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Dr. Peter Brukner OAM2 min read

Show me the evidence: Low carb and autoimmune disease

Autoimmune disease occurs when the body, for some reason, attacks itself. It is usually associated with chronic inflammation. Examples of common autoimmune diseases are Hashimoto’s, multiple sclerosis, rheumatoid arthritis, type 1 diabetes, Crohns Disease and lupus. There are thought to be 80-100 different autoimmune diseases. Women are affected more than men with around 80% of cases being in females.

There is evidence for the effect of a diet such as a low carbohydrate or ketogenic diet on individual diseases (see multiple sclerosis).

Recently, an interesting paper was published looking at the effect of a ketogenic diet (KD) on human immunity using an in vitro model using primary human immune cells and a nutritional intervention study enrolling healthy volunteers. The ketogenic diet markedly improved specific responses of human T lymphocytes in a balanced way—including T effector and T regulatory cell function—and increased the formation of memory T cells both in vitro and in vivo. This effect was based on a redirection of T-cell metabolism toward aerobic mitochondrial oxidation, resulting in enhanced cellular energy supply and respiratory reserve. Furthermore, thesefunctional changes were in line with transcriptomic alterations, linking the KD to a fundamental immunometabolic reprogramming of human T cells.

Impact.

The data suggest that KD is a feasible and effective clinical tool to augment human T-cell immunity. This could impact various clinical issues intimately correlated to T-cell immune disorders. In conclusion, the study changes the perspective on nutrition as a clinical tool and could help to redefine the role of dietary interventions in modern medicine. Citation: Hirtschberger S, Strauss G, Effinger D et al. Very-low-carbohydrate diet enhances human T-cell immunity through immunometabolic reprogramming EMBO Mol Med 2021;13:e14323

The effect of a change in nutrition on human immunity is not surprising when you realise the relationship between food intolerances and immunity. Immunoglobulin levels for specific food antibodies were significantly higher in patients with autoimmune conditions indicatinga greater immune reaction to these foods.

Citation: Coucke F. Food intolerance in patients with manifest autoimmunity. Observational study. Autoimmun Rev. 2018 Nov;17(11):1078-1080. doi: 10.1016/j.autrev.2018.05.011. Epub 2018 Sep 11. PMID: 30213697.

The potential for the use of a low carb or ketogenic diet in a wide variety of auto-immune disease is exciting. We look forward to further RCTs to investigate the relationship.