The ketogenic diet has been well established in the medical community as a treatment approach for those with epilepsy. However, research is revealing benefits which may apply to a broader population as well. As chronic diseases such as Alzheimer’s, type-2-diabetes, and heart disease are linked to inflammation, the anti-inflammatory effects of a keto diet are becoming especially compelling.
So, can a ketogenic diet reduce inflammation and lower your risk for chronic disease? In short, the research is looking very promising. But first, let’s take a closer look at inflammation, so we can better understand why it’s bad.
What is Inflammation?
Inflammation is not always bad. It is actually a mechanism that allows our body to respond to injury, and heal itself. We fall down, bloody our knee, and our immune system leaps into action, like a general on a battlefield. To protect the site of injury your body mounts a defensive response. White blood cells are rushed to the area to fight off foreign bacteria, break down damaged tissue, and then begin the repair process. During this time, the area is often warm, swollen, and red because your body increases blood flow to accelerate healing.
Given above is an example of acute inflammation. It’s a vital part of the human immune system guided by the best of intentions. But, what happens when your body is constantly triggering this response? In the most extreme cases, there are autoimmune diseases, like rheumatoid arthritis which cause your body to attack and break down healthy tissue. However, there’s another form of chronic inflammation which is often more subtle, and undetected. This is referred to as chronic low-grade inflammation.
Chronic inflammation is problematic because it causes an immune reaction, even when there is no injury. It is chronic because if it is not diagnosed and reduced, the inflammation will persist in your body. Over time this can begin to damage arteries, organs, and contribute to diseases such as Alzheimer’s and cardiovascular disease.
Symptoms & Causes of Chronic Inflammation
Causes of Chronic Inflammation
Chronic inflammation can be caused by several unrelated factors including:
• infections that don't heal properly or timely
• abnormal immune reactions
In addition, autoimmune diseases can trigger chronic inflammation. Some of these diseases are lupus and rheumatoid arthritis. It can also be caused by conditions that continually wear on your body, like inflammatory bowel disease.
Obesity and Inflammation
If you have excess fat, and particularly abdominal fat around your waist, there’s a good chance you also have some chronic low-level inflammation.
Fat cells in the abdomen release the proinflammatory cytokine interleukin 6, therefore inducing chronic inflammation. The more belly fat you have, the more cytokine interleukin 6 you produce, and the worse you feel.
Many people with obesity find themselves in a downward spiral of weight gain, inflammation, and then fatigue. As the inflammation and fatigue come on from gaining weight, a person is even less apt to lose weight and exercise to help themselves. However,
A lot of people have success losing body fat on a keto diet, thus also lowering their ability to produce the proinflammatory cytokine. Plus, as we will discuss below, a ketogenic diet is naturally anti-inflammatory, so you get a double whammy of help with obesity related inflammation on a keto diet.
Symptoms of Chronic Inflammation
There are several symptoms of chronic inflammation that you can notice in your body. If you notice these symptoms, you should set up an appointment with your doctor to determine if you have chronic inflammation.
In addition to obesity, sSome other warning signs of chronic inflammation can include
• persistent aches and pains,
• acne, and
Like we mentioned above, chronic inflammation causes an immune reaction in your body, which is actually what all the above symptoms stem from. Each of these symptoms can be attributed to an immune response in the cells responsible for that part or action of the body.
For example, allergies are an immune response to external stimuli such as pollen or dust; if the allergies worsen or do not get better, they could very well be attributed to an over-reactive immune response. This is just one symptom of chronic inflammation.
Fatigue is also a symptom of chronic inflammation.
Testing for Chronic Inflammation
Clearly, if you have some of the symptoms of chronic inflammation, it’s something you want to address immediately, possibly with a keto diet. But, how do you know if its occurring in your body? You may want to know if there's a real way to detect chronic inflammation, outside of just some symptoms that could be caused by something else.
Since ichronic inflammationt often occurs at low levels, it’s not as obvious to detect as the swelling which occurs when you twist an ankle.
But, there are a variety of blood tests your physician can run to help detect chronic inflammation, the most common of which is a test for C-Reactive protein (CRP).
Some CRP can always be detected in the blood, but levels spike when there’s any inflammation, chronic or acute. If you’re testing for chronic inflammation, you’ll want to take this test when you don’t have any known injuries which could be triggering an acute inflammatory response. Ideally, your CRP level should be below 1, with 0 indicating no inflammation. If your CRP is elevated, absent of any injuries, it could indicate you have some chronic low-level inflammation occurring.
However, as helpful as a CRP test can be, there are some other clues which can suggest chronic inflammation absent of getting a blood test.
Other Disease Associated with Inflammation
Inflammation in itself can lead to and/or worsen diseases and health problems. A review titled "The inflammation theory of disease"[i] describes how chronic inflammation can lead to cancerous tumors and degenerative diseases like ALS. Reasons for this are that as tissue is consistently inflamed it leads to "tissue destruction and scarring", which creates an environment for tumor growth.
In addition, it is now even being associated with leading to depression.[ii]
How the Ketogenic Diet Helps Reduce Inflammation
The keto diet has been long believed to have anti-inflammatory effects, and thanks to a recent study from the University of California San Francisco (UCSF)[iii], we have a better understanding of one of the reasons.
In this study, performed on rats, researchers wanted to know why the ketogenic diet was related to reduced inflammation in the brain. The researchers induced a ketogenic state in the rats which in turn restricted the rate of glucose metabolism. During glucose metabolism, NAD+ is converted to NADH, and increases the ratio of NADH/NAD+. In a ketogenic state this ratio is lowered which activates a regulatory protein called CtBP that blocks the expression of inflammatory genes, thus reducing inflammation.
The UCSF study is especially significant because it demonstrates a biochemical mechanism through which the ketogenic diet can directly reduce inflammation. Evidence from other studies suggest an anti-inflammatory effect to the ketogenic diet which reaches beyond the brain.
Another reason the ketogenic diet reduces inflammation is because ketone metabolism produces fewer free radicals and reactive oxygen species[iv], often responsible for triggering inflammation. Ketone metabolism also causes an increase in the production of adenosine, a nucleoside long known to be anti-inflammatory[v].
Finally, the ketogenic diet’s anti-inflammatory effect can also be linked to a specific ketone that’s produced in the liver from acetoacetate during ketosis. The ketone beta-hydroxybutyrate can block an immune system receptor linked to inflammation, the NLRP inflammasome[vi]. If we’re constantly exposed to inflammatory triggers, such as inflammatory foods, or obesity, the NLRP inflammasome can be overly activated, quintessentially being stuck in the on position. With a ketogenic diet, there is an increase in the amount of beta-hydroxybutyrate, which could then help reduce inflammation by blocking the NLRP inflammasome.
The Anti-Inflammatory Effects of Keto Foods
As you can see, there are several metabolic mechanisms that can help explain the anti-inflammatory effects of a ketogenic diet. However, the keto diet may also be anti-inflammatory due to the foods it eliminates, and includes (if you’re doing it right).
The first thing that gets eliminated on a keto diet are carbohydrates with a high glycemic index. You simply cannot reach a state of ketosis with these types of foods, so they are the first to go. Carbohydrates with a high glycemic index have been associated with a higher level of CRP[vii], which may explain some of the anti-inflammatory effects of the ketogenic diet. In addition, the high fiber carbohydrates (aka vegetables) that are moderately included in a ketogenic diet are also believed to be anti-inflammatory.[viii] These include leafy greens like spinach, and the super popular and versatile cauliflower. See a list of recommended low-carb vegetables for the keto diet.
Another defining characteristic of the ketogenic diet is its emphasis on consuming healthy fats. Since 65-90% of your calorie intake is going to come from fat, you need to prioritize healthy fats and oils. If you’re doing that you’ll be focusing on reducing the amount of pro-inflammatory omega-6 fatty acids, and increasing the amount of anti-inflammatory omega-3's. Coconut oil, another hallmark of the ketogenic diet, has also been shown to reduce oxidative stress and inflammatory markers in humans[ix].
Ketogenic Diet Foods to Eat And Avoid
Here's a list of anti-inflammatory foods and spices that you can incorporate into a ketogenic diet:
- Organic meats (good omega-3/6 profile)
- Organic dairy (good omega-3/6 profile)
- Green leafy vegetables like spinach and bok choy
- Cruciferous vegetables like cauliflower and broccoli
- Spices like turmeric and garlic
- Coconut oil
- Avocados and avocado oil
- Vary sparingly eat some low-carb berries like blackberries
Here's a list of inflammatory foods to avoid on keto:
- Nightshade vegetables like tomatoes, peppers and eggplant are known to be inflammatory in some people
- Inorganic dairy
- Inorganic meats
- Burning or overcooking meats can cause them to be inflammatory
Other Ways to Reduce Chronic Inflammation
The ketogenic diet can have some significant benefits to help reduce inflammation. However, it’s not the only approach you can take to help reduce chronic inflammation. If you’re serious about lowering your inflammation (and you should be), here are some other known methods to reduce chronic inflammation.
- Get more exercise
- Consume more omega-3 fatty acids, while reducing omega-6
- Eat foods high in antioxidants & polyphenols
- Reduce nightshade vegetables (tomatoes and peppers)
- Reduce your stress level
- Improve your sleep
[i] Philip Hunter. The inflammation theory of disease. EMBO Rep. 2012 Nov; 13(11): 968–970
[ii] Steptoe A, Wikman A, Molloy GJ, Messerli-Bürgy N, Kaski JC. Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease. Brain Behav Immun. 2013 Jul;31:183-8.
[iii]Yiguo Shen, David Kapfhamer, Angela M. Minnella, Ji-Eun Kim, Seok Joon Won, Yanting Chen, Yong Huang, Ley Hian Low, Stephen M. Massa & Raymond A. Swanson. “Bioenergetic State Regulates Innate Inflammatory Responses through the Transcriptional Co-Repressor CtBP.” Nature Communications 8, Article number: 624 (2017)
[iv] Sullivan PG, Rippy NA, Dorenbos K, Concepcion RC, Agarwal AK, Rho JM. The ketogenic diet increases mitochondrial uncoupling protein levels and activity. Ann Neurol. 2004 Apr;55(4):576-80.
[v] Masino SA, Ruskin DN. Ketogenic Diets and Pain. Journal of child neurology. 2013 Aug; 28(8): 993–1001.
[vi] Youm YH, Nguyen KY, Grant RW, et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nature medicine. Nat Med. 2015 Mar; 21(3): 263–269.
[vii] Levitan EB, Cook NR, Stampfer MJ, et al. Dietary glycemic index, dietary glycemic load, blood lipids, and C-reactive protein. Metabolism 2008 Mar;57(3):437-43.
[ix] North CJ, Venter CS, Jerling JC. The effects of dietary fibre on C-reactive protein, an inflammation marker predicting cardiovascular disease. European journal of clinical nutrition. 2009 Aug;63(8):921-33.
[ix] Gao M, Singh A, Macri K, et al. Antioxidant components of naturally-occurring oils exhibit marked anti-inflammatory activity in epithelial cells of the human upper respiratory system. Respiratory research. 2011 Jul 13;12:92.