Inflammation has become a prevalent topic in health and wellness, with many seeking dietary strategies to manage it. The ketogenic (keto) diet, known for its low-carb, high-fat approach, has also been recognized for its potential anti-inflammatory benefits. This article delves into the anti-inflammatory keto diet, providing a food list and guidance on how to incorporate it into your lifestyle.
Understanding Inflammation
Inflammation is a natural immune response that helps the body adapt to stress and heal from wounds, injuries, or illnesses. While essential for maintaining good health, chronic, long-term inflammation can lead to various health issues, including:
- Being overweight and obesity
- Metabolic syndrome
- Type 2 diabetes
- Heart disease
- Cognitive decline
- Autoimmune conditions
- Irritable bowel syndrome
- Inflammatory bowel disease (Crohn’s disease, ulcerative colitis)
- Cancer
Diet plays a crucial role in managing inflammation. The standard American/Western diet, high in refined oils, added sugars, and ultra-processed foods, is considered pro-inflammatory. Removing these foods from your diet may help reduce inflammation and improve metabolic health.
The Anti-Inflammatory Diet: Key Principles
Anti-inflammatory diets, regardless of their macronutrient breakdown, share common characteristics:
- High-Quality Foods: Prioritize organic produce and ingredients, as well as humanely raised and harvested meats (e.g., grass-fed beef, free-range chicken and pork, wild-caught fish). These options may be less inflammatory than their conventional counterparts due to fewer pesticide residues and more favorable nutrient profiles.
- Nutrient Density: Focus on foods rich in nutrients and phytochemicals (plant compounds). This includes healthy fats, protein sources, a diverse assortment of herbs and spices, and a wide variety of fruits and vegetables in varying colors.
- Minimal Processing: Build your diet around minimally processed foods and homemade meals, as ultra-processed foods can be highly inflammatory.
The Ketogenic Diet and Inflammation
Ketogenic diets have demonstrated potential in reducing inflammation. This may be attributed to ketosis, the metabolic state achieved when you restrict carbs. Ketosis triggers biochemical changes that may help lower inflammation.
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However, the popularity of keto has led to a surge in highly processed "keto" foods. These options are often low in quality, with suboptimal nutrient profiles and heavily processed ingredients. Relying on these foods may hinder the anti-inflammatory benefits of keto.
Top 20 Keto-Friendly Anti-Inflammatory Foods
To maximize the anti-inflammatory potential of your keto diet, focus on incorporating these foods:
- Grass-fed Beef: Higher in anti-inflammatory omega-3 fats compared to conventionally raised beef.
- Salmon: A rich source of omega-3 fats, promoting anti-inflammatory, brain health, and heart health benefits. Look for wild, sustainably fished salmon, anchovies, sardines, and butterfish. The fat profile of salmon is particularly impressive. Salmon may be the star player, but other fatty fish help reduce inflammation as well.
- Walnuts: May help decrease brain inflammation, potentially slowing cognitive decline.
- Eggs: Adding eggs to a plant-based diet may offer protection against inflammation and metabolic syndrome factors. It’s important to eat whole eggs rather than egg whites since most of an egg’s nutrients are found in the yolk. This includes the antioxidants lutein and zeaxanthin, which protect eye health.
- Strawberries: Contain antioxidant anthocyanins, potentially reducing inflammation related to obesity.
- Coconut Oil: A less inflammatory option compared to highly refined oils rich in pro-inflammatory omega-6 fats (e.g., soybean oil, corn oil). Opt for cold-pressed coconut oil.
- Olive Oil: A Mediterranean diet staple thanks to its anti-inflammatory oleic acid content. Olive oil provides impressive benefits for your heart. It’s high in monounsaturated fats and polyphenol antioxidants, which may help reduce inflammation and manage blood pressure, cholesterol, and glucose levels. As a pure fat source, olive oil contains no carbs. It’s an ideal base for salad dressings and mayonnaise.
- Broccoli: Contains sulforaphane, a compound that may help with blood sugar control, oxidative stress, and inflammation.
- Flax Seeds: Rich in fiber and a good plant-based source of omega-3 fat. May help protect against inflammatory conditions like heart disease and type 2 diabetes.
- Raspberries: Like strawberries, a rich source of anti-inflammatory anthocyanins.
- Avocado: Regular avocado consumption may improve heart health and markers of oxidative stress. This keto-friendly toast combines avocado and salmon to give you an inflammation-busting breakfast, lunch or dinner.
- Green Tea: Contains anti-inflammatory catechins, particularly epigallocatechin-3-gallate (EGCG), which may be helpful for some inflammatory conditions.
- Turmeric: A spice rich in anti-inflammatory curcuminoids, potentially acting as a natural pain reliever. Curry isn’t just delicious, it’s a functional food. Make turmeric a daily non-negotiable in your life to maximize the health benefits. From curry to golden smoothies there are plenty of ways to enjoy this wonder root.
- Ginger: May offer health benefits for inflammation, immune health, and gastrointestinal health.
- Garlic: May be excellent for immune health, heart health, and metabolic health due to its anti-inflammatory organosulfur compounds.
- Kale: Contains anti-inflammatory sulforaphane compounds.
- Peppers: Hot and sweet peppers are rich sources of vitamin C, regulating the immune system and inflammation.
- Mushrooms: Contain a variety of nutrients and phytochemicals that may help reduce inflammation and boost overall health.
- Spinach: A dark leafy green vegetable rich in anti-inflammatory phytochemicals.
- Fermented Cabbage: Fermented cabbages like kimchi or sauerkraut are a source of probiotics, improving gut microbiome health.
Other Keto-Friendly Foods to Consider
Besides the top 20, many other foods fit well into an anti-inflammatory keto diet:
- Seafood: Fish and shellfish are very keto-friendly. Frequent fish intake is also linked to improved brain health and a decreased risk of disease.
- Meat and Poultry: Fresh meat and poultry contain no carbs and are rich in B vitamins and several important minerals. They’re also a great source of high quality protein, which may help preserve muscle mass during a very low carb diet.
- Cheese: Most cheeses are very low in carbs and high in fat, making them a great fit for the keto diet. Here are some cheeses that are lower in carbs for a keto diet: blue cheese, Brie, Camembert, cheddar, chevre, Colby jack, cottage cheese, cream cheese, feta, goat cheese, halloumi, Havarti, Limburger, Manchego, mascarpone, mozzarella, Muenster, Parmesan, pepper jack, provolone, Romano, string cheese and Swiss cheese.
- Plain Greek Yogurt and Cottage Cheese: While they contain some carbs, you can eat them in moderation on keto. Both Greek yogurt and cottage cheese have been shown to help decrease appetite and promote feelings of fullness.
- Cream and Half-and-Half: Very low in carbs and high in fat, making them ideal for keto. Despite this, it’s best to enjoy them in moderation.
- Unsweetened Plant-Based Milk: Several varieties of plant-based milk, including soy, almond, and coconut milk, are keto-friendly.
- Other Nonstarchy Vegetables: Several other nonstarchy vegetables are low in calories and carbs yet full of nutrients and antioxidants. Keto vegetable list: asparagus, broccoli, cabbage, cauliflower, mushrooms, cucumber, green beans, eggplant, tomatoes, radishes, Brussels sprouts, celery and okra.
- Nuts and Seeds: High in fat and low in carbs. Some keto-friendly nut and seed options to consider include: almonds, macadamia nuts, pecans, walnuts, chia seeds and flaxseeds.
- Berries: Most fruits are too high in carbs to eat on the keto diet, but berries are an exception. These tiny fruits are loaded with antioxidants that may reduce inflammation and help protect against disease.
- Shirataki Noodles: A fantastic addition to the keto diet.
- Dark Chocolate and Cocoa Powder: Delicious sources of antioxidants. You can eat chocolate on keto, but it’s important to choose dark chocolate that contains a minimum of 70% cocoa solids - preferably more - and eat it in moderation.
- Butter and Ghee: Good fats to include while on the keto diet.
- Unsweetened Coffee and Tea: Healthy, carb-free drinks.
- Unsweetened Sparkling Water: A great keto-friendly alternative to soda.
Foods to Avoid or Limit
People following an anti-inflammatory keto diet should avoid or limit their intake of:
- Processed foods
- Foods with added sugar or salt
- Unhealthful oils
- Processed carbs (white bread, white pasta, baked goods)
- Processed snack foods (chips, crackers)
- Premade desserts (cookies, candy, ice cream)
- Excess alcohol
- Vegetable oils as they dramatically increase inflammation.
Some people may also have intolerances to specific foods (gluten, dairy, nightshade vegetables, cruciferous vegetables), meaning that eating them can cause inflammation and other adverse effects.
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Sample Anti-Inflammatory Keto Meal Ideas
Here are a few ideas to get you started:
- Breakfast: Keto-friendly toast combines avocado and salmon to give you an inflammation-busting breakfast, lunch or dinner.
- Lunch: Crispy Skin Salmon with Pesto Cauliflower Rice is perfect for getting your omega-3s in.
- Dinner: This spicy bowl packs anti-inflammation power from omega-3-rich salmon and ginger.
- Dessert: Macadamia Nut Keto Fat Bombs pack loads of healthy fat plus another anti-inflammation powerhouse: dark chocolate. This keto fluff is bursting with the anti-inflammatory benefits of macadamia nuts because the star ingredient is Perfect Keto Nut Butter, which is a creamy blend of macadamia, cashews, and coconuts.
Additional Tips for Success
- Consult Professionals: When adopting a new diet, consulting with a healthcare provider or nutritionist is invaluable.
- Pantry Revamp: Out with processed foods, refined sugars, and high sodium items. Embrace the keto principle from the core.
- Stay Informed: A Google search for “anti-inflammatory diet” is bound to deliver loads of information. But for a quick intro to inflammation and specifically how food plays into it, check out this page from the Academy of Nutrition and Dietetics. It includes five steps to making your plate less inflammatory and offers lifestyle tips for fighting chronic inflammation as well.
- Meal Planning: Suggestic offers personalized eating plans for a number of diets, one being the anti-inflammatory diet. Once you download, create a profile, and select the anti-inflammatory diet as the program for you, the app will give you a broad overview of what to eat, eat less of, and avoid, and then will map out recipes for your daily meals. If you log what you eat, the app will also track your nutrient intake.
- Incorporate Healthy Swaps: Arthritis New South Wales has a helpful list of anti-inflammatory foods to try in place of some of your usual go-tos. For instance, do you love chips? Try snacking on kale chips or nuts instead. The page lists swaps for every meal, plus has extra tips to make it easier to stick with this way of eating.
- Cookbook Resources: The Anti-Inflammatory Kitchen by Leslie Langevin is a must-have if you’re committing to this way of eating. In it, you’ll find more than 100 recipes, a 30-day meal plan, a guide to sticking to the diet while eating out, and tips on how to live an anti-inflammatory lifestyle.
- Podcast Insights: Liz’s Healthy Table podcast from Liz Weiss features Carolyn Williams, PhD, RD, the author of Meals That Heal: 100+ Everyday Anti-Inflammatory Recipes in 30 Minutes or Less: A Cookbook.
- Consider Supplements: Talk to a healthcare professional about supplements, such as cod liver oil or a multivitamin.
- Exercise Regularly: Incorporate 30 minutes of moderate exercise into your daily routine.
- Practice Good Sleep Hygiene: Poor sleep can worsen inflammation.
The Broader Impact of Keto on Neurological Health
The ketogenic diet, originally developed for the treatment of epilepsy in non-responder children, is spreading to be used in the treatment of many diseases, including Alzheimer’s disease. The main activity of the ketogenic diet has been related to improved mitochondrial function and decreased oxidative stress. B-Hydroxybutyrate, the most studied ketone body, has been shown to reduce the production of reactive oxygen species (ROS), improving mitochondrial respiration: it stimulates the cellular endogenous antioxidant system with the activation of nuclear factor erythroid-derived 2-related factor 2 (Nrf2), it modulates the ratio between the oxidized and reduced forms of nicotinamide adenine dinucleotide (NAD+/NADH) and it increases the efficiency of electron transport chain through the expression of uncoupling proteins. Furthermore, the ketogenic diet performs anti-inflammatory activity by inhibiting nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) activation and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome as well as inhibiting histone deacetylases (HDACs), improving memory encoding.
Chronic inflammation and oxidative stress are considered two key factors in the development of Alzheimer’s disease, underlying neurotoxic mechanisms leading to neuronal death occurring in the brain areas responsible for memory and cognitive processes.
A bulk of studies have shown that the blood-brain barrier is impaired in Alzheimer’s disease resulting in an altered expression of some transporters, including the down-regulation of glucose transporter. The primary fuel for the brain is glucose that must be taken from the blood and transported across the BBB by the specific glucose transporters (GLUTs) due to the inability of neurons to synthesize or store it. When there is a decreased expression of these transporters, as it has been shown in AD, Ketone Bodies (KBs) become the alternative energy source to glucose for the brain due to their ability to cross the BBB carried by specific transporters that are not down-regulated during AD.
Scientific Research and Clinical Trials
Several clinical trials have explored the effects of ketogenic diets on cognitive function in individuals with Alzheimer's disease and mild cognitive impairment (MCI).
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- Reger et al.: Studied 20 individuals with probable AD or amnestic MCI.
- Henderson et al.: Compared AC-1202 (a ketogenic agent) to placebo in a randomized, double-blind study. AC-1202 rapidly elevated serum ketone bodies in AD patients and resulted in significant differences in ADAS-Cog scores compared to the Placebo after 45 and 90 days of treatment.
- Ohnuma et al.: Analyzed the effect of 90-day administration of a ketogenic meal “Axona” on cognitive function in mild-to-moderate Alzheimer’s disease (AD) patients.
- Taylor et al.: The primary objective of Ketogenic Diet Retention and Feasibility Trial (KDRAFT) was to address the feasibility of implementing a very high-fat ketogenic diet (VHF-KD) intervention in AD participants; secondary objectives included evaluating the effects of a VHF-KD on cognition.
These studies suggest that ketogenic diets may have potential benefits for cognitive function in individuals with AD and MCI.
Mechanisms of Action
The ketogenic diet's effects on inflammation and oxidative stress are linked to several mechanisms:
- Mitochondrial Function: The ketogenic diet has been related to improved mitochondrial function and decreased oxidative stress.
- Reactive Oxygen Species (ROS): B-Hydroxybutyrate has been shown to reduce the production of reactive oxygen species (ROS), improving mitochondrial respiration.
- Nrf2 Activation: β-Hydroxybutyrate stimulates the cellular endogenous antioxidant system with the activation of nuclear factor erythroid-derived 2-related factor 2 (Nrf2).
- Inflammatory Pathways: The ketogenic diet performs anti-inflammatory activity by inhibiting nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) activation and nucleotide-binding domain, leucine-rich-containing family, pyrin domain-containing-3 (NLRP3) inflammasome as well as inhibiting histone deacetylases (HDACs), improving memory encoding.
Medium-Chain Triglycerides (MCTs)
The advances in understanding of the mechanisms of action of medium-chain fatty acids (e.g., decanoic acid and octanoic acid) have more recently shifted attention away from ketone bodies to the direct role of fatty acids as a therapeutic effectors, paving the way for novel dietary and drug therapies for epilepsy and other disorders. Medium-chain fatty acids are able to cross the blood-brain barrier reaching in the brain a concentrations more than 50% greater than the plasma one, providing an alternative energy source for brain neurons and astrocytes. Octanoic acid seems to undergo β-oxidation in astrocytes more easily than decanoic acid and readily produces ketone bodies; decanoic acid instead stimulates glycolysis producing lactate available as fuel for the brain cells.