Ketogenic Diet and Cardiometabolic
Keto Diet

Ketogenic Diet and Cardiometabolic

As an emerging weight loss diet, the ketogenic diet has been questioned and combated by everyone. However, a growing number of real-life cases and scientific studies have found that the ketogenic diet can accurately improve cardiometabolic problems.

In a recent review published in the Journal of the American College of Cardiology (JACC), researchers at the University Medical Center Groningen in the Netherlands say that evidence from experimental and clinical studies suggests that:

Ketogenic Diet and Cardiometabolic

The ketogenic diet induces the body to produce ketone bodies that can be used through a variety of mechanisms to exploit the potential and therapeutic benefits of ketone bodies in the treatment of cardiovascular disease. Next, we’ll look at how ketone bodies protect the heart.

How Ketone Bodies are Produced?

Ketone bodies come in three forms: acetone, acetoacetate, and beta-hydroxybutyrate. When the body needs the energy to use body fuel, the body prioritizes the use of glucose in the body. Under extreme conditions, such as prolonged fasting, periods of severe carbohydrate restriction, or very strenuous exercise, the body begins to burn fat after the glucose in the body’s blood is depleted to a certain level. The fatty acids then pass through enzymes in the liver and are converted into ketone bodies, which provide the body with energy and provide auxiliary fuel.

ketone bodies in the liver and extrahepatic organs
(Metabolic pathways of ketone bodies in the liver and extrahepatic organs)

How do Ketone Bodies Relate to Cardiometabolic?

Researchers have compared a healthy heart to an unhealthy heart primarily in terms of fuel utilization.

1. Healthy Cardiometabolic

In the healthy adult heart, the preferred substrate for the heart is acetyl coenzyme A (the primary metabolite of fatty acids), which is relied upon primarily for energy production of ATP at a rate of about 40% to 60%.

2. Unhealthy Cardiometabolic

Under normal conditions, the healthy heart uses little to no glucose as an energy source. However, in the early stages of structural heart disease, the heart’s ability to use fatty acids (its primary fuel) decreases, fatty acid oxidation decreases, and it begins to use glucose more. This in turn does not provide the heart with enough energy and can lead to a lack of energy in the heart muscle, which can lead to heart failure.

As the heart’s ability to use fatty acids decreases, the heart in heart failure reprograms its metabolic processes, altering them to increase its reliance on ketone bodies to provide more fuel for the heart.

Many studies have found that in an unhealthy heart, the reprogramming of the heart is an adaptive metabolic response, a survival response. Simply put, in an unhealthy cardiometabolic, the ability to use fatty acids (the primary fuel) is reduced, and relying on glucose for energy is not enough, so it must alter itself so that ketone bodies become the heart’s second fuel so that it can have enough energy.

Benefits of Ketone Bodies for Cardiometabolic

Research has referred to sodium-glucose cotransporter inhibitors (SGLT2i), a drug that lowers insulin levels, stimulates lipolysis, and promotes ketone body production in the liver.

In a double-blind trial, researchers found that sodium-glucose cotransporter inhibitors (SGLT2i) reduced the risk of hospitalization and cardiovascular death in patients with heart failure, regardless of the presence of diabetes.

double-blind trial

Ketone Bodies Protect the Heart in Multiple Ways

A growing number of experimental and clinical studies suggest that nutritional ketone bodies are beneficial in the treatment of cardiovascular disease. While research is still being explored, ketone bodies may protect the heart in a variety of ways, in addition to providing energy for the heart.

Reduces Inflammation

NLRP3 inflammatory vesicles, if activated, trigger inflammation that exacerbates dysfunction, cell death, and cardiac remodeling in an unhealthy heart. In contrast, beta-hydroxybutyrate (betaOHB), the primary ketone body produced in a ketogenic diet, has a direct anti-inflammatory effect. betaOHB (ketone bodies) block the activation and release of NLRP3 inflammatory vesicles. Clinical trials have also shown that a ketogenic diet reduces circulating markers of inflammation compared to a low-fat diet.

Improving Vascular Endothelial Function

The vascular endothelium is critical in regulating vascular tone and largely determines a person’s blood pressure. In addition, the vascular endothelium protects tissues from a variety of toxic substances, regulates blood clotting mechanisms, controls fluid, electrolytes, and many other substances that flow back and forth between blood and tissue, and regulates inflammation. Protecting the vascular endothelium helps minimize the risk of cardiovascular disease, and ketone bodies have a proven track record in this regard. In some clinical trials, researchers have given betaHOB (ketone bodies) infusions to heart failure patients to increase myocardial blood flow and induce vasodilation.

Boosting Mitochondrial Function

Mitochondria convert food into energy and are the energy factories of cells. And ketone bodies can reduce oxidative stress and enhance mitochondrial function. In animal experiments, a ketogenic diet in mice can have a protective effect on the heart after overall ischemia, increasing the number of cardiac mitochondria. βOHB ketone body infusion reduces mitochondrial stress in the myocardium after ischemia/reperfusion injury. These data all suggest that ketone bodies have great potential to reduce oxidative stress and enhance mitochondrial function in patients with cardiovascular disease.

Cardiac Remodeling

Cardiac remodeling refers to abnormal changes in the size, shape, structure, and function of the heart due to myocardial injury, and it is considered an important clinical determinant of heart failure. In animal studies on heart failure, a ketogenic diet improved cardiac function and reduced pathological cardiac remodeling.

Improvement in Cardiovascular Risk Factors

The benefits of the ketogenic diet in weight loss, lowering blood sugar, improving blood pressure, and raising good cholesterol levels, such as the VITRA organization, which uses a low-carbohydrate ketogenic diet to reverse diabetes, have published the results of their study. more than 300 diabetic patients were divided into 2 groups, and after 1 year in the ketogenic group, 262 diabetic patients had improved cardiovascular risk indicators.

cardiometabolic risk indicators

As you can see from the analysis above, ketone bodies can be cardiovascular protective in many ways. In particular, for patients with heart failure, entering a ketogenic state through a ketogenic diet or supplementation with ketone bodies can improve cardiometabolic health in patients with cardiovascular disease.

Endogenous Ketogenic

Endogenous ketogenic refers to the reliance on fat burning to produce ketone bodies. To enter a ketogenic state and use ketone bodies for energy, a ketogenic diet is a good option. People on a ketogenic diet eat mostly meat, eggs, and vegetables, and 70% of their energy source is fat, which is a diet with a very low percentage of carbohydrates and a high percentage of fat. When undertaking this diet, the body switches its energy supply to a ketogenic state, using ketone bodies, a product of fat metabolism, to provide the body with energy.

Exogenous Ketogenic

Exogenous means that ketone bodies are obtained from outside the body. Exogenous ketogenesis refers to the direct intake of ketone precursors, i.e. substances that can be converted to ketone bodies in the body, such as 1,3-butanediol and medium-chain triglycerides (MCT). However, 1,3-butanediol has more side effects, and ingesting MCT oil may be an easier way to get into ketone bodies, and many people are drinking coconut oil, which has a lot of MCT in it.

Then there are supplements to get into a ketogenic state, such as ketone salts (KS) or ketone esters (KE). However, researchers say the dose of ketone salts needed to enter a ketogenic state is high for patients with cardiovascular disease, and long-term use may increase the patient’s sodium load.


A healthy cardiometabolic can use fatty acids normally for energy, requiring only a very small amount of glucose. But if the heart is unhealthy, the heart will begin to use glucose, which provides far less energy, and the heart will reprogram itself to choose ketone bodies, a more efficient fuel, to survive, and ketone bodies become an important auxiliary fuel for the heart. Ketone bodies also protect the heart in many ways, including many cardiovascular benefits for endothelial function, oxidative stress, mitochondrial function, inflammation, cardiac remodeling, and more.