One Month of Classic Therapeutic Ketogenic Diet Decreases Short Chain Fatty Acids Production in Epileptic Patients

Ketogenic diet (KD), a high fat and very low carbohydrates diet, is used worldwide for the treatment of drug resistant epilepsy but, due to its composition, it might exert an impact on gut health. Even though data of KD effects on intestinal microbiota changes are recently emerging, its influence on gut environment has been scarcely addressed so far. The aim of this study was to investigate whether one month of KD affects gut environment in epileptic patients, by analyzing short chain fatty acids (SCFA) production and fecal water toxicity. A total of 7 patients were enrolled. Stool samples were collected before (T0) and after one month of KD (4:1 ketogenic ratio) (T1). SCFA were determined by GC-FID and fecal water toxicity in Caco-2 cell culture by comet assay. Concentrations of SCFA significantly decreased after KD (p<0.05): in particular, we found a 55% reduction of total SCFA level, 64% reduction of acetate, 33% of propionate and 20% of butyrate (p<0.05). Cytotoxicity of fecal water extracted from stool samples was not significantly altered by diet, while genotoxicity resulted slightly decreased after KD (p