KC. Haavardsholm, M. Zamani, M. Skjelland, A. Ramm-Pettersen and K. Skagen (2025). Carotid intima-media thickness may be an early biomarker for cardiovascular risk in patients treated with ketogenic dietary therapy. Epilepsia open, 10(6), 1860-1870. https://doi.org/10.1002/epi4.70152

PubMed 41026111

[Abstract]
OBJECTIVE: To assess early signs of atherosclerosis following long-term treatment with the ketogenic diet therapy due to concerns regarding the impact of this low-carbohydrate, high-fat diet on cardiovascular health.

METHOD: In this cohort study, 28 patients aged 6 to 49 years who had been treated with ketogenic diet therapy for more than five years and 28 age- and gender-matched controls underwent ultrasound assessment of carotid intima media (cIMT). Measurements were compared between the two groups. Traditional cardiovascular risk factors were recorded in the patient group.

RESULTS: We found increased cIMT in patients treated with the ketogenic diet compared with controls (median 0.62 mm (IQR 0.12) vs. 0.53 mm (IQR 0.14), p < 0.001). This difference increased with age (median 0.69 (IQR 0.18) vs. 0.60 mm (IQR 0.12), p = 0.029). The type of ketogenic diet (classical or modified) did not affect cIMT. Blood pressure, body mass index (BMI), and blood lipids in patients treated with the ketogenic diet for more than 5 years were within the normal range.

SIGNIFICANCE: cIMT may be an early biomarker for cardiovascular risk and be warranted in the standard follow-up of patients with long-term ketogenic diet treatment.

PLAIN LANGUAGE SUMMARY: This study documents increased thickness of the inner layers of the carotid artery (carotid intima media) (cIMT) in 28 patients treated with a high-fat, low-carbohydrate, and adequate protein (ketogenic) diet for more than 5 years compared with controls and that this difference increased with age. The type of ketogenic diet (classical or modified) did not affect cIMT. Blood pressure, body mass index, and blood lipids in patients treated with the ketogenic diet for more than 5 years were within the normal range.