Table 2.

Highlighted recent clinical studies investigating therapies targeting nutritional ketosis without comprehensive diet modification in adults

Disease	Reference	Study design	Pts (n)	KDT type	Duration (days)	Control treatment	Adherence measure (result)	Study results	Attrition (reason)
Alzheimer’s disease	Ota et al. [18]	RCT crossover	20	MCT-ketogenic formula AC-1202 (20 g MCT)	1	Isocaloric formula w/o MCT	Serum ketones (significant increase in MCT group compared to controls)	No difference in cognitive test scores between groups	0/20
	Ota et al. [18]	Obs	19	Daily MCT-ketogenic formula AC-1202 (20 g MCT)	84	N/A	Serum ketones (no change from baseline levels)	Significant improvement in logical memory test scores and digit-symbol coding from baseline	3/19 (diarrhea)
	Torosyan et al. [19]	RCT	18	Daily MCT caprylidene (40 g)	45	Placebo (two patients only)	No method reported (authors state pts adhered to daily supplementation)	Significant long-term elevation in regional cerebral blood flow in patients lacking an ε4 allele only (five patients)	4/14 (did not complete four PET scans)
Performance enhancement	Waldman et al. [20]	RCT crossover	15	Ingestion of βHB salts (11.38 g)	1	Placebo	Serum βHB levels (significant increase in βHB group – 0.53 vs. 0.21 mmol/l)	No difference in cognitive performance or high-intensity cycling	0/15
	Evans et al. [21]	RCT crossover	19	Ingestion of βHB salts (0.38 g/kg)	1	Placebo	Serum βHB levels (significant increase in βHB group – 0.28±0.13 mmol/l)	Elevated HR and RER during exercise; no effect on perceived exertion or muscular efficiency 13/19 (68%) experienced GI adverse effects	0/19
Obesity	Choi et al. [23]	RCT	46	Exclusive ketogenic drink use (either 4:1 or 1.7:1 ratio)	14	Balanced nutrition drink	Serum ketone level (significant increase in both ketogenic drink groups – 2.05±1.55 mmol/l for 4 : 1, 1.33±0.85 mmol/l for 1.7:1)	Decreased body weight in all groups; improved lipid profiles in 1.7: 1 group and reduced appetite in ketogenic drink groups	16/46 (poor compliance, accidental ingestion, and so on)
	Valente et al. [22]	RCT crossover	17	25 ml Virgin coconut oil (VCO)	1	25 ml extra-virgin olive oil	No method reported	No difference in energy metabolism or cardiometabolic risk markers; but less hunger suppression, satiety, and fullness with VCO	2/17 (personal reasons)

βHB, beta-hydroxybutyrate; g, grams; GI, gastrointestinal; HR, heart rate; KDT, ketogenic diet therapy; kg, kilogram of body mass; MAD, modified Atkins diet; Obs, observational study; Pts, participants; RCT, randomized controlled trial; RER, respiratory exchange quotient.