Other Conditions

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.

Mental Health

This is an emerging area. Studies include diets favouring whole foods or avoiding potential trigger foods. There are a number of features that may connect the conditions e.g. nutrient sufficiency, insulin resistance, metabolic syndrome, hormonal responses (ghrelin/leptin) and brain glucose hypometabolism/insulin signaling issues which support the potential role of nutritional interventions.

The significant burden of metabolic syndrome in these patients, along with the possible role of drug side effects, could indicate a benefit of therapeutic carbohydrate restriction as an independent consideration. 

Due to the therapeutic effect of carbohydrate restriction, medical supervision is advised when adopting this approach – reflected in the following article: Ede G (Author), Scher B (Medical review) Low Carb and Mental Health: Getting Started & Managing Medications. Diet Doctor.


  1. Adan RAH, van der Beek EM, Buitelaar JK, et al. Nutritional psychiatry: Towards improving mental health by what you eat. European Neuropsychopharmacology. Published online November 2019:S0924977X19317237. doi:10.1016/j.euroneuro.2019.10.011
  2. Tillery EE, Ellis KD, Threatt TB, Reyes HA, Plummer CS, Barney LR. The use of the ketogenic diet in the treatment of psychiatric disorders. Mental Health Clinician. 2021;11(3):211-219. doi:10.9740/mhc.2021.05.211 
  3. Sarnyai Z, Palmer CM. Ketogenic Therapy in Serious Mental Illness: Emerging Evidence. Int J Neuropsychopharmacol. 2020;23(7):434-439. doi:10.1093/ijnp/pyaa036 
  4. Marx W, Moseley G, Berk M, Jacka F. Nutritional psychiatry: the present state of the evidence. Proceedings of the Nutrition Society. 2017;76(4):427-436. doi:10.1017/S0029665117002026
  5. Bremner JD, Moazzami K, Wittbrodt MT, et al. Diet, Stress and Mental Health. Nutrients. 2020;12(8):2428. doi:10.3390/nu12082428
  6. Firth J, Gangwisch JE, Borisini A, Wootton RE, Mayer EA. Food and mood: how do diet and nutrition affect mental wellbeing? BMJ. 2020;369. doi:10.1136/bmj.m2382
  7. Aranburu E, Matias S, Simón E, et al. Gluten and FODMAPs Relationship with Mental Disorders: Systematic Review. Nutrients. 2021;13(6):1894. doi:10.3390/nu13061894
  8. Kovacs Z, D’Agostino D, Diamond DM, Kindy MS, Rogers C, Ari C. Therapeutic Potential of Exogenous Ketone Supplement Induced Ketosis in the Treatment of Psychiatric Disorders: Review of Current Literature. Front Psychiatry. 2019;10. doi:10.3389/fpsyt.2019.00363 
  9. Garcia-Rizo C, Kirkpatrick B, Fernandez-Egea E, Oliveira C, Bernardo M. Abnormal glycemic homeostasis at the onset of serious mental illnesses: a common pathway. Psychoneuroendocrinology. 2016;67:70-75. doi:10.1016/j.psyneuen.2016.02.001
  10. Palmer CM. Diets and Disorders: Can Foods or Fasting Be Considered Psychopharmacologic Therapies? J Clin Psychiatry. 2019;81(1):0-0. doi:10.4088/JCP.19ac12727
  11. Norwitz NG, Dalai SS, Palmer CM. Ketogenic diet as a metabolic treatment for mental illness. Current Opinion in Endocrinology, Diabetes and Obesity. 2020;27(5):269–274. doi:10.1097/MED.0000000000000564 PDF
  12. Ross K, VanNortwick M, Dragone D. Innovative therapies for mood disorders: A Case report. EXPLORE. Published online May 4, 2020. doi:10.1016/j.explore.2020.03.011 ABSTRACT
  13. Fond G, Macgregor A, Leboyer M, Michalsen A. Fasting in mood disorders: neurobiology and effectiveness. A review of the literature. Psychiatry Research. 2013;209(3):253-258. doi:10.1016/j.psychres.2012.12.018  ABSTRACT  PDFtable
  14. Operto FF, Matricardi S, Pastorino GMG, Verrotti A, Coppola G. The Ketogenic Diet for the Treatment of Mood Disorders in Comorbidity With Epilepsy in Children and Adolescents. Front Pharmacol. 2020;11. doi:10.3389/fphar.2020.57839
  15. Stone LA, Harmatz ES, Goosens KA. Ghrelin as a Stress Hormone: Implications for Psychiatric Illness. Biological Psychiatry. 2020;88(7):531-540. doi:10.1016/j.biopsych.2020.05.013
  16. Whipp AM, Vuoksimaa E, Korhonen T, et al. Ketone body 3-hydroxybutyrate as a biomarker of aggression. Scientific Reports. 2021;11(1):5813. doi:10.1038/s41598-021-84635-6
  17. Garrido-Torres N, Rocha-Gonzalez I, Alameda L, et al. Metabolic syndrome in antipsychotic-naïve patients with first-episode psychosis: a systematic review and meta-analysis. Psychological Medicine. Published online undefined/ed:1-14. doi:10.1017/S0033291721002853

Depression and Anxiety

  1. Jeremiah OJ, Cousins G, Boland F, Kirby BP, Ryan BK. Evaluation of the effect of insulin sensitivity-enhancing lifestyle- and dietary-related adjuncts on antidepressant treatment response: A systematic review and meta-analysis. Heliyon. 2020;6(9):e04845. doi:10.1016/j.heliyon.2020.e04845 
  2. Tolkien K, Bradburn S, Murgatroyd C. An anti-inflammatory diet as a potential intervention for depressive disorders: A systematic review and meta-analysis. Clinical Nutrition. 2019;38(5):2045-2052. doi:10.1016/j.clnu.2018.11.007
  3. Shamshtein, D. and Liwinski, T. (2022) ‘Ketogenic Therapy for Major Depressive Disorder: A Review of Neurobiological Evidence’, Recent Progress in Nutrition, 2(1), pp. 1–1. doi:10.21926/rpn.2201003.
  4. Setayesh L, Ebrahimi R, Pooyan S, Yarizadeh H, Rashidbeygi E, Badrooj N, et al. The possible mediatory role of adipokines in the association between low carbohydrate diet and depressive symptoms among overweight and obese women. PloS one. 2021;16(9). doi:10.1371/journal.pone.0257275
  5. Arab A, Mehrabani S, Moradi S, Amani R. The association between diet and mood: A systematic review of current literature. Psychiatry Research. 2019;271:428-437. doi:10.1016/j.psychres.2018.12.014 ABSTRACT
  6. Ren M, Zhang H, Qi J, et al. An Almond-Based Low Carbohydrate Diet Improves Depression and Glycometabolism in Patients with Type 2 Diabetes through Modulating Gut Microbiota and GLP-1: A Randomized Controlled Trial. Nutrients. 2020;12(10):3036. doi:10.3390/nu12103036
  7. Jacka FN, O’Neil A, Opie R, et al. A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med. 2017;15. doi:10.1186/s12916-017-0791-y 
  8. Parletta N, Zarnowiecki D, Cho J, et al. A Mediterranean-style dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED). Nutritional Neuroscience. 2019;22(7):474-487. doi:10.1080/1028415X.2017.1411320
  9. Breymeyer KL, Lampe JW, McGregor BA, Neuhouser ML. Subjective Mood and Energy Levels of Healthy Weight and Overweight/Obese Healthy Adults on High-and Low-Glycemic Load Experimental Diets. Appetite. 2016;107:253-259. doi:10.1016/j.appet.2016.08.008     PDF 
  10. Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function. Archives of Internal Medicine. 2009;169(20):1873-1880. doi:10.1001/archinternmed.2009.329
  11. Adams, R.N. et al. (2022) ‘Depressive symptoms improve over 2 years of type 2 diabetes treatment via a digital continuous remote care intervention focused on carbohydrate restriction’, Journal of Behavioral Medicine [Preprint]. doi:10.1007/s10865-021-00272-4.
  12. Francis HM, Stevenson RJ, Chambers JR, Gupta D, Newey B, Lim CK. A brief diet intervention can reduce symptoms of depression in young adults – A randomised controlled trial. PLOS ONE. 2019;14(10):e0222768. doi:10.1371/journal.pone.0222768
  13. Stapel, B. et al. (2022) ‘Impact of fasting on stress systems and depressive symptoms in patients with major depressive disorder: a cross-sectional study’, Scientific Reports, 12, p. 7642. doi:10.1038/s41598-022-11639-1.
  14. Brinkworth GD, Luscombe-Marsh ND, Thompson CH, et al. Long-term effects of very low-carbohydrate and high-carbohydrate weight-loss diets on psychological health in obese adults with type 2 diabetes: randomized controlled trial. J Intern Med. 2016;280(4):388-397. doi:10.1111/joim.12501 (with exercise)
  15. Ortega, M.A., Fraile-Martínez, Ó., García-Montero, C., Alvarez-Mon, M.A., Lahera, G., Monserrat, J., Llavero-Valero, M., Mora, F., Rodríguez-Jiménez, R., Fernandez-Rojo, S., Quintero, J., Alvarez De Mon, M., 2022. Nutrition, Epigenetics, and Major Depressive Disorder: Understanding the Connection. Front Nutr 9, 867150. https://doi.org/10.3389/fnut.2022.867150
  16. Gangwisch JE, Hale L, Garcia L, et al. High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative1. Am J Clin Nutr. 2015;102(2):454-463. doi:10.3945/ajcn.114.103846
  17. Cox N, Gibas S, Salisbury M, Gomer J, Gibas K. Ketogenic diets potentially reverse Type II diabetes and ameliorate clinical depression: A case study. Diabetes Metab Syndr. 2019;13(2):1475-1479. doi:10.1016/j.dsx.2019.01.055 ABSTRACT
  18. Geraets AFJ, Köhler S, Muzambi R, et al. The association of hyperglycaemia and insulin resistance with incident depressive symptoms over 4 years of follow-up: The Maastricht Study. Diabetologia. Published online August 5, 2020. doi:10.1007/s00125-020-05247-9
  19. Darooghegi Mofrad M, Siassi F, Guilani B, Bellissimo N, Suitor K, Azadbakht L. The association of food quality index with mental health in women: a cross-sectional study. BMC Res Notes. 2020;13. doi:10.1186/s13104-020-05401-x
  20. Colognesi M, Gabbia D, De Martin S. Depression and Cognitive Impairment—Extrahepatic Manifestations of NAFLD and NASH. Biomedicines. 2020;8(7):229. doi:10.3390/biomedicines8070229
  21. Reis DJ, Ilardi SS, Namekata MS, Wing EK, Fowler CH. The depressogenic potential of added dietary sugars. Medical Hypotheses. 2020;134:109421. doi:10.1016/j.mehy.2019.109421  
  22. LaChance LR, Ramsey D. Antidepressant foods: An evidence-based nutrient profiling system for depression. World J Psychiatry. 2018;8(3):97-104. doi:10.5498/wjp.v8.i3.97
  23. Duygu Sen Z, Vera Danyeli L, Woelfer M, et al. Linking atypical depression and insulin resistance-related disorders via low-grade chronic inflammation: integrating the phenotypic, molecular and neuroanatomical dimensions. Brain, Behavior, and Immunity. Published online December 23, 2020. doi:10.1016/j.bbi.2020.12.020 PDF
  24. Watson KT, Simard JF, Henderson VW, et al. Incident Major Depressive Disorder Predicted by Three Measures of Insulin Resistance: A Dutch Cohort Study. AJP. Published online September 23, 2021:appi.ajp.2021.20101479. doi:10.1176/appi.ajp.2021.20101479


  1. Daneshzad E, Keshavarz S-A, Qorbani M, Larijani B, Azadbakht L. Association between a low-carbohydrate diet and sleep status, depression, anxiety, and stress score. J Sci Food Agric. 2020;100(7):2946-2952. doi:10.1002/jsfa.10322
  2. Włodarczyk A, Cubała WJ, Wielewicka A. Ketogenic Diet: A Dietary Modification as an Anxiolytic Approach? Nutrients. 2020;12(12):3822. doi:10.3390/nu12123822
  3. Bear TLK, Dalziel JE, Coad J, Roy NC, Butts CA, Gopal PK. The Role of the Gut Microbiota in Dietary Interventions for Depression and Anxiety. Adv Nutr. 2020;11(4):890-907. doi:10.1093/advances/nmaa01
  4. Shegelman A, Carson KA, McDonald TJW, Henry-Barron BJ, Diaz-Arias LA, Cervenka MC. The psychiatric effects of ketogenic diet therapy on adults with chronic epilepsy. Epilepsy & Behavior. 2021;117:107807. doi:10.1016/j.yebeh.2021.107807 ABSTRACT
  5. Norwitz NG, Naidoo U. Nutrition as Metabolic Treatment for Anxiety. Front Psychiatry. 2021;12:598119. doi:10.3389/fpsyt.2021.598119
  6. Kose J, Cheung A, Fezeu LK, et al. A Comparison of Sugar Intake between Individuals with High and Low Trait Anxiety: Results from the NutriNet-Santé Study. Nutrients. 2021;13(5):1526. doi:10.3390/nu13051526
  7. Aucoin, M. et al. (2021) ‘Diet and Anxiety: A Scoping Review’, Nutrients, 13(12), p. 4418. doi:10.3390/nu13124418.

Bipolar Disorder

  1. Campbell IH, Needham N, Grossi H, et al. A Pilot Study of a Ketogenic Diet in Bipolar Disorder: Clinical, Metabolomic and Magnetic Resonance Spectroscopy Outcomes. Published online October 23, 2023:2023.10.23.23297391. doi:10.1101/2023.10.23.23297391    (preprint)
  2. Needham N, Campbell IH, Grossi H, et al. Pilot study of a ketogenic diet in bipolar disorder. BJPsych Open. 2023;9(6):e176. doi:10.1192/bjo.2023.568
  3. H. Campbell I, Campbell H. Ketosis and bipolar disorder: Controlled analytic study of online reports. BJPsych Open. 2019;5. doi:10.1192/bjo.2019.49
  4. Phelps JR, Siemers SV, El-Mallakh RS. The ketogenic diet for type II bipolar disorder. Neurocase. 2013;19(5):423-426. doi:10.1080/13554794.2012.690421 ABSTRACT 
  5. Yu B, Ozveren R, Dalai SS. Ketogenic diet as a metabolic therapy for bipolar disorder: Clinical developments. doi:10.21203/rs.3.rs-334453/v2
  6. Chmiel I. Ketogenic diet in therapy of bipolar affective disorder – case report and literature review. Psychiatr Pol. 2022;56(6):1345-1363. doi:10.12740/PP/OnlineFirst/136356
  7. Campbell IH, Campbell H, Smith DJ. Insulin signaling as a therapeutic mechanism of lithium in bipolar disorder. Transl Psychiatry. 2022;12(1):1-8. doi:10.1038/s41398-022-02122-6
  8. Calkin C, McClelland C, Cairns K, Kamintsky L, Friedman A. Insulin Resistance and Blood-Brain Barrier Dysfunction Underlie Neuroprogression in Bipolar Disorder. Front Psychiatry. 2021;12. doi:10.3389/fpsyt.2021.636174
  9. Schuster MP, Borkent J, Chrispijn M, et al. Increased prevalence of metabolic syndrome in patients with bipolar disorder compared to a selected control group – A Northern Netherlands LifeLines population cohort study. Journal of Affective Disorders. Published online September 6, 2021. doi:10.1016/j.jad.2021.08.139
  10. Calkin CV. Insulin resistance takes center stage: a new paradigm in the progression of bipolar disorder. Annals of Medicine. 2019;51(5-6):281-293. doi:10.1080/07853890.2019.1659511
  11. Calkin CV, Ruzickova M, Uher R, et al. Insulin resistance and outcome in bipolar disorder. The British Journal of Psychiatry. 2015;206(1):52-57. doi:10.1192/bjp.bp.114.152850
  12. Campbell I, Campbell H. A pyruvate dehydrogenase complex disorder hypothesis for bipolar disorder. Medical Hypotheses. 2019;130:109263. doi:10.1016/j.mehy.2019.109263 (Ketogenic diet, epilepsy and bipolar connections)
  13. Campbell I, Campbell H. Mechanisms of insulin resistance, mitochondrial dysfunction and the action of the ketogenic diet in bipolar disorder. Focus on the PI3K/AKT/HIF1-a pathway. Medical Hypotheses. 2020;145:110299. doi:10.1016/j.mehy.2020.110299 ABSTRACT
  14. Mansur RB, Delgado-Peraza F, Subramaniapillai M, et al. Exploring brain insulin resistance in adults with bipolar depression using extracellular vesicles of neuronal origin. Journal of Psychiatric Research. Published online December 4, 2020. doi:10.1016/j.jpsychires.2020.12.007
  15. Saraga M, Misson N, Cattani E. Ketogenic diet in bipolar disorder. Bipolar Disorders. n/a(n/a). doi:10.1111/bdi.13013 ABSTRACT


  1. Gilbert-Jaramillo J, Vargas-Pico D, Espinosa-Mendoza T, et al. The effects of the ketogenic diet on psychiatric symptomatology, weight and metabolic dysfunction in schizophrenia patients. Clin Nutr Metab. 2018;1(1). doi:10.15761/CNM.1000105
  2. Kraft BD, Westman EC. Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature. Nutr Metab (Lond). 2009;6:10. doi:10.1186/1743-7075-6-10
  3. Joseph J, Depp C, Shih PB, Cadenhead KS, Schmid-Schönbein G. Modified Mediterranean Diet for Enrichment of Short Chain Fatty Acids: Potential Adjunctive Therapeutic to Target Immune and Metabolic Dysfunction in Schizophrenia? Published online 2017. Front. Neurosci. 11:155. doi: 10.3389/fnins.2017.00155
  4. Adamowicz K, Mazur A, Mak M, Samochowiec J, Kucharska-Mazur J. Metabolic Syndrome and Cognitive Functions in Schizophrenia—Implementation of Dietary Intervention. Front Psychiatry. 2020;11. doi:10.3389/fpsyt.2020.00359
  5. Argüello C. Revisiting Evidence for Recommending a Gluten- Free Diet in Schizophrenia – Review and Presentation. Researchgate/355184985. November 2021.
  6. Levinta A, Mukovozov I, Tsoutsoulas C. Use of a Gluten-Free Diet in Schizophrenia: A Systematic Review. Advances in nutrition (Bethesda, Md). 2018;9. doi:10.1093/advances/nmy056 ABSTRACT
  7. Jackson J, Eaton W, Cascella N, et al. A gluten-free diet in people with schizophrenia and anti-tissue transglutaminase or anti-gliadin antibodies. Schizophrenia research. 2012;140:262-263. doi:10.1016/j.schres.2012.06.011
  8. Rubin A. Gluten-Free Intervention for Schizophrenia. American Journal of Psychiatry Residents’ Journal. 2020;15(3):8-8. (Commentary) doi:10.1176/appi.ajp-rj.2020.150303
  9. Nandeesha H, Keshri N, Rajappa M, Menon V. Association of hyperglycaemia and hyperlipidaemia with cognitive dysfunction in schizophrenia spectrum disorder. Arch Physiol Biochem. Published online November 3, 2020:1-8. doi:10.1080/13813455.2020.1839500 ABSTRACT
  10. Wijtenburg SA, Kapogiannis D, Korenic S, et al. Brain Insulin Resistance and Altered Brain Glucose are Related to Memory Impairments in Schizophrenia. Schizophr Res. 2019;208:324-330. doi:10.1016/j.schres.2019.01.031 PDF
  11. Sarnyai Z, Kraeuter A-K, Palmer CM. Ketogenic diet for schizophrenia: clinical implication. Curr Opin Psychiatry. June 2019. doi:10.1097/YCO.0000000000000535 ABSTRACT  
  12. Włodarczyk A, Wiglusz MS, Cubała WJ. Ketogenic diet for schizophrenia: Nutritional approach to antipsychotic treatment. Medical Hypotheses. 2018;118:74-77. doi:10.1016/j.mehy.2018.06.022 ABSTRACT
  13. Palmer CM, Gilbert-Jaramillo J, Westman EC. The ketogenic diet and remission of psychotic symptoms in schizophrenia: Two case studies. Schizophr Res. April 2019. doi:10.1016/j.schres.2019.03.019 NO ABSTRACT
  14. Palmer CM. Ketogenic diet in the treatment of schizoaffective disorder: Two case studies. Schizophrenia Research. 2017;189:208-209. doi:10.1016/j.schres.2017.01.053 NO ABSTRACT
  15. Hu J, Zhou Y, Wang R, et al. Abnormal glucose metabolism is associated with clinical symptoms of adolescent-onset patients with first-episode drug-naive schizophrenia. Asian J Psychiatr. 2021;62:102716. doi:10.1016/j.ajp.2021.102716 ABSTRACT

Anorexia Nervosa and Obsessive Compulsive Disorder

To be considered with caution – added for completeness. These disorders have been listed together due to the fact they are highly co-morbid which may be an important consideration for treatment. See media links for examples of clinicians using a reduced carbohydrate approach for disordered eating.

  1. Calabrese, L., Scolnick, B., Zupec-Kania, B., Beckwith, C., Costello, K., Frank, G.K.W., 2022. Ketogenic diet and ketamine infusion treatment to target chronic persistent eating disorder psychopathology in anorexia nervosa: a pilot study. Eat Weight Disord. doi.org/10.1007/s40519-022-01455-x
  2. Scolnick B, Zupec-Kania B, Calabrese L, Aoki C, Hildebrandt T. Remission from Chronic Anorexia Nervosa With Ketogenic Diet and Ketamine: Case Report. Front Psychiatry. 2020;11. doi:10.3389/fpsyt.2020.00763
  3. Scolnick B. Ketogenic diet and anorexia nervosa. Medical Hypotheses. 2017;109:150-152. doi:10.1016/j.mehy.2017.10.011 ABSTRACT
  4. Rodrigo L, Álvarez N, Fernández-Bustillo E, Salas-Puig J, Huerta M, Hernández-Lahoz C. Efficacy of a Gluten-Free Diet in the Gilles de la Tourette Syndrome: A Pilot Study. Nutrients. 2018;10(5). doi:10.3390/nu10050573
  5. Holton KF, Cotter EW. Could dietary glutamate be contributing to the symptoms of obsessive-compulsive disorder? Future Sci OA. 2018;4(3). doi:10.4155/fsoa-2017-0105
  6. Couture DC, Chung MK, Shinnick P, Curzon J, McClure MJ, LaRiccia PJ. Integrative Medicine Approach to Pediatric Obsessive-Compulsive Disorder and Anxiety: A Case Report. Glob Adv Health Med. 2016;5(1):117-121. doi:10.7453/gahmj.2015.091
  7. Seitz J, Dahmen B, Keller L, Herpertz-Dahlmann B. Gut Feelings: How Microbiota Might Impact the Development and Course of Anorexia Nervosa. Nutrients. 2020;12(11):3295. doi:10.3390/nu12113295
  8. Parker, E.K. et al. (2021) ‘A standard enteral formula versus an iso-caloric lower carbohydrate/high fat enteral formula in the hospital management of adolescent and young adults admitted with anorexia nervosa: a randomised controlled trial’, Journal of Eating Disorders, 9(1), p. 160. doi:10.1186/s40337-021-00513-6.

PTSD and Glutamate

  1. Brandley E, Kirkland A, Sarlo G, VanMeter J, Baraniuk J, Holton K. The Effects of a Low Glutamate Dietary Intervention on Anxiety and PTSD in Veterans with Gulf War Illness (FS15-08-19). Curr Dev Nutr. 2019;3(Supplement_1). doi:10.1093/cdn/nzz031.FS15-08-19
  2. Brandley E, Kirkland A, Holton K. Gulf War Veterans with Psychiatric Symptoms (Anxiety, Depression, and PTSD) Significantly Improve on a Low Glutamate Diet. Curr Dev Nutr. 2020;4(Supplement_2):1192-1192. doi:10.1093/cdn/nzaa057_008
  3. Kraal AZ, Arvanitis NR, Jaeger AP, Ellingrod VL. Could Dietary Glutamate Play a Role in Psychiatric Distress? NPS. 2020;79(1-2):13-19. doi:10.1159/000496294
  4. Li C-T, Yang K-C, Lin W-C. Glutamatergic Dysfunction and Glutamatergic Compounds for Major Psychiatric Disorders: Evidence From Clinical Neuroimaging Studies. Front Psychiatry. 2019;9. doi:10.3389/fpsyt.2018.00767

Substance Use Disorders

  1. Mahajan, V.R. et al. (2021) ‘Nutritional Ketosis as a Potential Treatment for Alcohol Use Disorder’, Frontiers in Psychiatry, 12. doi:10.3389/fpsyt.2021.781668.
  2. Wiers, C.E. et al. (2021) ‘Ketogenic diet reduces alcohol withdrawal symptoms in humans and alcohol intake in rodents’, Science Advances, 7(15), p. eabf6780. doi:10.1126/sciadv.abf6780.
  3. The Ketogenic Diet and Alcohol: Withdrawal, Hangover, Cravings, and Consumption – ProQuest  28542923 (2021). 
  4. 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
  5. Wiss, D.A. (2019) ‘Chapter 2 – The Role of Nutrition in Addiction Recovery: What We Know and What We Don’t’, in Danovitch, I. and Mooney, L.J. (eds) The Assessment and Treatment of Addiction. Elsevier, pp. 21–42. doi:10.1016/B978-0-323-54856-4.00002-X. ABSTRACT
  6. Diet, Nutrition, and Opioid Addiction | Abstract (2021). Journal of Alcoholism & Drug Dependence ISSN: 2329-6488. ABSTRACT
  7. S, M. et al. (2021) ‘Association between Metabolic Syndrome and Substance Dependence: A Cross-sectional Study in Kenya’. doi:10.21203/rs.3.rs-139422/v1.

Pre-clinical and Ongoing Trials

  1. Ketone Ester Intervention in Alcohol Use Disorder – Full Text View – ClinicalTrials.gov (2020). Identifier: NCT04616781 – Ongoing clinical trial 
  2. Blanco-Gandía, M. del C. et al. (2021) ‘Ketogenic Diet Decreases Alcohol Intake in Adult Male Mice’, Nutrients, 13(7), p. 2167. doi:10.3390/nu13072167.
  3. Bornebusch, A.B. et al. (2021) ‘Effects of ketogenic diet and ketone monoester supplement on acute alcohol withdrawal symptoms in male mice’, Psychopharmacology. doi:10.1007/s00213-020-05735-1.

Medication - Cautions and Metabolic Changes/Weight Gain

Due to the therapeutic effect of carbohydrate restriction, medical supervision is advised when adopting this approach – reflected in the following article: Ede G (Author), Scher B (Medical review) Low Carb and Mental Health: Getting Started & Managing Medications. Diet Doctor.

The following section highlights the potential of medications to cause metabolic syndrome and weight gain. The therapeutic application of carbohydrate restriction may also have a role in this setting.

  1. Alonso-Pedrero L, Bes-Rastrollo M, Marti A. Effects of antidepressant and antipsychotic use on weight gain: A systematic review. Obes Rev. 2019;20(12):1680-1690. doi:10.1111/obr.12934 ABSTRACT
  2. Cao H, Meng Y, Li X, et al. The metabolic effects of antipsychotics in the early stage of treatment in first-episode patients with schizophrenia: A real-world study in a naturalistic setting. Journal of Psychiatric Research. 2020;129:265-271. doi:10.1016/j.jpsychires.2020.07.038 ABSTRACT
  3. Gurusamy J, Gandhi S, Damodharan D, Ganesan V, Palaniappan M. Exercise, diet and educational interventions for metabolic syndrome in persons with schizophrenia: A systematic review. Asian J Psychiatr. 2018;36:73-85. doi:10.1016/j.ajp.2018.06.018
  4. Bradshaw T, Mairs H. Obesity and Serious Mental Ill Health: A Critical Review of the Literature. Healthcare. 2014;2(2):166-182. doi:10.3390/healthcare2020166
  5. Abo Alrob O, Alazzam S, Alzoubi K, et al. The Effect of Long-Term Second-Generation Antipsychotics Use on the Metabolic Syndrome Parameters in Jordanian Population. Medicina (Kaunas). 2019;55(7). doi:10.3390/medicina55070320
  6. Carli M, Kolachalam S, Longoni B, et al. Atypical Antipsychotics and Metabolic Syndrome: From Molecular Mechanisms to Clinical Differences. Pharmaceuticals. 2021;14(3):238. doi:10.3390/ph14030238
  7. Faulkner G, Soundy AA, Lloyd K. Schizophrenia and weight management: a systematic review of interventions to control weight. Acta Psychiatrica Scandinavica. 2003;108(5):324-332. doi:10.1034/j.1600-0447.2003.00218.x  PDF
  8. Asmar KE, Fève B, Colle R, et al. Early weight gain predicts later weight gain in depressed patients treated with antidepressants: Findings from the METADAP cohort. J Affect Disord. 2018;241:22-28. doi:10.1016/j.jad.2018.07.059
  9. Jaberi N, Faramarzi E, Farahbakhsh M, Ostadarahimi A, Asghari Jafarabadi M, Fakhari A. Prevalence of metabolic syndrome in schizophrenia patients treated with antipsychotic medications. Caspian J Intern Med. 2020;11(3):310-314. doi:10.22088/cjim.11.3.310
  10. Bussell K, Reeves G, Hager E, et al. Dietary Consumption Among Youth with Antipsychotic-Induced Weight Gain and Changes Following Healthy Lifestyle Education. J Child Adolesc Psychopharmacol. 2021;31(5):364-375. doi:10.1089/cap.2020.0173 ABSTRACT
  11. Khasanova, A.K., Dobrodeeva, V.S., Shnayder, N.A., Petrova, M.M., Pronina, E.A., Bochanova, E.N., Lareva, N.V., Garganeeva, N.P., Smirnova, D.A., Nasyrova, R.F., 2022. Blood and Urinary Biomarkers of Antipsychotic-Induced Metabolic Syndrome. Metabolites 12, 726. doi.org/10.3390/metabo12080726
Media Links
  1. BMJ and Swiss Re – Food for Thought 2020 – Food for Mind and Body The Impact of Nutrition on Mental Well Being.; 2020
  2. Dr Ann Childers – Mental Health & Nutrition with Ann Childers : Dr.Pallavi’s Mind & Body Wellness :The Webinar Series.; 2020. 
  3. Dr. Georgia Ede – “Our Descent into Madness: Modern Diets and the Global Mental Health Crisis.”; 2018. 
  4. Georgia Ede, MD – Mood and Memory: How Sugar Affects Brain Chemistry-.; 2016. 
  5. Dr Chris Palmer – The Ketogenic Diet in Medicine and Psychiatry.; 2019.

Food Addiction and Binge Eating Disorder Spectrum

Food Addiction is an emerging and complicated area of interest that may be part of the clinical picture for some patients. The following papers reflect the main points of discussion and support the concept that food addiction may be a ‘valid phenotype of obesityand ‘should be incorporated into the spectrum of disordered eating’.

  1. Gordon EL, Ariel-Donges AH, Bauman V, Merlo LJ. What Is the Evidence for “Food Addiction?” A Systematic Review. Nutrients. 2018;10(4). doi:10.3390/nu10040477
  2. Anguah KO-B, Syed-Abdul MM, Hu Q, et al. Changes in Food Cravings and Eating Behavior after a Dietary Carbohydrate Restriction Intervention Trial. Nutrients. 2020;12(1):52. doi:10.3390/nu12010052
  3. Carmen M, Safer DL, Saslow LR, et al. Treating binge eating and food addiction symptoms with low-carbohydrate Ketogenic diets: a case series. J Eat Disord. 2020;8(1):2. doi:10.1186/s40337-020-0278-7
  4. 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
  5. Sethi Dalai S, Sinha A, Gearhardt AN. Low carbohydrate ketogenic therapy as a metabolic treatment for binge eating and ultraprocessed food addiction. Current Opinion in Endocrinology, Diabetes and Obesity. 2020;27(5):275–282. doi:10.1097/MED.0000000000000571 ABSTRACT
  6. Ayton A, Ibrahim A, Dugan J, Galvin E, Wroe-Wright O. Ultra-Processed Foods and Binge Eating: A Retrospective Observational Study. NutriXiv; 2020. doi:10.31232/osf.io/3gdtw
  7. Lin Y-S, Tung Y-T, Yen Y-C, Chien Y-W. Food Addiction Mediates the Relationship between Perceived Stress and Body Mass Index in Taiwan Young Adults. Nutrients. 2020;12(7):1951. doi:10.3390/nu12071951
  8. Pedram P, Wadden D, Amini P, et al. Food Addiction: Its Prevalence and Significant Association with Obesity in the General Population. PLOS ONE. 2013;8(9):e74832. doi:10.1371/journal.pone.0074832
  9. Sawamoto R, Nozaki T, Nishihara T, et al. Predictors of successful long-term weight loss maintenance: a two-year follow-up. Biopsychosoc Med. 2017;11. doi:10.1186/s13030-017-0099-3
  10. Gearhardt AN, White MA, Masheb RM, Morgan PT, Crosby RD, Grilo CM. An Examination of the Food Addiction Construct in Obese Patients with Binge Eating Disorder. Int J Eat Disord. 2012;45(5):657-663. doi:10.1002/eat.20957
  11. Gearhardt AN, White MA, Masheb RM, Grilo CM. An Examination of Food Addiction in a Racially Diverse Sample of Obese Patients with Binge Eating Disorder in Primary Care Settings. Compr Psychiatry. 2013;54(5):500-505. doi:10.1016/j.comppsych.2012.12.009
  12. Imperatori C, Innamorati M, Lamis DA, et al. Childhood trauma in obese and overweight women with food addiction and clinical-level of binge eating. Child Abuse Negl. 2016;58:180-190. doi:10.1016/j.chiabu.2016.06.023
  13. Aviram-Friedman R, Kafri L, Baz G, Alyagon U, Zangen A. Prisoners of Addictive Cues: Biobehavioral Markers of Overweight and Obese Adults with Food Addiction. Nutrients. 2020;12(11):3563. doi:10.3390/nu12113563
  14. Darcey, V.L. et al. (2022) Restriction of dietary fat, but not carbohydrate, alters brain reward circuitry in adults with obesity. preprint. Neuroscience. doi:10.1101/2022.04.19.488800.
  1. Constant A, Moirand R, Thibault R, Val-Laillet D. Meeting of Minds around Food Addiction: Insights from Addiction Medicine, Nutrition, Psychology, and Neurosciences. Nutrients. 2020;12(11):3564. doi:10.3390/nu12113564
  2. Wiss D, Brewerton T. Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients. 2020;12(10). doi:10.3390/nu12102937
  3. Grigolon RB, Gerchman F, Schöffel AC, et al. Mental, emotional, and behavioral effects of ketogenic diet for non-epileptic neuropsychiatric conditions. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2020;102:109947. doi:10.1016/j.pnpbp.2020.109947 ABSTRACT
  4. Ayton A, Ibrahim A. The Western diet: a blind spot of eating disorder research?—a narrative review and recommendations for treatment and research. Nutr Rev. 2020;78(7):579-596. doi:10.1093/nutrit/nuz089
  5. Adams RC, Sedgmond J, Maizey L, Chambers CD, Lawrence NS. Food Addiction: Implications for the Diagnosis and Treatment of Overeating. Nutrients. 2019;11(9):2086. doi:10.3390/nu11092086
  6. Hauck C, Cook B, Ellrott T. Food addiction, eating addiction and eating disorders. Proc Nutr Soc. 2020;79(1):103-112. doi:10.1017/S0029665119001162
  7. Wiss DA, Avena N, Gold M. Food Addiction and Psychosocial Adversity: Biological Embedding, Contextual Factors, and Public Health Implications. Nutrients. 2020;12(11):3521. doi:10.3390/nu12113521
  8. Gearhardt AN, Hebebrand J. The concept of “food addiction” helps inform the understanding of overeating and obesity: YES. The American Journal of Clinical Nutrition. 2021;113(2):263-267. doi:10.1093/ajcn/nqaa343 . See these links for NO & DEBATE CONSENSUS
Media Links
  1. Low Carb MD Podcast – Episode 69: Dr. Molly Rutherford. Google Podcasts
  2. Fast Keto with Ketogenic Girl – Beating Sugar Addiction with Dr Jen Unwin & Bitten Jonsson. Google Podcasts (from 4m30s)
  3. Low Carb MD Podcast – Episode 162. Google Podcasts. Dr. Ali Ibrahim – consultant child and adolescent eating disorders psychiatrist
  4. Public Health Collaboration. Is What We Eat Relevant to Eating Disorders? By Dr Agnes Ayton & Dr Ali Ibrahim  #PHCvcon2021. 

Appetite Control

  1. Gibson AA, Seimon RV, Lee CMY, et al. Do ketogenic diets really suppress appetite? A systematic review and meta-analysis. Obesity Reviews. 2015;16(1):64-76. doi:10.1111/obr.12230 PDF
  2. Hu T, Yao L, Reynolds K, et al. The Effects of a Low-Carbohydrate Diet on Appetite: A Randomized Controlled Trial. Nutr Metab Cardiovasc Dis. 2016;26(6):476-488. doi:10.1016/j.numecd.2015.11.011
  3. Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am J Clin Nutr. 2008;87(1):44-55. doi:10.1093/ajcn/87.1.44
  4. Stubbs, B.J. et al. (2018) ‘A Ketone Ester Drink Lowers Human Ghrelin and Appetite’, Obesity (Silver Spring, Md.), 26(2), p. 269. doi:10.1002/oby.22051.
  5. Vestergaard ET, Zubanovic NB, Rittig N, et al. Acute ketosis inhibits appetite and decreases plasma concentrations of acyl ghrelin in healthy humans. Diabetes Obes Metab. Published online April 14, 2021. doi:10.1111/dom.14402
  6. Martins C, Nymo S, Truby H, Rehfeld JF, Hunter GR, Gower BA. Association Between Ketosis and Changes in Appetite Markers with Weight Loss Following a Very Low-Energy Diet. Obesity. 2020;28(12):2331-2338. doi:10.1002/oby.23011
  7. Holsen LM, Hoge WS, Lennerz BS, et al. Diets Varying in Carbohydrate Content Differentially Alter Brain Activity in Homeostatic and Reward Regions in Adults. The Journal of Nutrition. 2021;(nxab090). doi:10.1093/jn/nxab090
  8. Sumithran P, Prendergast LA, Delbridge E, et al. Ketosis and appetite-mediating nutrients and hormones after weight loss. European Journal of Clinical Nutrition. 2013;67(7):759-764. doi:10.1038/ejcn.2013.90
  9. Paoli A, Bosco G, Camporesi EM, Mangar D. Ketosis, ketogenic diet and food intake control: a complex relationship. Front Psychol. 2015;6. doi:10.3389/fpsyg.2015.00027 
  10. Wyatt P, Berry SE, Finlayson G, et al. Postprandial glycaemic dips predict appetite and energy intake in healthy individuals. Nature Metabolism. Published online April 12, 2021:1-7. doi:10.1038/s42255-021-00383-x 
  11. Roekenes J, Martins C. Ketogenic diets and appetite regulation. Current Opinion in Clinical Nutrition & Metabolic Care. 2021;Publish Ahead of Print. doi:10.1097/MCO.0000000000000760
  12. B Keogh J, M Clifton P. Energy Intake and Satiety Responses of Eggs for Breakfast in Overweight and Obese Adults—A Crossover Study. Int J Environ Res Public Health. 2020;17(15). doi:10.3390/ijerph17155583
  13. ao Y, Tsintzas K, Macdonald IA, Cordon SM, Taylor MA. Effects of intermittent (5:2) or continuous energy restriction on basal and postprandial metabolism: a randomised study in normal-weight, young participants. European Journal of Clinical Nutrition. Published online May 26, 2021:1-9. doi:10.1038/s41430-021-00909-2 (appetite considered)
  14. Darcey, V.L. et al. (2022) Restriction of dietary fat, but not carbohydrate, alters brain reward circuitry in adults with obesity. preprint. Neuroscience. doi:10.1101/2022.04.19.488800.
  15. Rondanelli M, Perna S, Ilyas Z, et al. Effect of very low-calorie ketogenic diet in combination with omega-3 on inflammation, satiety hormones, body composition, and metabolic markers. A pilot study in class I obese subjects. Endocrine. Published online September 16, 2021. doi:10.1007/s12020-021-02860-5

For additional articles on appetite suppression see Time Restricted Feeding


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. 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
  3. 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
  4. 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
  5. 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
  6. Gray A, Dang BN, Moore TB, Clemens R, Pressman P. A review of nutrition and dietary interventions in oncology: SAGE Open Medicine. Published online June 1, 2020. doi:10.1177/2050312120926877
  7. 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
  8. 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
  9. Weber DD, Aminazdeh-Gohari S, Kofler B. Ketogenic diet in cancer therapy. Aging (Albany NY). 2018;10(2):164-165. doi:10.18632/aging.101382 
  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. 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
  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


  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). doi.org/10.1186/1743-7075-8-75 
  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. Krusinska B, Hawrysz I, Wadolowska L, et al. Associations of Mediterranean Diet and a Posteriori Derived Dietary Patterns with Breast and Lung Cancer Risk: A Case-Control Study. Nutrients. 2018;10(4). doi:10.3390/nu10040470 
  10. Sun B, Karin M. Obesity, inflammation, and liver cancer. Journal of Hepatology.2012; vol.56: 704–713 PDF 
  11. Nilsson LM, Winkvist A, Johansson I, et al. Low-carbohydrate, high-protein diet score and risk of incident cancer; a prospective cohort study. Nutr J. 2013;12:58. doi:10.1186/1475-2891-12-58 
  12. Wright C, Simone NL. Obesity and tumor growth: Inflammation, immunity, and the role of a ketogenic diet. Curr Opin Clin Nutr Metab Care. 2016;19(4):294-299. doi:10.1097/MCO.0000000000000286  ABSTRACT
  13. 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
  14. Ebrahimpour-Koujan S, Shayanfar M, Benisi-Kohansal S, Mohammad-Shirazi M, Sharifi G, Esmaillzadeh A. Adherence to low carbohydrate diet in relation to glioma: A case-control study. Clinical Nutrition. November 2018. doi:10.1016/j.clnu.2018.11.023 ABSTRACT
  15. Restoring the Metabolic Syndrome-Cancer Hypothesis; Implications for Cancer Research and Treatment. Clinics in Oncology. 2019;4:5. PDF
  16. 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

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. 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
  3. 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. doi.org/10.7759/cureus.26457
  4. 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
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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
  10. 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 
  11. 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
  12. 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
  13. 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  
  14. Schreck K, Hsu F-C, Berrington A, et al. DDRE-31. FEASIBILITY AND BIOLOGIC ACTIVITY OF A KETOGENIC / INTERMITTENT FASTING DIET IN GLIOMA PATIENTS. Neuro-Oncology Advances. 2021;3(Supplement_1):i13-i13. doi:10.1093/noajnl/vdab024.05
  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. 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
  2. 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)
  3. 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
  4. 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 
  5. 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. 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.
  2. 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
  3. 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 
  4. 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
  5. 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
  6. 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)
  7. 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
  8. Pan K, Chlebowski RT, Mortimer JE, et al. Insulin resistance and breast cancer incidence and mortality in postmenopausal women in the Women’s Health Initiative. Cancer. Published online June 12, 2020. doi:10.1002/cncr.33002
  9. 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
  10. 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
  11. 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
  12. 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
  13. 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
  14. 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
  15. 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
  16. Kirkham AA, King K, Joy AA, et al. Rationale and design of the Diet Restriction and Exercise-induced Adaptations in Metastatic breast cancer (DREAM) study: a 2-arm, parallel-group, phase II, randomized control trial of a short-term, calorie-restricted, and ketogenic diet plus exercise during intravenous chemotherapy versus usual care. BMC Cancer. 2021;21(1):1093. doi:10.1186/s12885-021-08808-2   (In progress – protocol only)
  17. Dong S, Wang Z, Shen K, Chen X. Metabolic Syndrome and Breast Cancer: Prevalence, Treatment Response, and Prognosis. Front Oncol. 2021;11. doi:10.3389/fonc.2021.629666
  18. Thomson, C.A. et al. (2010) ‘Changes in Body Weight and Metabolic Indexes in Overweight Breast Cancer Survivors Enrolled in a Randomized Trial of Low-Fat vs. Reduced Carbohydrate Diets’, Nutrition and Cancer, 62(8), pp. 1142–1152. doi:10.1080/01635581.2010.513803 ABSTRACT
  19. Harvie, M. et al. (2021) ‘Randomised controlled trial of intermittent vs continuous energy restriction during chemotherapy for early breast cancer’, British Journal of Cancer, pp. 1–11. doi:10.1038/s41416-021-01650-0.

Cancer - Paediatric

  1. 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
  2. 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:https://doi.org/10.1002/cnr2.1383    PDF
  3. 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
  4. 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. doi.org/10.1016/j.ejca.2022.05.046
  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. doi.org/10.7759/cureus.27603

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. Safdie FM, Dorff T, Quinn D, et al. Fasting and cancer treatment in humans: A case series report. Aging (Albany NY). 2009;1(12):988-1007. doi: 10.18632/aging.100114      
  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. 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
  2. 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 
  3. 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    https://doi.org/10.2337/db22-212-OR.)
  4. 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
  5. 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.
  6. 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
  7. 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
  8. 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.
  9. Chrysohoou C, Panagiotakos DB, Pitsavos C, Das UN, Stefanadis C. Adherence to the Mediterranean diet attenuates inflammation and coagulation process in healthy adults: The Attica study. Journal of the American College of Cardiology. 2004;44(1):152-158. doi:10.1016/j.jacc.2004.03.039
  10. Bonaccio M, Pounis G, Cerletti C, Donati MB, Iacoviello L, Gaetano G de. Mediterranean diet, dietary polyphenols and low grade inflammation: Results from the MOLI-SANI study. British Journal of Clinical Pharmacology. 2017;83(1):107-113. doi:10.1111/bcp.12924   
  11. 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
  12. Ebringer A, Wilson C. The Use of a Low Starch Diet in the Treatment of Patients Suffering from Ankylosing Spondylitis. Clin Rheumatol. 1996;15(1):62-66. doi:10.1007/BF03342649 ABSTRACT
  13. Pagliai G, Giangrandi I, Dinu M, Sofi F, Colombini B. Nutritional Interventions in the Management of Fibromyalgia Syndrome. Nutrients. 2020;12(9):2525. doi:10.3390/nu12092525
  14. Karimi E, Yarizadeh H, Setayesh L, Sajjadi SF, Ghodoosi N, Mirzaei K. High Carbohydrate Intakes May Predict More Inflammatory Status Than High Fat Intakes in Pre-Menopause Women With Overweight or Obesity: A Cross-Sectional Study. In Review; 2021. doi:10.21203/rs.3.rs-322285/v1
  15. Senna MK, Sallam RA-ER, Ashour HS, Elarman M. Effect of weight reduction on the quality of life in obese patients with fibromyalgia syndrome: a randomized controlled trial. Clin Rheumatol. 2012;31(11):1591-1597. doi:10.1007/s10067-012-2053-x      PDF
  16. 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. Kaushik AS, Strath LJ, Sorge RE. Dietary Interventions for Treatment of Chronic Pain: Oxidative Stress and Inflammation. Pain Ther. Published online October 21, 2020. doi:10.1007/s40122-020-00200-5
  9. 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
  10. 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. 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.
  3. Liu S-Y, Zhu W-T, Chen B-W, Chen Y-H, Ni G-X. Bidirectional association between metabolic syndrome and osteoarthritis: a meta-analysis of observational studies. Diabetol Metab Syndr. 2020;12(1):38. doi:10.1186/s13098-020-00547-x
  4. 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
  5. 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.
  6. Tchetina EV, Markova GA, Sharapova EP. Insulin Resistance in Osteoarthritis: Similar Mechanisms to Type 2 Diabetes Mellitus. Journal of Nutrition and Metabolism. doi:https://doi.org/10.1155/2020/4143802
  7. Dickson BM, Roelofs AJ, Rochford JJ, Wilson HM, De Bari C. The burden of metabolic syndrome on osteoarthritic joints. Arthritis Res Ther. 2019;21(1):289. doi:10.1186/s13075-019-2081-x
  8. Wang X, Hunter D, Xu J, Ding C. Metabolic triggered inflammation in osteoarthritis. Osteoarthritis and Cartilage. 2015;23(1):22-30. doi:10.1016/j.joca.2014.10.002
  9. Tan Q, Jiang A, Li W, Song C, Leng H. Metabolic syndrome and osteoarthritis: possible mechanisms and management strategies. Medicine in Novel Technology and Devices. Published online December 17, 2020:100052. doi:10.1016/j.medntd.2020.100052
  10. Meng T, Antony B, Venn A, et al. Association of glucose homeostasis and metabolic syndrome with knee cartilage defects and cartilage volume in young adults. Seminars in Arthritis and Rheumatism. October 2019. doi:10.1016/j.semarthrit.2019.10.001 ABSTRACT
  11. Pan F, Tian J, Cicuttini F, Jones G. Metabolic syndrome and trajectory of knee pain in older adults. Osteoarthr Cartil. August 2019. doi:10.1016/j.joca.2019.05.030 ABSTRACT
  12. Wang T, He C. Pro-inflammatory cytokines: The link between obesity and osteoarthritis. Cytokine & Growth Factor Reviews. 2018;44:38-50. doi:10.1016/j.cytogfr.2018.10.002 ABSTRACT
  13. Athanassiou P, Athanassiou L, Kostoglou-Athanassiou I. Nutritional Pearls: Diet and Rheumatoid Arthritis. Mediterr J Rheumatol. 2020;31(3):319-324. doi:10.31138/mjr.31.3.319
  14. 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
  15. 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
  16. 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
  17. 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:https://doi.org/10.1002/mbo3.1194
  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. 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
  3. 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
  4. 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 
  5. 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
  6. 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
  7. 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). 
  8. 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
  9. 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 
  10. 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)


  1. 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
  2. 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
  3. 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
  4. 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

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
  11. A Zero Carbohydrate, Carnivore Diet can Normalize Hydrogen Positive Small Intestinal Bacterial Overgrowth Lactulose Breath Tests: A Case Report. Published online January 19, 2021. doi:10.21203/rs.3.rs-148500/v1
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. 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
  3. 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  
  4. Padhi T, Garima. Metabolic Syndrome and Skin: Psoriasis and Beyond. Indian J Dermatol. 2013;58(4):299-305. doi:10.4103/0019-5154.113950 
  5. 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:  https://doi.org/10.2114/jpa.22.237 PDF
  6. 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
  7. 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
  8. 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
  9. de Carvalho JF, Pereira CP, Torales MBP. Nummular Eczema Successfully Treated with a Gluten- free Diet: First Description.. IMAJ 2021; 23: 329–330
  10. 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. 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
  6. Melnik BC. Diet in acne: further evidence for the role of nutrient signalling in acne pathogenesis. Acta Derm Venereol. 2012;92(3):228-231. doi:10.2340/00015555-1358 
  7. Nagpal M, De D, Handa S, Pal A, Sachdeva N. Insulin Resistance and Metabolic Syndrome in Young Men With Acne. JAMA Dermatol. 2016;152(4):399-404. doi:10.1001/jamadermatol.2015.4499
  8. Romańska-Gocka K, Woźniak M, Kaczmarek-Skamira E, Zegarska B. The possible role of diet in the pathogenesis of adult female acne. Postepy Dermatol Alergol. 2016;33(6):416-420. doi:10.5114/ada.2016.63880
  9. 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
  10. Md SSH. A case report of successful acne treatment following Ramadan fasting. Research. Published online April 11, 2014.doi: http://dx.doi.org/10.13070/rs.en.1.684

Acne Inversa (Hidradenitis Suppurativa)

  1. 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
  2. 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
  3. 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: https://doi.org/10.1080/10408398.2022.2083070.
  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. 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
  5. Cui C, Zhou M, Cheng L, et al. Admission hyperglycemia as an independent predictor of long-term prognosis in non-diabetic patients with acute myocardial infarction: a retrospective study. Journal of Diabetes Investigation. n/a(n/a). doi:https://doi.org/10.1111/jdi.13468
  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/rs.3.rs-649111/v1
  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. Berezin AE, Berezin AA, Lichtenauer M. Emerging Role of Adipocyte Dysfunction in Inducing Heart Failure Among Obese Patients With Prediabetes and Known Diabetes Mellitus. Front Cardiovasc Med. 2020;7. doi:10.3389/fcvm.2020.583175
  9. 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
  10. 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
  11. 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
  12. Zheng Y, Xie Z, Li J, et al. Meta-analysis of metabolic syndrome and its individual components with risk of atrial fibrillation in different populations. BMC Cardiovasc Disord. 2021;21(1):90. doi:10.1186/s12872-021-01858-1
  13. Wesół-Kucharska, D. (2022) ‘The Effectiveness of the Ketogenic Diet for Leigh Syndrome with Cardiomiopathy’(sic), 8(16), p. 7. ISSN 2639-8109
  14. 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. https://core.ac.uk/reader/81156938
  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. doi.org/10.1016/j.ymgmr.2022.100904
  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:https://doi.org/10.1113/JP281004 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/rs.3.rs-101239/v1 
  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. 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
  2. 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 
  3. 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
  4. 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 
  5. 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 
  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. 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.
  8. 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
  9. 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
  10. 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
  11. 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/rs.3.rs-125271/v1
  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. 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
  2. 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
  3. 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  
  4. 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
  5. 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
  6. 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
  7. Broadhead GK, Hong T, Bahrami B, Flood V, Liew G, Chang AA. Diet and risk of visual impairment: a review of dietary factors and risk of common causes of visual impairment. Nutr Rev. doi:10.1093/nutrit/nuaa100
  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. 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
  2. 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
  3. 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
  4. 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
  5. 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 
  6. 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
  7. 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
  8. Parveen S. Impact of calorie restriction and intermittent fasting on periodontal health. Periodontology 2000. 2021;87(1):315-324. doi:10.1111/prd.12400
  9. 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
  10. 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
  11. 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
  12. Pirih FQ, Monajemzadeh S, Singh N, et al. Association between metabolic syndrome and periodontitis: The role of lipids, inflammatory cytokines, altered host response, and the microbiome. Periodontology 2000. 2021;87(1):50-75. doi:10.1111/prd.12379
  13. The Association between Carbohydrate Intake and the Oral Microbiome in Postmenopausal Women – ProQuest; 08.2020-Thesis


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. 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. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. 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 

Immune Function

  1. 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
  2. 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
  3. 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.
  4. 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
  5. 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.
  6. 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 
  7. 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
  8. 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.
  9. 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/j.it.2021.03.007 
  10. 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
  11. 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.
  12. 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
  13. 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)
  14. Ryu S, Shchukina I, Youm Y-H, et al. Ketogenic diet restrains aging-induced exacerbation of coronavirus infection in mice. Elife. 2021;10:e66522. doi:10.7554/eLife.66522    PDF (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: https://doi.org/10.1371/journal.pone.0269440.

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:https://doi.org/10.1096/fasebj.30.1_supplement.678.12 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. Orchard T, Yildiz V, Steck SE, et al. Dietary Inflammatory Index, Bone Mineral Density, and Risk of Fracture in Postmenopausal Women: Results From the Women’s Health Initiative. Journal of Bone and Mineral Research. 2017;32(5):1136-1146. doi:10.1002/jbmr.3070  
  4. 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
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Updated 01 October 2022