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Available online 6 July 2024
In Press, Journal Pre-proof

Impacts of the Ketogenic Diet on Outcomes of the Highly Prevalent Neurological Diseases in the United Kingdom and Possible Biochemical Mechanisms behind: A Review

https://doi.org/10.1016/j.nutos.2024.07.001

Abstract
Purpose
To identify what impacts the ketogenic diet (KD) may have on the outcomes of the highly prevalent neurological diseases (NDs) in the UK. These NDs are migraine, traumatic brain injury (TBI), stroke, fibromyalgia and restless legs syndrome (RLS). Additionally, if KD does impact the NDs outcomes, to identify by what biochemical mechanisms that does occur.

Methods
Electronic databases (Medline, CLINAL PLUS, Cochrane, APA Psyclnfo, APA PsycArticles, AMED and SPORTdiscuss) were searched using 4 main themes (highly prevalent NDs, KD, neurological outcomes and biochemical mechanisms) to identify the studies using KD as an intervention to treat NDs.

Results
Twelve articles were identified and no studies for fibromyalgia and RLS. KD had positive impacts on all outcomes in migraine (attack frequency, duration, intensity, etc.) and stroke (balance & coordination, sensation, etc.). KD also had positive impacts on all outcomes in TBI ranging from physical, mental & behaviour and cognitive aspects, except no impact on “anxiety-like behaviour” and “brain oedema”. Improvement of mitochondria metabolism and reduction of neuroinflammation are the common biochemical mechanisms of KD improving the NDs outcomes. The specific mechanisms for migraine, TBI and stroke include inhibition of neuronal excitability, preservation of brain volume and increase in adenosine activity respectively.

Conclusion
KD improved almost all outcomes in migraine, TBI and stroke by different biochemical mechanisms. However, cautions are needed to be taken while interpreting the results as RCTs on humans were lacking in this review.