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Safety of Ketogenic Diet in Group 2 Pulmonary Hypertension Patients
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A5687 - Safety of Ketogenic Diet in Group 2 Pulmonary Hypertension Patients
Author Block: J. Dyer, S. Wolver, D. Grinnan; VCU Medical Center, Richmond, VA, United States.
RATIONALE: Pulmonary hypertension secondary to heart failure with preserved ejection fraction (PH-HFpEF) has limited treatment options due to the complexity of the disease. However, multiple studies have shown that the release of adipokines (IL-6, TNF-α) lead to a constant state of inflammation that could serve as the link between obesity and pulmonary hypertension. A ketogenic diet (high-fat, adequate protein, and low carbohydrate diet) has been shown to be an effective weight loss strategy. The safety profile of a ketogenic diet has never been explored in a PH-HFpEF population, which is the purpose of this review.
METHODS: Retrospective chart review was performed on five consecutive patients with PH-HFpEF (confirmed by right heart catheterization) who were enrolled in a ketogenic diet for at least a one month period. The ketogenic diet consisted of 20g of total carbohydrates or less per day. Additionally, patients were enrolled in small groups with psychologists. Patients followed every 4-6 weeks while on the diet. Chart review focused on adverse events, success in weight loss, medication changes, and functional improvement.
RESULTS: The ketogenic diet resulted in substantial weight loss in all five patients who were enrolled in the ketogenic diet. Patients averaged 59 weeks on the diet with a mean weight loss of 23.1 lbs. One patient who had spent 175 weeks on the diet demonstrated a dramatic reduction in her diuretics from furosemide 80mg PO BID to 20mg PO daily. Patient interviews at follow up visits remarked on improved dyspnea on exertion after initiation of the diet. Serial labs did not show any sustained elevation in creatinine, BUN, or lipid panel in any patient. Additionally, there were no adverse events noted in pulmonary hypertension patients while on a ketogenic diet.
CONCLUSIONS: There remains a paucity of treatment options for patients with PH-HFpEF. However, a ketogenic diet could serve as adjunct to current therapy as patients who were compliant with the diet showed substantial weight loss and improved dyspnea. No adverse effects were noted in the patient population. The lack of a clinical protocol for following parameters of pulmonary hypertension throughout the protocol is a limitation of this retrospective review. Future prospective evaluations appear indicated based on this preliminary data.
Author Block: J. Dyer, S. Wolver, D. Grinnan; VCU Medical Center, Richmond, VA, United States.
RATIONALE: Pulmonary hypertension secondary to heart failure with preserved ejection fraction (PH-HFpEF) has limited treatment options due to the complexity of the disease. However, multiple studies have shown that the release of adipokines (IL-6, TNF-α) lead to a constant state of inflammation that could serve as the link between obesity and pulmonary hypertension. A ketogenic diet (high-fat, adequate protein, and low carbohydrate diet) has been shown to be an effective weight loss strategy. The safety profile of a ketogenic diet has never been explored in a PH-HFpEF population, which is the purpose of this review.
METHODS: Retrospective chart review was performed on five consecutive patients with PH-HFpEF (confirmed by right heart catheterization) who were enrolled in a ketogenic diet for at least a one month period. The ketogenic diet consisted of 20g of total carbohydrates or less per day. Additionally, patients were enrolled in small groups with psychologists. Patients followed every 4-6 weeks while on the diet. Chart review focused on adverse events, success in weight loss, medication changes, and functional improvement.
RESULTS: The ketogenic diet resulted in substantial weight loss in all five patients who were enrolled in the ketogenic diet. Patients averaged 59 weeks on the diet with a mean weight loss of 23.1 lbs. One patient who had spent 175 weeks on the diet demonstrated a dramatic reduction in her diuretics from furosemide 80mg PO BID to 20mg PO daily. Patient interviews at follow up visits remarked on improved dyspnea on exertion after initiation of the diet. Serial labs did not show any sustained elevation in creatinine, BUN, or lipid panel in any patient. Additionally, there were no adverse events noted in pulmonary hypertension patients while on a ketogenic diet.
CONCLUSIONS: There remains a paucity of treatment options for patients with PH-HFpEF. However, a ketogenic diet could serve as adjunct to current therapy as patients who were compliant with the diet showed substantial weight loss and improved dyspnea. No adverse effects were noted in the patient population. The lack of a clinical protocol for following parameters of pulmonary hypertension throughout the protocol is a limitation of this retrospective review. Future prospective evaluations appear indicated based on this preliminary data.
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