What Do We Know About The Role of Ketones?

Coronavirus: What Do We Know About The Role of Ketones?

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It's March 29th, 2020 and the world is awash in confusion (and hand sanitizer). With the COVID-19 pandemic progressing so quickly and the deluge of advice hitting your news feed, it's hard to know what advice helpful and what advice is not.

Certainly, hoarding toilet paper and chugging gallons of orange juice (in the hopes that it's meagre vitamin C contents will boost immune function and shield you from the virus) isn't going to save lives. In fact, a fair number of people are now experiencing weight gain as a result of being cooped up inside without access to gyms and unrelenting proximity to their fridges and pantries.

We're not criticizing the responsible choice to stay at home and prevent viral spread, but what we are saying is that now, more than ever, it's important to be conscious of our health choices so we don't end up damaging our overall health, exacerbating problems like obesity, diabetes, and heart disease, and impairing our immune systems to boot!

As experts in ketogenic nutrition, we here at KetoDietApp thought we'd share some thoughts on the potential relationship between ketogenic diets and COVID-19.

Ketones could possibly protect against COVID-19 in at least two ways. First, a mouse study, published this past December in Science Immunology, found that a ketogenic diet protects mice against the influenza flu virus, which is like COVID-19's cousin. The mechanism by which the ketogenic diet protected the mice is the same mechanism by which infants are protected against the influenza ( 1). Since we know infants are also protected against COVID-19, although we aren't yet sure why, it's possible that it's the babies' ketones that protect them.

Second, it's important to note that it's not the COVID-19 virus that kills people, it's the body's response to the virus. When the body is overwhelmed (more likely in elderly and immunocompromised people), it overreacts with what is known as a "cytokine storm." This is a fancy way of saying, the body releases tons of inflammatory factors that can lead to "acute respiratory distress syndrome" (ARDS) in COVID-19, the need for ventilator support, and ultimately, death.

Ketones are known to be potent inhibitors of inflammation by increasing levels of an important molecule called NADPH ( 2), inhibiting the NLRP3 inflammasome ( 3), and other mechanisms. Therefore, ketones may protect against the cytokine storm that leads to death in severe cases of COVID-19.

At this time, the relationship between ketones and COVID-19 is still within the realm of speculation although researchers are hard at work to change that. However, it's notable that there have been numerous clinical reports of individuals (including the elderly and those with chronic diseases) who are in ketosis and have presented with mild respiratory symptoms — runny noses, scratchy throats, and mild coughs — as well as other COVID-19-associated symptoms — conjunctivitis ( 4) and diarrhea ( 5) — but who are otherwise fine.

Is it possible that they are infected and that their diets are blunting the impact of the virus? Possibly. In any case, we'd argue that you're better off simply trying to eat healthily than chugging orange juice while hidden inside your fortress made of toilet paper.

It's not the COVID-19 virus that kills people, it's the body's response to the virus. When the body is overwhelmed, more likely in elderly & immunocompromised people, it overreacts with what is known as a "cytokine storm."

Update 4/2/2020

I am going to add a little amendment to this post. I intentionally didn’t add it to begin with because I didn’t want to add too much nuance in the main body of the post. However, for those of you who are a particularly well informed on the literature, you may appreciate this.

Ostensibly counter to the notion that ketosis could help in the case of corona virus, there is data to suggest that, while ketones protect against bacterial infections, it’s actually good to have glucose to protect against viral infections (see this explanation for more).

However, this is not just any old virus. We aren’t going to dramatically decrease to total viral burden overtime, at least at this point in the US and UK. What we are aiming to do now is “flatten the curve.” But why? What does that actually mean. We don’t want to decrease the virus’s spread, per se (in fact, if more less susceptible people got infected, we’d move more quickly towards herd immunity, protecting the vulnerable overtime). Rather, we want to decrease the rate at which vulnerable people experience severe complications of the virus, end up in the hospital in need of ventilation, and overwhelm the medical system’s capacity.

These severe complications (specifically ARDS) are a result of the body’s overreaction to the virus (cytokine storm). Therefore, the goal is to dampen inflammation. The possibility (even if only a small possibility) that ketones may help to improve lung carrier function (there is also some clinical evidence/observations in COPD patients) is just a “fun” if I’m allowed to say that cherry on top. This is a very nuanced topic. I’m not advising being flippant, but I also caution against a societal overreaction which could be equally as harmful in the long run.

Take Home Message It's not the COVID-19 virus that kills people, it's the body's response to the virus. When the body is overwhelmed, it overreacts with what is known as a "cytokine storm." The relationship between ketones and COVID-19 is still within the realm of speculation. Theory suggests that ketogenic diets could help protect against the "cytokine storm" in COVID-19, but research is needed to determine whether theory translates into clinical practice. It's important — now more than ever — to be conscious of our health choices. Getting enough sleep, stress management and eating a healthy nutrient-dense diet low in processed foods can help you maintain a strong immune system.

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Nicholas Norwitz MD-PhD candidate at Oxford University Nicholas Norwitz is a Harvard medical student and Oxford PhD researcher who specializes in ketone metabolism. He a rising star in the scientific community, with peer-reviewed publications on topics ranging from brain health to bone health to heart health to gut health. Informed by his own medical history, he has an infectious passion for food as medicine and a drive to find innovative ways to teach the general public about the latest nutrition science. More posts by Nicholas Norwitz Expert Article This article was written by Nicholas Norwitz who is a qualified expert. At KetoDiet we work with a team of health professionals to ensure accurate and up-to-date information. You can find out more on the About us page. Evidence Based Evidence-Based articles are based on medical research, and scientific evidence. Our expert authors focus on hard evidence alone and include relevant research references from trusted sources to support their articles. We always aim to deliver relevant, trustworthy and up-to-date information based on trusted evidence and proven research.