Ketogenic diet reduces weight, raises aldosterone

Adherence to ketogenic diets (KDs) results in weight reduction and increased aldosterone concentrations without worsening cardiometabolic risk factors, suggests a study.

To assess the effects of KDs with varying sodium content relative to low-fat diets (LFDs) on renin‒angiotensin‒aldosterone system (RAAS) in overweight and obese adults, the investigators randomized 28 individuals to a KD plus ketone salt supplement (KD + KS) or a KD plus placebo (KD + PL) arm with prepared hypocaloric meals. Of the participants, 12 were enrolled in a post hoc LFD arm.

Subsequently, the investigators evaluated serum renin, aldosterone, and anthropometric and metabolic biomarkers at 0, 2, 4, and 6 weeks. They also compared between-group differences, controlling for sex and body mass index (BMI), using linear mixed models with random intercepts.

Of the participants (median age 33 years, weight 91.3 kg, BMI 30.6 kg/m²), 51 percent were female. Weight decreased by 6, 8, and 7 kg on average at week 6 in the KD + KS, KD + PL, and LFD arms, respectively (p<0.05).

Aldosterone increased by 88 percent in the KD + PL group and by 144 percent in the KD + KS group, but not in the LFD group after 6 weeks. On the other hand, renin decreased across all arms. No change was observed in systolic and diastolic blood pressure in the KD + PL and KD + KS groups.

Notably, log ketone showed a positive association with aldosterone (p<0.001), while aldosterone showed no relationship with cardiovascular measures such as blood pressure and ejection fraction (p>0.05).

“Future KD studies are needed to elucidate mechanistic connections between ketones and aldosterone,” the investigators said.

“KDs and LFDs result in similar weight loss but have differential cardiometabolic effects on lipids and insulin. Generally, weight loss decreases RAAS activity,” they noted.