EP192: Ketogenic Diets and the Heart

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I’m a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Podcast Summary Introduction: Dr. Warrick Bishop is a practicing cardiologist and author dedicated to improving patient care through heart health education. In this episode, he explores the potential role of ketogenic diets in cardiac failure management, examining the science behind ketone metabolism and how it might benefit heart function while considering its place within current cardiovascular health guidelines. Key Takeaways: Ketogenic diets originated in the 1920s as a treatment for pediatric epilepsy and have since shown potential benefits for neurodegenerative diseases, diabetes, non-alcoholic fatty liver disease, certain cancers, and weight loss. A ketogenic diet typically consists of 70-80% fat, 10-20% protein, and 5-10% carbohydrates, which reduces insulin levels and allows the body to convert fatty acids into ketones for energy. Ketosis is a normal metabolic state that endurance athletes naturally enter after 35-45 minutes of exercise, demonstrating that using ketones as fuel is a natural bodily process. The heart can utilize ketones as an unregulated energy source, raising the theoretical question of whether ketogenic diets could improve cardiac function in heart failure patients. Current research on ketogenic diets specifically for cardiac failure is limited, despite evidence from the EMPA-REG trial showing that reducing glucose levels benefits cardiac failure outcomes. Ketogenic diets contrast sharply with current cardiovascular guidelines that recommend fruits, vegetables, and whole grains—foods that are restricted in keto due to carbohydrate content. Dr. Bishop favors moderate carbohydrate reduction (rather than full ketogenic restriction) as it can reduce insulin levels, aid weight loss, improve HDL cholesterol, and lower triglycerides. While some patients may report subjective benefits from ketogenic diets in cardiac failure, any such approach should only be undertaken under close medical supervision by a cardiologist. Dr. Bishop does not currently advocate ketogenic diets specifically for cardiac failure treatment due to insufficient evidence, though he remains optimistic about future research in this area. More research is needed to definitively establish the safety and efficacy of ketogenic diets in cardiac failure before broader clinical recommendations can be made.