From the Guidelines
The ketogenic diet is not recommended as a primary treatment for autoimmune degenerative bone diseases like rheumatoid arthritis due to insufficient clinical evidence, as stated in the 2023 guideline by England et al. 1.
Key Considerations
- The guideline emphasizes a "food first" approach, focusing on high-quality foods to obtain necessary nutrients, rather than relying on dietary supplements 1.
- Maintaining a healthy body weight is crucial, and rheumatology clinicians should consider involving registered dieticians in the interprofessional care team to assist patients with dietary modifications 1.
- While some integrative interventions like standardized self-management programs, CBT, and mind-body approaches are conditionally recommended, the evidence supporting these interventions is of low certainty 1.
Dietary Approach
- If a patient still wishes to explore the ketogenic diet, it is essential to implement a well-formulated diet consisting of 70-80% fat, 15-20% protein, and 5-10% carbohydrates, focusing on healthy fats and non-starchy vegetables.
- Supplementing with calcium, vitamin D, magnesium, and vitamin K2 may be necessary to support bone health, but this should be done under medical supervision 1.
Monitoring and Supervision
- Regular monitoring of bone density and medical supervision are crucial, as the ketogenic diet may affect medication absorption and potentially increase the acidic load on bones.
- The ketogenic diet should complement, not replace, conventional treatments like bisphosphonates, DMARDs, or other prescribed medications for bone diseases.
Prioritizing Conventional Treatments
- Conventional treatments, such as DMARDs, should remain the primary approach for managing autoimmune degenerative bone diseases, with the ketogenic diet considered only as a potential adjunctive therapy, if at all.
From the Research
Ketogenic Diet and Autoimmune Degenerative Bone Disease
- There is limited research on the specific topic of ketogenic diet and autoimmune degenerative bone disease, however, some studies suggest that dietary changes can have an impact on autoimmune diseases such as rheumatoid arthritis 2.
- A study published in 2021 found that the ketogenic diet may have anti-inflammatory properties that could be beneficial for patients with inflammatory arthritis, although more research is needed to confirm this 2.
- Other studies have found that omega-3 fatty acids, which are often included in ketogenic diets, can have a positive effect on rheumatoid arthritis symptoms and disease activity 3, 4, 5.
- A 2017 study found that dietary intake of vitamin D and omega-3 fatty acids was associated with better treatment results in patients with early rheumatoid arthritis 3.
- A 2015 study found that omega-3 fatty acid supplementation resulted in significant clinical benefit and reduced the need for concomitant analgesic consumption in patients with active rheumatoid arthritis 5.
Mechanisms and Potential Benefits
- The ketogenic diet may exert its anti-inflammatory effects through the production of β-hydroxybutyrate (BHB), which has been shown to inhibit pro-inflammatory cytokines 2.
- Weight loss, which is often a result of the ketogenic diet, can also have anti-inflammatory effects by reducing adipose tissue and improving insulin sensitivity 2.
- Omega-3 fatty acids have been shown to reduce morning stiffness, tender joints, and swollen joints in patients with rheumatoid arthritis, and may also have a positive effect on disease activity and remission 4, 5.
Limitations and Future Research
- More research is needed to fully understand the potential benefits and mechanisms of the ketogenic diet in autoimmune degenerative bone disease 2.
- Future studies should investigate the effects of the ketogenic diet on specific domains and clinical outcomes in patients with inflammatory arthritis, and explore the potential for omega-3 fatty acids and other nutrients to enhance treatment results 3, 2.