Cardiovascular Disease, Obesity

Retrospective Review of the Safety and Effectiveness of a Low Carbohydrate Ketogenic Diet Intervention in Patients with Overweight or Obesity and Heart Failure

This retrospective study evaluated the safety and effectiveness of a low-carbohydrate ketogenic diet (LCKD) in adults with overweight or obesity and heart failure (HF), including both reduced (HFrEF) and preserved (HFpEF) ejection fraction. Conducted at a university-based weight loss clinic between 2006 and 2024, the study included 125 patients who followed an LCKD for at least one year.

Outcomes assessed included changes in body weight, metabolic markers, cardiac function, medication use, and heart failure hospitalizations. The primary aim was to determine whether an LCKD could be safely implemented in a real-world clinical setting and whether it offered potential benefits in weight loss, metabolic health, or heart failure-related outcomes.

Key Findings:

• Median weight loss was 24.7 lb (11.2 kg) over an average of two years
• Patients with strict or mostly consistent adherence lost 3.8% more weight than those with lower adherence
• HDL cholesterol increased, and triglycerides decreased significantly, whereas total cholesterol and LDL remained stable
• Liver enzymes (AST and ALT) improved in patients with HFpEF
• No significant change in ejection fraction, diastolic function, or mitral regurgitation
• Heart failure hospitalizations declined from 28.8 to 15.8 events per 100 person-years, with the largest reduction in HFpEF
• All-cause mortality was 3.2 per 100 person-years; no significant differences by HF subtype
• Among patients with type 2 diabetes, 45.2% reduced their insulin dose, and significantly more reduced than increased or maintained it (p < 0.01)
• No significant changes in most heart failure medication classes; however, ACE inhibitors, ARBs, or ARNIs were reduced in 39% of patients with HFrEF

These findings suggest that a low-carb ketogenic diet is a safe and effective option for weight loss in patients with heart failure and obesity, with additional benefits in metabolic health and reduced hospitalization rates. Randomized controlled trials are needed to confirm the outcomes from this retrospective study and to evaluate long-term safety and efficacy in this population.