Keto and Inflammation: BHB, Blood Sugar and Omega-3s

Written by Dr. Ryan Kneessi, ND

Quick answer: Research suggests keto may lower inflammation in several ways. The ketone beta-hydroxybutyrate (BHB) may calm the NLRP3 inflammasome and activate AMPK. Fewer blood sugar spikes mean less oxidative stress and fewer advanced glycation end products (AGEs). And a better omega-3 to omega-6 balance favors anti-inflammatory signals. Much of this evidence is from lab and animal studies.

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Key takeaways

The ketone BHB may calm certain inflammatory pathways, though much of the evidence comes from lab and animal studies.

Fewer blood sugar spikes mean less oxidative stress from glucose surges and less activation of inflammatory pathways.

Omega-3 fats compete with omega-6 fats and help the body resolve inflammation, so fat quality matters on keto.

Beta-hydroxybutyrate (BHB)

Much of this research comes from lab and animal studies.

NLRP3 inflammasome

BHB may block this immune complex, which drives inflammatory signals.

AMPK

BHB may activate this energy sensor, which dampens inflammatory pathways.

Oxidative stress

Ketones may reduce reactive oxygen species and support antioxidant defenses.

Gene expression

BHB may switch on genes that protect against oxidative stress.

Fewer blood sugar spikes

Fewer spikes mean less oxidative stress from glucose surges and less activation of inflammatory pathways like NF-kB. They also mean fewer advanced glycation end products (AGEs), which stiffen tissues, and a healthier blood vessel lining (endothelium).

Omega-3 balance

Omega-3 fats compete with omega-6 fats for the same enzymes, shift cell membranes and gene expression, and help resolve inflammation. See keto fat foods.

Healthy aging lens

Chronic low-grade inflammation, sometimes called inflammaging, is thought to contribute to aging and many age-related diseases. See inflammaging.

When to see a naturopathic doctor

It may be time to see a naturopathic doctor if you have diabetes or take insulin, sulfonylureas or SGLT2 inhibitors (risk of low blood sugar or ketoacidosis), or if you take blood pressure medication or diuretics. The same is true if you have kidney, liver, gallbladder or pancreas disease, or high cholesterol, if you are pregnant, breastfeeding, or have a history of disordered eating, or if you want a keto plan tailored to your labs and goals.

See a medical provider promptly for nausea and vomiting, abdominal pain, confusion, fruity-smelling breath with rapid breathing, or very high blood sugar or ketone readings, which can signal ketoacidosis.

What the research shows

In a 2008 randomized study by Forsythe and colleagues, overweight adults with unhealthy blood fats ate either a very low carbohydrate diet (about 12% of calories from carbs) or a low-fat diet for 12 weeks. Both diets lowered several inflammatory markers, but the low-carb diet lowered more of them, including TNF-alpha, IL-6 and IL-8. The abstract does not report the number of participants, and both groups lost weight, which also lowers inflammation.

Blood sugar swings may be part of the story. In a 2006 JAMA study by Monnier and colleagues, 21 adults with type 2 diabetes wore continuous glucose monitors and were compared with 21 matched controls. A urine marker of oxidative stress was higher in those with diabetes and tracked closely with the size of their daily glucose swings, more than with HbA1c. This was an observational comparison, so it shows a link rather than proof that smoothing glucose lowers inflammation.

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Questions to bring to your clinician

These questions can help you get the most out of your next visit.

Should we measure inflammation markers before and after I try keto?

Could keto help with inflammation in my case?

Which fats should I emphasize to keep keto anti-inflammatory?

Would an inflammation lab help us track my progress on keto?

Frequently asked questions

Does keto reduce inflammation?

Research suggests it may, mostly from lab and animal studies.

What is BHB?

The main ketone body, which also acts as a signaling molecule.

What are AGEs?

Compounds formed when sugar binds proteins or fats, linked to tissue damage.

Do omega-3s help inflammation?

They help the body resolve inflammation.

Sources

Forsythe CE, Phinney SD, Fernandez ML, et al. Comparison of low fat and low carbohydrate diets on circulating fatty acid composition and markers of inflammation. Lipids 2008. PMID: 18046594. https://pubmed.ncbi.nlm.nih.gov/18046594/
Monnier L, Mas E, Ginet C, et al. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA 2006. PMID: 16609090. https://pubmed.ncbi.nlm.nih.gov/16609090/
Youm YH, et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome-mediated inflammatory disease. Nat Med 2015. PMID: 25686106. https://pmc.ncbi.nlm.nih.gov/articles/PMC4352123/
Shimazu T, et al. Suppression of oxidative stress by β-hydroxybutyrate, an endogenous histone deacetylase inhibitor. Science 2013. PMID: 23223453. https://pmc.ncbi.nlm.nih.gov/articles/PMC3735349/
Calder PC. Omega-3 fatty acids and inflammatory processes: from molecules to man. Biochem Soc Trans 2017. PMID: 28900017. https://pubmed.ncbi.nlm.nih.gov/28900017/
Franceschi C, et al. Inflammaging: a new immune-metabolic viewpoint for age-related diseases. Nat Rev Endocrinol 2018. PMID: 30046148. https://pubmed.ncbi.nlm.nih.gov/30046148/
NIH ODS: Omega-3 Fatty Acids

This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.