterology Practice.; 2019
  2. Dr. Pran Yoganathan – Low Carb Down Under – YouTub – The Human Gut: A Masterpiece of Evolution.; 2021. 



  1. Fomin DA, Handfield K. The ketogenic diet and dermatology: a primer on current literature.Cutis. 2020;105(1):40-43. PMID: 32074146 PDF
  2. Roster, K. et al. (2024) ‘Impact of Ketogenic and Low-Glycemic Diets on Inflammatory Skin Conditions’, Cutis, 113, pp. 75–80. Available at:
  3. Bragazzi NL, Sellami M, Salem I, et al. Fasting and Its Impact on Skin Anatomy, Physiology, and Physiopathology: A Comprehensive Review of the Literature. Nutrients. 2019;11(2). doi:10.3390/nu11020249
  4. Binobead, M.A. et al. (2023) ‘Effect of Low-Carbohydrate Diet on Beta-Hydroxybutyrate Ketogenesis Metabolic Stimulation and Regulation of NLRP3 Ubiquitination in Obese Saudi Women’, Nutrients, 15(4), p. 820. Available at:
  5. Misitzis A, Cunha PR, Kroumpouzos G. Skin Disease Relating to Metabolic Syndrome in Women. International Journal of Women’s Dermatology. July 2019. doi:10.1016/j.ijwd.2019.06.030  
  6. Nakamura H, Shimoji K, Kouda K, Tokunaga R, Takeuchi H. An adult with atopic dermatitis and repeated short-term fasting. J Physiol Anthropol Appl Human Sci. 2003;22(5):237-240.doi: PDF
  7. Nosrati A, Afifi L, Danesh MJ, et al. Dietary modifications in atopic dermatitis: patient-reported outcomes. J Dermatolog Treat. 2017;28(6):523-538. doi:10.1080/09546634.2016.1278071
  8. Fomin DA, McDaniel B, Crane J. The promising potential role of ketones in inflammatory dermatologic disease: a new frontier in treatment research. Journal of Dermatological Treatment. 2017;28(6):484-487. doi:10.1080/09546634.2016.1276259 ABSTRACT
  9. Aoki M, Murase T. Obesity-associated insulin resistance adversely affects skin function. PLOS ONE. 2019;14(10):e0223528. doi:10.1371/journal.pone.0223528 PDF
  10. de Carvalho JF, Pereira CP, Torales MBP. Nummular Eczema Successfully Treated with a Gluten- free Diet: First Description.. IMAJ 2021; 23: 329–330
  11. Usher B. THE RELATION OF CARBOHYDRATE METABOLISM TO ECZEMA: AN EXPERIMENTAL STUDY. Arch Derm Syphilol. 1928;18(3):423-428. doi:10.1001/archderm.1928.02380150089012 ABSTRACT

Acne vulgaris

  1. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107-115. doi:10.1093/ajcn/86.1.107
  2. Fabbrocini G, Izzo R, Faggiano A, et al. Low glycaemic diet and metformin therapy: a new approach in male subjects with acne resistant to common treatments. Clin Exp Dermatol. 2016;41(1):38-42. doi:10.1111/ced.12673
  3. Kwon HH, Yoon JY, Hong JS, Jung JY, Park MS, Suh DH. Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: a randomized, controlled trial. Acta Derm Venereol. 2012;92(3):241-246. doi:10.2340/00015555-1346
  4. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. The effect of a high-protein, low glycemic–load diet versus a conventional, high glycemic–load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial. Journal of the American Academy of Dermatology. 2007;57(2):247-256. doi:10.1016/j.jaad.2007.01.046  ABSTRACT
  5. Barrea, L. et al. (2023) ‘The effect of the ketogenic diet on Acne: Could it be a therapeutic tool?’, Critical Reviews in Food Science and Nutrition, 0(0), pp. 1–20. Available at:
  6. Paoli A, Grimaldi K, Toniolo L, Canato M, Bianco A, Fratter A. Nutrition and Acne: Therapeutic Potential of Ketogenic Diets. Skin pharmacology and physiology. 2012;25:111-117. doi:10.1159/000336404
  7. Çerman AA, Aktaş E, Altunay İK, Arıcı JE, Tulunay A, Ozturk FY. Dietary glycemic factors, insulin resistance, and adiponectin levels in acne vulgaris. J Am Acad Dermatol. 2016;75(1):155-162. doi:10.1016/j.jaad.2016.02.1220  ABSTRACT
  8. Md SSH. A case report of successful acne treatment following Ramadan fasting. Research. Published online April 11, 2014.doi:

Acne Inversa (Hidradenitis Suppurativa)

  1. Verde, L. et al. (2024a) ‘Very low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): an effective and safe tool for improvement of the clinical severity of disease. Results of a pilot study’, Journal of Translational Medicine, 22, p. 149. Available at:
  2. Damiani G, Mahroum N, Pigatto PDM, et al. The Safety and Impact of a Model of Intermittent, Time-Restricted Circadian Fasting (“Ramadan Fasting”) on Hidradenitis Suppurativa: Insights from a Multicenter, Observational, Cross-Over, Pilot, Exploratory Study. Nutrients. 2019;11(8):1781. doi:10.3390/nu11081781
  3. Yar, N. et al. (2022) ‘Consuming an All-Meat Ketogenic Diet for the Long-Term Management of Candida Vulvovaginitis and Vaginal Hidradenitis Suppurativa: A 47-Month Follow-Up Case Report’, Cureus [Preprint]. Available at:
  4. Danby FW. Diet in the prevention of hidradenitis suppurativa (acne inversa). Journal of the American Academy of Dermatology. 2015;73(5, Supplement 1):S52-S54. doi:10.1016/j.jaad.2015.07.042  ABSTRACT
  5. Vilanova I, Hernández JL, Mata C, et al. Insulin resistance in hidradenitis suppurativa: a case-control study. J Eur Acad Dermatol Venereol. 2018;32(5):820-824. doi:10.1111/jdv.14894  PDF


  1. Campanati A, Molinelli E, Ganzetti G, et al. The effect of low-carbohydrates calorie-restricted diet on visceral adipose tissue and metabolic status in psoriasis patients receiving TNF-alpha inhibitors: results of an open label controlled, prospective, clinical study. J Dermatolog Treat. 2017;28(3):206-212. doi:10.1080/09546634.2016.1214666
  2. Castaldo G, Galdo G, Rotondi Aufiero F, Cereda E. Very low-calorie ketogenic diet may allow restoring response to systemic therapy in relapsing plaque psoriasis. Obes Res Clin Pract. 2016;10(3):348-352. doi:10.1016/j.orcp.2015.10.008
  3. Castaldo G, Pagano I, Grimaldi M, et al. Effect of Very-Low-Calorie Ketogenic Diet on Psoriasis Patients: A Nuclear Magnetic Resonance-Based Metabolomic Study. J Proteome Res. Published online November 9, 2020. doi:10.1021/acs.jproteome.0c00646
  4. Barrea, L. et al. (2022) ‘Clinical and nutritional management of very-low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: a practical guide for the nutritionist’, Critical Reviews in Food Science and Nutrition, pp. 1–17. Available at:
  5. Castaldo G, Rastrelli L, Galdo G, Molettieri P, Aufiero FR, Cereda E. Aggressive weight loss program with a ketogenic induction phase for the treatment of chronic plaque psoriasis: a proof-of-concept, single-arm, open label clinical trial. Nutrition. February 2020:110757. doi:10.1016/j.nut.2020.110757 ABSTRACT
  6. Peralta C, Hamid P, Batool H, Al Achkar Z, Maximus P. Psoriasis and Metabolic Syndrome: Comorbidities and Environmental and Therapeutic Implications. Cureus. 2019;11(12):e6369. doi:10.7759/cureus.6369 
  7. Barrea L, Megna M, Cacciapuoti S, et al. Very low-calorie ketogenic diet (VLCKD) in patients with psoriasis and obesity: an update for dermatologists and nutritionists. Crit Rev Food Sci Nutr. Published online September 24, 2020:1-17. doi:10.1080/10408398.2020.1818053
  8. Brazzelli V, Maffioli P, Bolcato V, et al. Psoriasis and Diabetes, a Dangerous Association: Evaluation of Insulin Resistance, Lipid Abnormalities, and Cardiovascular Risk Biomarkers. Front Med (Lausanne). 2021;8. doi:10.3389/fmed.2021.605691
  9. Aalemi AK, Bahain MB, Hamdard AG. Metabolic Syndrome and Psoriasis: A Case-Control Study in Kabul, Afghanistan. Diabetes Metab Syndr Obes. 2021;14:1465-1471. doi:10.2147/DMSO.S305806
  10. Raza MH, Iftikhar N, Mashhood AA, Bin Hamid MA, Rehman F, Tariq S. Frequency Of Metabolic Syndrome In Patients With Psoriasis. J Ayub Med Coll Abbottabad. 2021;33(3):484-487. PMID: 34487662
  11. Kim H-N, Han K, Park Y-G, Lee JH. Metabolic syndrome is associated with an increased risk of psoriasis: A nationwide population-based study. Metabolism – Clinical and Experimental. 2019;99:19-24. doi:10.1016/j.metabol.2019.07.001 ABSTRACT
  12. Bajaj S, Mandal S, Singh KG, Prajapati R. Metabolic Diseases and Associated Complications in Patients with Psoriasis. J Assoc Physicians India. 2020;68(10):44-46. PMID: 32978925
  13. Jiang Y, Jarr K, Layton C, et al. Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases. Nutrients. 2021;13(3). doi:10.3390/nu13030890

Heart Function

  1. González-Islas D, Orea-Tejeda A, Castillo-Martínez L, et al. The effects of a low-carbohydrate diet on oxygen saturation in heart failure patients: a randomized controlled clinical trial. Nutr Hosp. 2017;34(4):792-798. doi:10.20960/nh.784
  2. Nielsen R, Møller N, Gormsen LC, et al. Cardiovascular Effects of Treatment With the Ketone Body 3-Hydroxybutyrate in Chronic Heart Failure Patients. Circulation. 2019;139(18):2129-2141. doi:10.1161/CIRCULATIONAHA.118.036459
  3. Zeybek C, Celebi A, Aktuglu‐Zeybek C, et al. The effect of low-carbohydrate diet on left ventricular diastolic function in obese children. Pediatrics International. 2010;52(2):218-223. doi:10.1111/j.1442-200X.2009.02940.x
  4. Berg-Hansen, K. et al. (2024) ‘Cardiovascular Effects of Oral Ketone Ester Treatment in Patients With Heart Failure With Reduced Ejection Fraction: A Randomized, Controlled, Double-Blind Trial’, Circulation, 0(0). Available at: ABSTRACT
  5. Solis-Herrera C, Qin Y, Honka H, et al. Effect of elevated plasma ketones on cardiac efficiency. American Heart Journal. 2021;242:163. doi:10.1016/j.ahj.2021.10.045 ABSTRACT
  6. Bejko J, Bottio T, Caraffa R, et al. Lipid-In, Sugar-Out: Early Results of Treatment with Additional Ketogenic Parenteral Nutrition in Left Ventricle Assist Device Patients. In Review; 2021. doi:10.21203/
  7. Deberles E, Maragnes P, Penniello-Valette M-J, Allouche S, Joubert M. Reversal of cardiac hypertrophy with a ketogenic diet in a child with mitochondrial disease and hypertrophic cardiomyopathy. Canadian Journal of Cardiology. 2020;0(0). doi:10.1016/j.cjca.2020.04.024 ABSTRACT
  8. Monzo L, Sedlacek K, Hromanikova K, et al. Ketone body metabolism in failing heart. Metabolism. Published online November 25, 2020:154452. doi:10.1016/j.metabol.2020.154452 ABSTRACT
  9. Hirose K, Nakanishi K, Daimon M, et al. Impact of insulin resistance on subclinical left ventricular dysfunction in normal weight and overweight/obese japanese subjects in a general community. Cardiovascular Diabetology. 2021;20(1):22. doi:10.1186/s12933-020-01201-6
  10. Kim D, Roberts C, McKenzie A, George MP. Nutritional ketosis to treat pulmonary hypertension associated with obesity and metabolic syndrome: a case report. Pulm Circ. 2021;11(1):2045894021991426. doi:10.1177/2045894021991426
  11. Wesół-Kucharska, D. (2022) ‘The Effectiveness of the Ketogenic Diet for Leigh Syndrome with Cardiomiopathy’(sic), 8(16), p. 7. ISSN 2639-8109
  12. Gajagowni, S., Tarun, T., Dorairajan, S., Chockalingam, A., 2022. First Report Of 50-Day Continuous Fasting in Symptomatic Multivessel Coronary Artery Disease and Heart Failure: Cardioprotection Through Natural Ketosis. Mo Med 119, 250–254. PMID: 36035583 (highlights importance of monitoring and adequate hydration/electrolytes)
Glycogen Storage Diseases
  1. Francini-Pesenti F, Tresso S, Vitturi N. Modified Atkins ketogenic diet improves heart and skeletal muscle function in glycogen storage disease type III. Acta Myol. 2019;38(1):17-20.PMID: 31309177 
  2. Marusic T, Zerjav Tansek M, Sirca Campa A, et al. Normalization of obstructive cardiomyopathy and improvement of hepatopathy on ketogenic diet in patient with glycogen storage disease (GSD) type IIIa. Mol Genet Metab Rep. 2020;24. doi:10.1016/j.ymgmr.2020.100628
  3. Mayorandan S, Meyer U, Hartmann H, Das AM. Glycogen storage disease type III: modified Atkins diet improves myopathy. 2014.
  4. Kumru Akin, B., Ozturk Hismi, B., Daly, A., 2022. Improvement in hypertrophic cardiomyopathy after using a high-fat, high-protein and low-carbohydrate diet in a non-adherent child with glycogen storage disease type IIIa. Molecular Genetics and Metabolism Reports 32, 100904.
  1. Karwi QG, Biswas D, Pulinilkunnil T, Lopaschuk GD. Myocardial Ketones Metabolism in Heart Failure: Karwi et al. Role of ketone in heart failure. Journal of Cardiac Failure. 2020;0(0). doi:10.1016/j.cardfail.2020.04.005     PDF
  2. Yurista SR, Chong C-R, Badimon JJ, Kelly DP, de Boer RA, Westenbrink BD. Therapeutic Potential of Ketone Bodies for Patients With Cardiovascular Disease: JACC Focus Seminar. Journal of the American College of Cardiology. Published online February 23, 2021. doi:10.1016/j.jacc.2020.12.065
  3. White H, Heffernan AJ, Worrall S, Grunsfeld A, Thomas M. A Systematic Review of Intravenous β-Hydroxybutyrate Use in Humans – A Promising Future Therapy? Frontiers in Medicine. 2021;8. doi:10.3389/fmed.2021.740374
  4. Cuenoud B, Hartweg M, Godin J-P, et al. Metabolism of Exogenous D-Beta-Hydroxybutyrate, an Energy Substrate Avidly Consumed by the Heart and Kidney. Front Nutr. 2020;7. doi:10.3389/fnut.2020.00013
  5. Abbasi J. Ketone Body Supplementation—A Potential New Approach for Heart Disease. JAMA. Published online June 17, 2021. doi:10.1001/jama.2021.8789
  6. Karwi QG, Lopaschuk GD. CrossTalk proposal: Ketone bodies are an important metabolic fuel for the heart. The Journal of Physiology. n/a(n/a). doi: ABSTRACT
  7. S S, Dp K, Kb M. Implications of Altered Ketone Metabolism and Therapeutic Ketosis in Heart Failure. Circulation. doi:10.1161/CIRCULATIONAHA.119.045033 ABSTRACT – open access 2021
  8. Lopaschuk Gary D., Karwi Qutuba G., Tian Rong, Wende Adam R., Abel E. Dale. Cardiac Energy Metabolism in Heart Failure. Circulation Research. 2021;128(10):1487-1513. doi:10.1161/CIRCRESAHA.121.318241 ABSTRACT
  9. Lopaschuk GD, Karwi QG, Ho KL, Pherwani S, Ketema EB. KETONE METABOLISM IN THE FAILING HEART. Biochimica et Biophysica Acta (BBA) – Molecular and Cell Biology of Lipids. Published online September 10, 2020:158813. doi:10.1016/j.bbalip.2020.158813 ABSTRACT

Respiratory Function

  1. Alessandro R, Gerardo B, Alessandra L, et al. Effects of Twenty Days of the Ketogenic Diet on Metabolic and Respiratory Parameters in Healthy Subjects. Lung. 2015;193(6):939-945. doi:10.1007/s00408-015-9806-7 ABSTRACT
  2. Suteerojntrakool O, Sanguanrungsirikul S, Sritippayawan S, Jantarabenjakul W, Sirimongkol P, Chomtho S. Effect of a low-carbohydrate diet on respiratory quotient of infants with chronic lung disease. J Med Assoc Thai. 2015;98 Suppl 1:S21-28. PMID: 25764609 ABSTRACT
  3. Stubbs BJ, Koutnik AP, Goldberg EL, et al. Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections. Med (N Y). Published online July 15, 2020. doi:10.1016/j.medj.2020.06.008 
  4. Gorji Z, Modaresi M, Yekanni-Nejad S, Rezaei N, Mahmoudi M. Comparing effects of low glycemic index/high-fat, high-calorie diet and high-fat, high-calorie diet on cytokine levels of patients with cystic fibrosis: A randomized controlled clinical trial. Eur Cytokine Netw. 2020;31(1):32-38. doi:10.1684/ecn.2020.0442
  5. Chen W-L, Wang C-C, Wu L-W, et al. Relationship between Lung Function and Metabolic Syndrome. PLOS ONE. 2014;9(10):e108989. doi:10.1371/journal.pone.0108989
  6. de Boer GM, Tramper-Stranders GA, Houweling L, et al. Adult but not childhood onset asthma is associated with the metabolic syndrome, independent from body mass index. Respiratory Medicine. 2021;188:106603. doi:10.1016/j.rmed.2021.106603
  7. Kim S H, Min H K, Kim H S, Lee S W. Association between insulin resistance and lung function change: Analysis from the community-based prospective Ansan-Ansung cohort in Korea. Published online November 4, 2020. doi:10.21203/ 
  8. Kim SH, Kim HS, Min HK, Lee SW. Association between insulin resistance and lung function trajectory over 4 years in South Korea: community-based prospective cohort. BMC Pulmonary Medicine. 2021;21(1):110. doi:10.1186/s12890-021-01478-7
  9. Lee S-A, Joshi P, Kim Y, Kang D, Kim WJ. The Association of Dietary Macronutrients with Lung Function in Healthy Adults Using the Ansan-Ansung Cohort Study. Nutrients. 2020;12(9):2688. doi:10.3390/nu12092688
  10. al-Saady NM, Blackmore CM, Bennett ED. High fat, low carbohydrate, enteral feeding lowers PaCO2 and reduces the period of ventilation in artificially ventilated patients. Intensive Care Med. 1989;15(5):290-295. doi:10.1007/bf00263863 ABSTRACT
  11. Gangitano, E. et al. (2021) ‘Ketogenic Diet for Obese COVID-19 Patients: Is Respiratory Disease a Contraindication? A Narrative Review of the Literature on Ketogenic Diet and Respiratory Function’, Frontiers in Nutrition, 8. doi:10.3389/fnut.2021.771047.
  12. Gangitano E, Tozzi R, Gandini O, et al. Ketogenic Diet as a Preventive and Supportive Care for COVID-19 Patients. Nutrients. 2021;13(3):1004. doi:10.3390/nu13031004
  13. Goldberg EL, Molony RD, Kudo E, et al. Ketogenic diet activates protective γδ T cell responses against influenza virus infection. Sci Immunol. 2019;4(41). doi:10.1126/sciimmunol.aav2026  (Pre-Clinical)
  1. Alsharairi, N.A. (2020) ‘The Role of Short-Chain Fatty Acids in the Interplay between a Very Low-Calorie Ketogenic Diet and the Infant Gut Microbiota and Its Therapeutic Implications for Reducing Asthma’, International Journal of Molecular Sciences, 21(24), p. 9580. Available at:
  2. Al-Rebdi, M. and Rabbani, U. (2023) ‘Alleviation of Asthma Symptoms After Ketogenic Diet: A Case Report’, Cureus [Preprint]. Available at:
  3. Yang G, Han Y-Y, Forno E, et al. Glycated hemoglobin A1c, lung function, and hospitalizations among adults with asthma. J Allergy Clin Immunol Pract. Published online June 19, 2020. doi:10.1016/j.jaip.2020.06.017 ABSTRACT
  4. Nejatifar F, Foumani AA, Poor ARG, Nejad AT .Association of Metabolic Syndrome and Asthma Status; A Prospective Study from Guilan Province-Iran. – Abstract – Europe PMC. doi:10.2174/1871530321666210305125059 
  5. Wu TD. Diabetes, insulin resistance, and asthma: a review of potential links. Current Opinion in Pulmonary Medicine. Published online September 29, 2020. doi:10.1097/MCP.0000000000000738
  6. Al-Sharif FM, Abd El-Kader SM, Neamatallah ZA, AlKhateeb AM. Weight reduction improves immune system and inflammatory cytokines in obese asthmatic patients. Afr Health Sci. 2020;20(2):897-902. doi:10.4314/ahs.v20i2.44 
  7. Alsharairi NA. The Role of Short-Chain Fatty Acids in the Interplay between a Very Low-Calorie Ketogenic Diet and the Infant Gut Microbiota and Its Therapeutic Implications for Reducing Asthma. International Journal of Molecular Sciences. 2020;21(24):9580. doi:10.3390/ijms21249580 
  8. de Boer GM, Tramper-Stranders GA, Houweling L, et al. Adult but not childhood onset asthma is associated with the metabolic syndrome, independent from body mass index. Respiratory Medicine. 2021;188:106603. doi:10.1016/j.rmed.2021.106603 
  9. Ghatas, T.S. (2021) ‘Metabolic syndrome and asthma’, Journal of Medicine in Scientific Research, 4(4), p. 314. doi:10.4103/jmisr.jmisr_34_21.
  10. Goyal JP, Kumar P, Thakur C, Khera D, Singh K, Sharma P. Effect of insulin resistance on lung function in asthmatic children. J Pediatr Endocrinol Metab. Published online October 1, 2021. doi:10.1515/jpem-2021-0351 ABSTRACT
  11. Carr TF, Granell R, Stern DA, et al. High Insulin in Early Childhood is Associated with Subsequent Asthma Risk Independent of Body Mass Index. The Journal of Allergy and Clinical Immunology: In Practice. Published online October 14, 2021. doi:10.1016/j.jaip.2021.09.047 ABSTRACT
  12. Buendia J, Acuña-Cordero R, TALAMONI H. The role of high carbohydrate-rich food intake and severity of wheezing exacerbation in children between 2 to 6 years aged. Published online 2021. doi:10.22541/au.162536704.41003159/v1 ABSTRACT
  13. Calcaterra V, Verduci E, Ghezzi M, et al. Pediatric Obesity-Related Asthma: The Role of Nutrition and Nutrients in Prevention and Treatment. Nutrients. 2021;13(11):3708. doi:10.3390/nu13113708
Chronic Obstructive Pulmonary Disease (COPD)
  1. Tümer G, Mercanligi̇l SM, Uzun O, Aygün C. The Effects of a High-Fat, Low-Carbohydrate Diet on the Prognosis of Patients with an Acute Attack of Chronic Obstructive Pulmonary Disease. Turkiye Klinikleri J Med Sci. 2009;29(4):895-904. ISSN:1300-0292 ABSTRACT
  2. Adherence to Low Carbohydrate Diet in Relation to Chronic Obstructive Pulmonary Disease (COPD). Published online December 11, 2020. (Research Square – Pre-print) doi:10.21203/
  3. Cai B, Zhu Y, Ma Y i, et al. Effect of Supplementing a High-Fat, Low-Carbohydrate Enteral Formula in COPD Patients. Nutrition (Burbank, Los Angeles County, Calif). 2003;19:229-232. doi:10.1016/S0899-9007(02)01064-X ABSTRACT
  4. Angelillo VA, Bedi S, Durfee D, Dahl J, Patterson AJ, O’Donohue WJ. Effects of low and high carbohydrate feedings in ambulatory patients with chronic obstructive pulmonary disease and chronic hypercapnia. Ann Intern Med. 1985;103(6 ( Pt 1)):883-885. doi:10.7326/0003-4819-103-6-883 ABSTRACT
  5. Norwitz NG, Winwood R, Stubbs BJ, D’Agostino DP, Barnes PJ. Case Report: Ketogenic Diet Is Associated With Improvements in Chronic Obstructive Pulmonary Disease. Front Med. 2021;0. doi:10.3389/fmed.2021.699427
  6. Katsiki N, Stoian AP, Steiropoulos P, Papanas N, Suceveanu AI, Mikhailidis DP. Metabolic Syndrome and Abnormal Peri-Organ or Intra-Organ Fat (APIFat) Deposition in Chronic Obstructive Pulmonary Disease: An Overview. Metabolites. 2020;10(11):465. doi:10.3390/metabo10110465
  7. Scoditti E, Massaro M, Garbarino S, Toraldo DM. Role of Diet in Chronic Obstructive Pulmonary Disease Prevention and Treatment. Nutrients. 2019;11(6). doi:10.3390/nu11061357

Ocular Health

  1. Hains, L.R. et al. (2024) ‘Diet-induced Resolution of Macular Oedema following Remission of Type 2 Diabetes Mellitus in a patient undergoing Therapeutic Carbohydrate Reduction’, Retinal Cases and Brief Reports, p. 10.1097/ICB.0000000000001614. Available at:
  2. Storoni M, Robert MP, Plant GT. The therapeutic potential of a calorie-restricted ketogenic diet for the management of Leber hereditary optic neuropathy. Nutr Neurosci. 2019;22(3):156-164. doi:10.1080/1028415X.2017.1368170 ABSTRACT
  3. Zarnowski T, Tulidowicz-Bielak M, Zarnowska I, et al. Kynurenic Acid and Neuroprotective Activity of the Ketogenic Diet in the Eye. Curr Med Chem. 2017;24(32):3547-3558. doi:10.2174/0929867324666170509120257 ABSTRACT
  4. Emperador S, López-Gallardo E, Hernández-Ainsa C, et al. Ketogenic treatment reduces the percentage of a LHON heteroplasmic mutation and increases mtDNA amount of a LHON homoplasmic mutation. Orphanet Journal of Rare Diseases. 2019;14(1):150. doi:10.1186/s13023-019-1128-z  
  5. New SH, Leow SN, Vasudevan SK, Idris IB, Tang SF, Din NM. Relationship between anthropometric and biochemical changes of metabolic syndrome with retinal nerve fiber layer and macular thickness. PLOS ONE. 2021;16(2):e0246830. doi:10.1371/journal.pone.0246830
  6. Chapman NA, Jacobs RJ, Braakhuis AJ. Role of diet and food intake in age-related macular degeneration: a systematic review. Clinical & Experimental Ophthalmology. 2019;47(1):106-127. doi:10.1111/ceo.13343
  7. Francisco SG, Smith KM, Aragonès G, et al. Dietary Patterns, Carbohydrates, and Age-Related Eye Diseases. Nutrients. 2020;12(9):2862. doi:10.3390/nu12092862
  8. Lima-Fontes M, Barata P, Falcão M, Carneiro Â. Ocular findings in metabolic syndrome: a review. Porto Biomedical Journal. 2020;5(6):104. doi:10.1097/j.pbj.0000000000000104
  9. Rezaeimanesh N, Jahromi SR, Ghorbani Z, et al. Low carbohydrate diet score and odds of neuromyelitis optica spectrum disorder: A case-control study. International Journal for Vitamin and Nutrition Research. Published online August 14, 2020:1-10. doi:10.1024/0300-9831/a000677 ABSTRACT
  10. Chandrasekaran P, Rani PK. Reversal of diabetic tractional retinal detachment attributed to keto diet. BMJ Case Reports CP. 2020;13(10):e235873. doi:10.1136/bcr-2020-235873 
  11. Thaler S, Choragiewicz TJ, Rejdak R, et al. Neuroprotection by acetoacetate and β-hydroxybutyrate against NMDA-induced RGC damage in rat—possible involvement of kynurenic acid. Graefes Arch Clin Exp Ophthalmol. 2010;248(12):1729-1735. doi:10.1007/s00417-010-1425-7 (Pre-clinical)
  12. Ryals RC, Huang SJ, Wafai D, et al. A Ketogenic & Low-Protein Diet Slows Retinal Degeneration in rd10 Mice. Trans Vis Sci Tech. 2020;9(11):18-18. doi:10.1167/tvst.9.11.18 (Pre-clinical)
  1. Zarnowski T, Tulidowicz-Bielak M, Kosior-Jarecka E, Zarnowska I, A. Turski W, Gasior M. A Ketogenic Diet May Offer Neuroprotection in Glaucoma and Mitochondrial Diseases of the Optic Nerve. Med Hypothesis Discov Innov Ophthalmol. 2012;1(3):45-49. PMC3939735
  2. Hanyuda A, Rosner BA, Wiggs JL, et al. Low-carbohydrate-diet scores and the risk of primary open-angle glaucoma: data from three US cohorts. Eye. Published online March 2, 2020:1-11. doi:10.1038/s41433-020-0820-5
  3. Lee JY, Kim JM, Lee KY, Kim B, Lee MY, Park KH. Relationships between Obesity, Nutrient Supply and Primary Open Angle Glaucoma in Koreans. Nutrients. 2020;12(3). doi:10.3390/nu12030878
  4. Choi JA, Park Y-M, Han K, Lee J, Yun J-S, Ko S-H. Fasting plasma glucose level and the risk of open angle glaucoma: Nationwide population-based cohort study in Korea. PLOS ONE. 2020;15(9):e0239529. doi:10.1371/journal.pone.0239529 
  5. Russo R, Nucci C, Adornetto A. The promise of neuroprotection by dietary restriction in glaucoma. Neural Regen Res. 2022;17(1):45-47. doi:10.4103/1673-5374.314308
  6. Jung Y, Han K, Park HYL, Lee SH, Park CK. Metabolic Health, Obesity, and the Risk of Developing Open-Angle Glaucoma: Metabolically Healthy Obese Patients versus Metabolically Unhealthy but Normal Weight Patients. Diabetes Metab J. December 2019. doi:10.4093/dmj.2019.0048 ABSTRACT
  7. Moreno-Montañés J, Gutierrez-Ruiz I, Gándara E, et al. Carbohydrate intake and risk of glaucoma in the sun cohort. European Journal of Ophthalmology. Published online April 25, 2021:11206721211012862. doi:10.1177/11206721211012862 ABSTRACT
Media Links
  1. Bret Schur MD. Diet Doctor Podcast – #66 – Dr. Ana Lorenzo. Google Podcasts. 

Dental Health

  1. Taher, H.A. et al. (2024) ‘Role of ketogenic diet and its effect on the periodontium. A scoping review’, Frontiers in Oral Health, 5. Available at:
  2. Bagde, H. et al. (2024) ‘The Effect of a Low-Carbohydrate Diet on Periodontal Health and Inflammation in Patients with Type 2 Diabetes’, Journal of Pharmacy and Bioallied Sciences, 16, pp. S644–S646. Available at:
  3. Woelber JP, Bremer K, Vach K, et al. An oral health optimized diet can reduce gingival and periodontal inflammation in humans – a randomized controlled pilot study. BMC Oral Health. 2016;17(1):28. doi:10.1186/s12903-016-0257-1
  4. Tennert C, Reinmuth A-C, Bremer K, et al. An oral health optimized diet reduces the load of potential cariogenic and periodontal bacterial species in the supragingival oral plaque: A randomized controlled pilot study. MicrobiologyOpen. n/a(n/a):e1056. doi:10.1002/mbo3.1056
  5. Littlemore, B. and Duerden, S. (2021) ‘Should we be giving dietary advice to prevent periodontal disease? The effect of a low-carbohydrate diet in reducing periodontal inflammation’, BDJ Team, 8(10), pp. 55–65. doi:10.1038/s41407-021-0783-9
  6. Woelber, J.P. et al. (2021) ‘Effects of a Non-Energy-Restricted Ketogenic Diet on Clinical Oral Parameters. An Exploratory Pilot Trial’, Nutrients, 13(12), p. 4229. doi:10.3390/nu13124229
  7. Hujoel PP, Lingström P. Nutrition, dental caries and periodontal disease: a narrative review. Journal of Clinical Periodontology. 2017;44(S18):S79-S84. doi:10.1111/jcpe.12672    PDF 
  8. Hancock S, Zinn C, Schofield G. The consumption of processed sugar- and starch-containing foods, and dental caries: a systematic review. Eur J Oral Sci. 2020;128(6):467-475. doi:10.1111/eos.12743 ABSTRACT
  9. Pappe CL, Steckhan N, Hoedke D, et al. Prolonged multimodal fasting modulates periodontal inflammation in female patients with metabolic syndrome. A prospective cohort study. J Clin Periodontol. Published online January 4, 2021. doi:10.1111/jcpe.13419
  10. Parveen S. Impact of calorie restriction and intermittent fasting on periodontal health. Periodontology 2000. 2021;87(1):315-324. doi:10.1111/prd.12400
  11. Gobin R, Tian D, Liu Q, Wang J. Periodontal Diseases and the Risk of Metabolic Syndrome: An Updated Systematic Review and Meta-Analysis. Front Endocrinol. 2020;11. doi:10.3389/fendo.2020.00336
  12. Rajaram SS, Rajaram SS, Nisha S, et al. Influence of a low-carbohydrate and rich in Omega-3 fatty acids, ascorbic acid, antioxidants, and fiber diet on clinical outcomes in patients with chronic gingivitis: A randomized controlled trial. Journal of International Society of Preventive and Community Dentistry. 2021;11(1):58. doi:10.4103/jispcd.JISPCD_365_20
  13. Horsophonphong S, Kitkumthorn N, Sritanaudomchai H, et al. High Glucose Affects Proliferation, Reactive Oxygen Species and Mineralization of Human Dental Pulp Cells. Brazilian Dental Journal. 2020;31(3):298-303. doi:10.1590/0103-6440202003120


There are a number of conditions that may be classified as having an autoimmune component. Many of these can be found in other sections e.g for Rheumatoid Arthritis see Pain/Inflammation – Arthritis, for Crohn’s disease see Gastrointestinal etc. The studies below don’t fit neatly into other categories or are too small for their own section.

  1. Choi IY, Lee C, Longo VD. Nutrition and fasting mimicking diets in the prevention and treatment of autoimmune diseases and immunosenescence. Molecular and Cellular Endocrinology. 2017;455:4-12. doi:10.1016/j.mce.2017.01.042    PDF
  2. Miyake CNH, Gualano B, Dantas WS, et al. Increased Insulin Resistance and Glucagon Levels in Mild/Inactive Systemic Lupus Erythematosus Patients Despite Normal Glucose Tolerance. Arthritis Care & Research. 2018;70(1):114-124. doi:10.1002/acr.23237
  3. Davies RJ, Lomer MCE, Yeo SI, Avloniti K, Sangle SR, D’Cruz DP. Weight loss and improvements in fatigue in systemic lupus erythematosus: a controlled trial of a low glycaemic index diet versus a calorie restricted diet in patients treated with corticosteroids. Lupus. 2012;21(6):649-655. doi:10.1177/0961203312436854 ABSTRACT
  4. Jiang Y, Jarr K, Layton C, et al. Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases. Nutrients. 2021;13(3). doi:10.3390/nu13030890
  5. Ciaffi, J. et al. (2021) ‘The Effect of Ketogenic Diet on Inflammatory Arthritis and Cardiovascular Health in Rheumatic Conditions: A Mini Review’, Frontiers in Medicine, 8. doi: 10.3389/fmed.2021.792846 
  6. Wu, Y. and Chen, X. (2023) ‘Ketogenic dietary intervention as therapy for thrombocytopenia’, Cancer Pathogenesis and Therapy, 1(3), pp. 227–228. Available at: (preclinical)
  1. Esposito T, Lobaccaro JM, Esposito MG, et al. Effects of low-carbohydrate diet therapy in overweight subjects with autoimmune thyroiditis: possible synergism with ChREBP. Drug Des Devel Ther. 2016;10:2939-2946. doi:10.2147/DDDT.S106440 
  2. Krysiak R, Szkróbka W, Okopień B. The Effect of Gluten-Free Diet on Thyroid Autoimmunity in Drug-Naïve Women with Hashimoto’s Thyroiditis: A Pilot Study. Exp Clin Endocrinol Diabetes. 2019;127(07):417-422. doi:10.1055/a-0653-7108 
  3. Chapela, S.P. et al. (2024) ‘Obesity and Obesity-Related Thyroid Dysfunction: Any Potential Role for the Very Low-Calorie Ketogenic Diet (VLCKD)?’, Current Nutrition Reports [Preprint]. Available at:
  4. Huang, X.-S. et al. (2024) ‘MRI quantitative assessment of the effects of low-carbohydrate therapy on Hashimoto’s thyroiditis’, Endocrine Connections, 1(aop). Available at:
  5. Cooper, I.D. et al. (2023) ‘Thyroid markers and body composition predict LDL-cholesterol change in lean healthy women on a ketogenic diet: experimental support for the lipid energy model’, Frontiers in Endocrinology, 14. Available at:
  6. Obaid, K.H. and Majeed, M.J. (2024) ‘Exploring the Impact of the Ketogenic Diet on Thyroid Function’, Modern Sport, 23(2), pp. 0157–0163. Available at: ABSTRACT

Immune Function

  1. Srivastava, S. et al. (2023) ‘Immune Modulatory Effects of Ketogenic Diet in Different Disease Conditions’, Immuno, 3(1), pp. 1–15. Available at:
  2. Hirschberger S, Strauß G, Effinger D, et al. Very-low-carbohydrate diet enhances human T-cell immunity through immunometabolic reprogramming. EMBO Molecular Medicine. Published online June 21, 2021:e14323. doi:10.15252/emmm.202114323
  3. Breukelman GJ, Shaw BS, Basson AK, Djarova TG, Millard L, Shaw I. Immune Function Response Following a Low-carbohydrate, High-fat Diet (LCHFD) in Patients with type 2 Diabetes. Asian Journal of Sports Medicine. Published December 30, 2025. doi:10.5812/asjsm.106582
  4. Lorenzo, P.M. et al. (2022) ‘Immunomodulatory effect of a very-low-calorie ketogenic diet compared with bariatric surgery and a low-calorie diet in patients with excessive body weight’, Clinical Nutrition, 0(0). doi:10.1016/j.clnu.2022.05.007.
  5. Stubbs BJ, Koutnik AP, Goldberg EL, et al. Investigating Ketone Bodies as Immunometabolic Countermeasures against Respiratory Viral Infections. Med (N Y). Published online July 15, 2020. doi:10.1016/j.medj.2020.06.008
  6. Watanabe, M. et al. (2022) ‘Rapid Weight Loss, Central Obesity Improvement and Blood Glucose Reduction Are Associated with a Stronger Adaptive Immune Response Following COVID-19 mRNA Vaccine’, Vaccines, 10(1), p. 79. doi:10.3390/vaccines10010079.
  7. Wood TR, Jóhannsson GF. Metabolic health and lifestyle medicine should be a cornerstone of future pandemic preparedness. Lifestyle Medicine. 2020;n/a(n/a):e2. doi:10.1002/lim2.2 
  8. Gangitano E, Tozzi R, Gandini O, et al. Ketogenic Diet as a Preventive and Supportive Care for COVID-19 Patients. Nutrients. 2021;13(3):1004. doi:10.3390/nu13031004
  9. Barrea, L. et al. (2022) ‘From the Ketogenic Diet to the Mediterranean Diet: The Potential Dietary Therapy in Patients with Obesity after CoVID-19 Infection (Post CoVID Syndrome)’, Current Obesity Reports [Preprint]. doi:10.1007/s13679-022-00475-z.
  10. Wilhelm C, Surendar J, Karagiannis F. Enemy or ally? Fasting as an essential regulator of immune responses. Trends Immunol. Published online April 14, 2021. doi:10.1016/ 
  11. Ealey KN, Phillips J, Sung H-K. COVID-19 and obesity: Fighting two pandemics with intermittent fasting. Trends in Endocrinology & Metabolism. Published online June 25, 2021. doi:10.1016/j.tem.2021.06.004    PDF
  12. Bhatti, S.I. and Mindikoglu, A.L. (2021) ‘The impact of dawn to sunset fasting on immune system and its clinical significance in Covid-19 pandemic’, Metabolism Open, p. 100162. doi:10.1016/j.metop.2021.100162.
  13. Wang, Y., Chi, H., 2022. Fasting as key tone for COVID immunity. Nat Metab 1–3.
  14. Nassar MF, El Gendy YGA, Hamza MT, Mohamed MN, Radwan N. The Effect of Ketogenic Diet on Neutrophil Count. QJM: An International Journal of Medicine. 2021;114(Supplement_1). doi:10.1093/qjmed/hcab113.041  ABSTRACT
  15. Goldberg EL, Molony RD, Kudo E, et al. Ketogenic diet activates protective γδ T cell responses against influenza virus infection. Science Immunology. 2019;4(41). doi:10.1126/sciimmunol.aav2026 (pre-clinical)


There are a number of conditions that may be classified as having an endocrine component. Many of these can be found in other sections. The studies below don’t fit neatly into other categories or are too small for their own section.

  1. Gupta L, Khandelwal D, Kalra S, Gupta P, Dutta D, Aggarwal S. Ketogenic diet in endocrine disorders: Current perspectives. J Postgrad Med. 2017;63(4):242-251. doi:10.4103/jpgm.JPGM_16_17
  2. Deru, L. et al. (2022) ‘Understanding the endocrine response to macronutrients in the context of a ketogenic diet’, The FASEB Journal, 36(S1). doi:10.1096/fasebj.2022.36.S1.R6073.
  3. Renck A, Sajoux I, Hallak J, Costa E. Metabolic and hormonal improvement after ketogenic VLCD diet (VLCK): Case report. In: BioScientifica; 2019. doi:10.1530/endoabs.63.P1155 ABSTRACT
  4. Ec C, Kac B, N E-S, Sjcmm N, Aj van der L. Eucaloric Very-Low-Carbohydrate Ketogenic Diet in Acromegaly Treatment. The New England journal of medicine. doi:10.1056/NEJMc1915808
  5. Iacovides, S. et al. (2022) ‘Could the ketogenic diet induce a shift in thyroid function and support a metabolic advantage in healthy participants? A pilot randomized-controlled-crossover trial’, PLOS ONE, 17(6), p. e0269440. Available at:

Bone Health

For more articles on  bone health as pertains to menopause, see the section under reproductive health and menopause.


  1. Hu T, Yao L, Bazzano L. Effects of a 12-month Low-Carbohydrate Diet vs. a Low-Fat Diet on Bone Mineral Density: A Randomized Controlled Trial. The FASEB Journal. 2016;30(S1):678.12-678.12. doi: ABSTRACT
  2. Athinarayanan SJ, Adams RN, Hallberg SJ, et al. Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-year Non-randomized Clinical Trial. Front Endocrinol. 2019;10. doi:10.3389/fendo.2019.00348
  3. Papageorgiou, M. et al. (2023) ‘The effects of time‐restricted eating and weight loss on bone metabolism and health: a 6‐month randomized controlled trial’, Obesity (Silver Spring, Md.), 31(Suppl 1), p. 85. Available at: ABSTRACT
  4. Vargas-Molina, S. et al. (2021) ‘Effects of a low-carbohydrate ketogenic diet on health parameters in resistance-trained women’, European Journal of Applied Physiology. Available at:
  5. Partial Replacement of Animal Proteins with Plant Proteins for 12 Weeks Accelerates Bone Turnover Among Healthy Adults: A Randomized Clinical Trial | The Journal of Nutrition | Oxford Academic. doi:10.1093/jn/nxaa264  ABSTRACT
  6. Tonks KT, White CP, Center JR, Samocha-Bonet D, Greenfield JR. Bone Turnover Is Suppressed in Insulin Resistance, Independent of Adiposity. J Clin Endocrinol Metab. 2017;102(4):1112-1121. doi:10.1210/jc.2016-3282 
  7. Almsaid H, Muhsin H. The effect of Ketogenic diet on vitamin D3 and testosterone hormone in patients with diabetes mellitus type 2. Current Issues in Pharmacy and Medical Sciences. 2021;33:202-205. doi:10.2478/cipms-2020-0033
  8. Islamoglu AH, Garipagaoglu M, Bicer HS, Kurtulus D, Ozturk M, Gunes FE. The effects of dietary changes on bone markers in postmenopausal vertebral osteopenia. Clinical Nutrition. 2020;0(0). doi:10.1016/j.clnu.2020.04.001 ABSTRACT
  9. Campillo-Sánchez F, Usategui-Martín R, Ruiz -de Temiño Á, et al. Relationship between Insulin Resistance (HOMA-IR), Trabecular Bone Score (TBS), and Three-Dimensional Dual-Energy X-ray Absorptiometry (3D-DXA) in Non-Diabetic Postmenopausal Women. Journal of Clinical Medicine. 2020;9(6):1732. doi:10.3390/jcm9061732 
  10. Lobene AJ, Panda S, Mashek DG, Manoogian ENC, Hill Gallant KM, Chow LS. Time-Restricted Eating for 12 Weeks Does Not Adversely Alter Bone Turnover in Overweight Adults. Nutrients. 2021;13(4):1155. doi:10.3390/nu13041155
  11. Hunt HB, Miller NA, Hemmerling KJ, et al. Bone tissue composition in post-menopausal women varies with glycemic control from normal glucose tolerance to type 2 diabetes mellitus. Journal of Bone and Mineral Research. n/a(n/a). doi:10.1002/jbmr.4186 ABSTRACT
  12. Karadeniz B, Gur C, Cakir D, et al. The relationship between glycemic control and osteocalcin, type 1 collagen C-terminal telopeptide, bone-specific alkaline phosphatase and the effects of anti-diabetic regimens on circulating markers of bone turnover in newly diagnosed diabetic patients: Bone health in diabetics. Clin Nephrol. Published online May 27, 2021. doi:10.5414/CN110394 ABSTRACT
  13. Silva VN da, Goldberg TBL, Silva CC, et al. Impact of metabolic syndrome and its components on bone remodeling in adolescents. PLOS ONE. 2021;16(7):e0253892. doi:10.1371/journal.pone.0253892
  14. Heikura IA, Burke LM, Hawley JA, et al. A Short-Term Ketogenic Diet Impairs Markers of Bone Health in Response to Exercise. Front Endocrinol (Lausanne). 2020;10. doi:10.3389/fendo.2019.00880
  15. Chiu H, Lee M-Y, Wu P-Y, Huang J-C, Chen S-C. Development of Metabolic Syndrome Decreases Bone Mineral Density T-Score of Calcaneus in Foot in a Large Taiwanese Population Follow-Up Study. Journal of Personalized Medicine. 2021;11(5):439. doi:10.3390/jpm11050439
  16. Rendina D, D’Elia L, Evangelista M, et al. Metabolic syndrome is associated to an increased risk of low bone mineral density in free-living women with suspected osteoporosis. J Endocrinol Invest. Published online September 22, 2020. doi:10.1007/s40618-020-01428-w ABSTRACT
  17. Onkarappa RS, Chauhan DK, Saikia B, Karim A, Kanojia RK. Metabolic Syndrome and Its Effects on Cartilage Degeneration vs Regeneration: A Pilot Study Using Osteoarthritis Biomarkers. JOIO. Published online July 24, 2020. doi:10.1007/s43465-020-00145-z ABSTRACT
  18. Saleem U, Mosley TH, Kullo IJ. Serum Osteocalcin Is Associated With Measures of Insulin Resistance, Adipokine Levels, and the Presence of Metabolic Syndrome. Arterioscler Thromb Vasc Biol. 2010;30(7):1474-1478. doi:10.1161/ATVBAHA.110.204859
  19. Bilinski WJ, Szternel L, Siodmiak J, et al. Effect of fasting hyperglycemia and insulin resistance on bone turnover markers in children aged 9–11 years. Journal of Diabetes and its Complications. Published online July 30, 2021:108000. doi:10.1016/j.jdiacomp.2021.108000 ABSTRACT
  20. Crivelli M, Chain A, da Silva ITF, Waked AM, Bezerra FF. Association of Visceral and Subcutaneous Fat Mass With Bone Density and Vertebral Fractures in Women With Severe Obesity. Journal of Clinical Densitometry. Published online October 16, 2020. doi:10.1016/j.jocd.2020.10.005
  21. Bredella MA, Fazeli PK, Bourassa J, et al. The Effect of Short-Term High-Caloric Feeding and Fasting on Bone Microarchitecture. Bone. Published online September 24, 2021:116214. doi:10.1016/j.bone.2021.116214
  1. Cooper ID, Brookler KH, Crofts CAP. Rethinking Fragility Fractures in Type 2 Diabetes: The Link between Hyperinsulinaemia and Osteofragilitas. Biomedicines. 2021;9(9):1165. doi:10.3390/biomedicines9091165
  2. Lecka-Czernik B. Diabetes, bone and glucose-lowering agents: basic biology. Diabetologia. 2017;60(7):1163-1169. doi:10.1007/s00125-017-4269-4 
  3. Fernandes TAP, Gonçalves LML, Brito JAA. Relationships between Bone Turnover and Energy Metabolism. Journal of Diabetes Research. 2017. doi:10.1155/2017/9021314  
  4. Gravenstein KS, Napora JK, Short RG, et al. Cross-Sectional Evidence of a Signaling Pathway from Bone Homeostasis to Glucose Metabolism. J Clin Endocrinol Metab. 2011;96(6):E884-E890. doi:10.1210/jc.2010-2589 
  5. Kawai M, de Paula FJA, Rosen CJ. New Insights into Osteoporosis: The Bone-Fat Connection. J Intern Med. 2012;272(4):317-329. doi:10.1111/j.1365-2796.2012.02564.x 
  6. Merlotti D, Cosso R, Eller-Vainicher C, et al. Energy Metabolism and Ketogenic Diets: What about the Skeletal Health? A Narrative Review and a Prospective Vision for Planning Clinical Trials on this Issue. Int J Mol Sci. 2021;22(1). doi:10.3390/ijms22010435


  1. Gangitano, E. et al. (2023) ‘Comparison of the Effects of a Ketogenic Diet and an Isocaloric Balanced Diet administered to Obese patients on Quality of Life and Sleep: a Randomized Clinical Trial’, in Endocrine Abstracts. ECE 2023, Bioscientifica. Available at:
  2. Siegmann MJ, Athinarayanan SJ, Hallberg SJ, et al. Improvement in patient-reported sleep in type 2 diabetes and prediabetes participants receiving a continuous care intervention with nutritional ketosis. Sleep Med. 2019;55:92-99. doi:10.1016/j.sleep.2018.12.014
  3. Barrea, L. et al. (2023) ‘Can the ketogenic diet improve our dreams? Effect of very low-calorie ketogenic diet (VLCKD) on sleep quality’, Journal of Translational Medicine, 21(1), p. 479. Available at:
  4. Merlino, G. et al. (2023) ‘Sleep of migraine patients is ameliorated by ketogenic diet, independently of pain control’, Sleep Medicine [Preprint]. Available at:
  5. Castro AI, Gomez-Arbelaez D, Crujeiras AB, et al. Effect of A Very Low-Calorie Ketogenic Diet on Food and Alcohol Cravings, Physical and Sexual Activity, Sleep Disturbances, and Quality of Life in Obese Patients. Nutrients. 2018;10(10). doi:10.3390/nu10101348
  6. Osman, A. et al. (2023) ‘Ketogenic diet acutely improves gas exchange and sleep apnoea in obesity hypoventilation syndrome: A non-randomized crossover study’, Respirology (Carlton, Vic.) [Preprint]. Available at:
  7. Robberechts, R. et al. (no date) ‘Exogenous Ketosis Improves Sleep Efficiency and Counteracts the Decline in REM Sleep Following Strenuous Exercise’, Medicine & Science in Sports & Exercise, p. 10.1249/MSS.0000000000003231. Available at:
  8. O’Hearn LA. The therapeutic properties of ketogenic diets, slow-wave sleep, and circadian synchrony. Current Opinion in Endocrinology, Diabetes and Obesity. Published online July 23, 2021. doi:10.1097/MED.000000000000066
  9. Tokuchi Y, Nakamura Y, Munekata Y, Tokuchi F. Low carbohydrate diet-based intervention for obstructive sleep apnea and primary hypothyroidism in an obese Japanese man. Asia Pac Fam Med. 2016;15. doi:10.1186/s12930-016-0029-8
  10. Kalam F, Gabel K, Cienfuegos S, Ezpeleta M, Wiseman E, Varady KA. Alternate Day Fasting Combined with a Low Carbohydrate Diet: Effect on Sleep Quality, Duration, Insomnia Severity and Risk of Obstructive Sleep Apnea in Adults with Obesity. Nutrients. 2021;13(1):211. doi:10.3390/nu13010211
  11. Pasca, L. et al. (2023) ‘The effects of ketogenic dietary therapies on sleep: A scoping review’, Journal of Sleep Research, n/a(n/a), p. e14073. Available at:
  12. McStay M, Gabel K, Cienfuegos S, Ezpeleta M, Lin S, Varady KA. Intermittent Fasting and Sleep: A Review of Human Trials. Nutrients. 2021;13(10):3489. doi:10.3390/nu13103489 
  13. Tavakoli A, Mirzababaei A, Mirzaei K. Association between low carbohydrate diet (LCD) and sleep quality by mediating role of inflammatory factors in women with overweight and obesity: A cross-sectional study. Food Science & Nutrition. n/a(n/a). doi:10.1002/fsn3.2584
  14. Barrea L, Pugliese G, Frias-Toral E, et al. Is there a relationship between the ketogenic diet and sleep disorders? International Journal of Food Sciences and Nutrition. 2021;0(0):1-11. doi:10.1080/09637486.2021.1993154 ABSTRACT
  15. Ünalp A, Baysal BT, Sarıtaş S, et al. Evaluation of the effects of ketogenic diet therapy on sleep quality in children with drug-resistant epilepsy and their mothers. Epilepsy Behav. 2021;124:108327. doi:10.1016/j.yebeh.2021.108327 ABSTRACT
  16. Makowski, M.S. et al. (2021) ‘Performance Nutrition for Physician Trainees Working Overnight Shifts: A Randomized Controlled Trial’, Academic Medicine [Preprint]. doi:10.1097/ACM.0000000000004509