13/05/2024, 14:56 Effects of very low carbohydrate ketogenic diets on skeletal...

: Current Opinion in Endocrinology, Diabetes and Obesity

Effects of very low carbohydrate ketogenic diets on

skeletal health : Current Opinion in Endocrinology,
Diabetes and Obesity
August 2023 - Volume 30 - Issue 4

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PARATHYROIDS, BONE AND MINERAL METABOLISM: Edited by Viral Shah

Effects of very low carbohydrate ketogenic diets on skeletal health

Best, Cora M.a; Hsu, Simonb,c

Author Information

aFood Science and Human Nutrition Department, University of Florida, Gainesville, Florida

bDivision of Nephrology, Department of Medicine

cKidney Research Institute, University of Washington, Seattle, Washington, USA

Correspondence to Cora M. Best, 572 Newell Dr, University of Florida, Gainesville, FL 32611, USA. Tel: +1 352 294 3751; e-
mail: corabest@ufl.edu

Current Opinion in Endocrinology & Diabetes and Obesity 30(4):p 184-191, August 2023. | DOI:
10.1097/MED.0000000000000811

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Abstract
Purpose of review

Very low carbohydrate ketogenic diet (KD) therapy has been associated with skeletal demineralization in children with drug-
resistant epilepsy, but the cause of this association is unclear. Recently, interest in the KD has grown owing to its potential
benefits for other illnesses including cancer, type 2 diabetes, obesity, and polycystic kidney disease. Summaries of the best
available evidence regarding effects of a KD on skeletal health are lacking.

Recent findings

Recent rodent studies found that a KD can harm the growing skeleton, which corroborates most but not all studies in pediatric
patients. Proposed mechanisms include chronic metabolic acidosis and depressed osteoanabolic hormones. Relative to other
weight-reducing diets, a weight-reducing KD for treatment of obesity and/or type 2 diabetes in adults has not been associated
with adverse skeletal effects. By contrast, recent evidence suggests that adaptation to a eucaloric KD may impair bone
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remodeling in elite adult athletes. Discrepancies in the literature may relate to differences between study populations and in
diet formulation.

Summary
Attention to skeletal health is warranted when using KD therapy given the uncertainty in the literature and suggestive harms
in certain populations. Future research should focus on potential mechanisms of injury.
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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