Reduction in serum leptin and IGF-1 but preserved T-lymphocyte numbers and activation after a ketogenic diet in rheumatoid arthritis patients.
OBJECTIVE
To assess the clinical, immunological and hormonal effects of carbohydrate restriction in rheumatoid arthritis (RA) patients via the provision of a ketogenic diet.


METHODS
Thirteen RA patients with active disease consumed a ketogenic diet for 7 days, providing the estimated requirements for energy and protein whilst restricting their carbohydrate intake to < 40 g/day. This was followed by a 2-week re-feeding period. Clinical and laboratory evaluations were carried out on days 0, 7 and 21. Changes in serum glucose, beta-hydroxybutyrate (beta-HB), leptin, insulin-like growth factor-1 (IGF-1) and cortisol were also measured at these time points. To study CD4+ and CD8+ lymphocyte responses, mitogen stimulated T-cell activation was assessed in heparinised whole blood via flow-cytometric analysis of CD69 expression.


RESULTS
After the 7-day ketogenic diet, there were significant increases in serum beta-HB and cortisol, and significant decreases in body weight, the total lymphocyte count, serum leptin, IGF-1 and glucose. However, with the exception of morning stiffness, there were no significant changes in any of the clinical or laboratory measures of disease activity, or in early T-lymphocyte activation and the absolute numbers of CD4+ and CD8+ cells.


CONCLUSIONS
In RA patients several of the metabolic and hormonal responses to a ketogenic diet, such as a fall in serum IGF-1 and leptin, resemble those which occur in response to acute starvation. However, the clinical and immunological changes which occur in response to acute starvation do not take place with a ketogenic diet and thus may be dependent upon energy and/or protein restriction.
Fraser
D A
DA
Centre for Rheumatic Diseases, National Hospital, Oslo, Norway. DFRA@nycomed.com
Thoen
J
J
Bondhus
S
S
Haugen
M
M
Reseland
J E
JE
Djøseland
O
O
Førre
O
O
Kjeldsen-Kragh
J
J
D020155:3-Hydroxybutyric Acid / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000178:diet therapy* / Q000503:physiopathology; D001786:Blood Glucose; D001835:Body Weight; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism*; D007659:Ketones / Q000378:metabolism*; D020738:Leptin / Q000097:blood*; D008213:Lymphocyte Activation; D018655:Lymphocyte Count; D012720:Severity of Illness Index
D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D007659:Ketones; D020738:Leptin; D007334:Insulin-Like Growth Factor I; D020155:3-Hydroxybutyric Acid; D006854:Hydrocortisone