From the Ketogenic Diet to the Mediterranean Diet: The Potential Dietary Therapy in Patients with Obesity after CoVID-19 Infection (Post CoVID Syndrome)

Abstract

Purpose of review: This review primarily examines the evidence for areas of consensus and on-going uncertainty or controversy about diet and physical exercise approaches for in the post-CoVID. We propose an ideal dietary and physical activity approach that the patient with obesity should follow after CoVID-19 infection in order to reduce the clinical conditions associated with post-CoVID syndrome.

Recent findings: The CoVID-19 disease pandemic, caused by the severe acute respiratory syndrome coronavirus-2, has spread all over the globe, infecting hundreds of millions of individuals and causing millions of death. It is also known to be is associated with several medical and psychological complications, especially in patients with obesity and weight-related disorders who in general pose a significant global public health problem, and in specific affected individuals are on a greater risk of developing poorer CoVID-19 clinical outcomes and experience a higher rate of mortality. Little is still known about the best nutritional approach to be adopted in this disease especially in the patients post-CoVID syndrome. To the best of our knowledge, no specific nutritional recommendations exist to manage in the patients post-CoVID syndrome. We report a presentation of nutritional therapeutic approach based on a ketogenic diet protocol followed by a transition to the Mediterranean diet in patients post-infection by CoVID, combined to a physical activity program to address conditions associated with post-CoVID syndrome.

Keywords: Gut; Ketogenic diet; Long-CoVID; Mediterranean diet; Muscle mass; Nutritionist; Obesity; Post-CoVID syndrome; VLCKD.

Fig. 1

Molecular mechanism of muscle damage in CoVID-19. The drawing schematically illustrates how, in CoVID-19, muscle damage is produced by different but converging factors, which include malnutrition, cytokine receptor activation, and the activation of glucocorticoid receptors either by exogenous glucocorticoid drugs, given to treat this disease, or by endogenous glucocorticoid hormones, released in response to stress. The figure was prepared using the clip arts freely available under a Creative Commons Attribution 3.0 Unported License at the Servier Medical Art (SMART) website (https://smart.servier.com/). IGF, insulin-like growth factor; GC, glucocorticoids; IRS, insulin receptor substrate; PI3K, phosphoinositide 3-kinase; TSC, tuberous sclerosis complex; mTORC, mechanistic Target of Rapamycim complex; AMPK, 5′-adenosine monophosphate-activated protein kinase; REDD1, regulated in development and DNA damage responses 1; KLF, Krüppel-like factor; FoxO, forkhead box O; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2; TLRs, Toll-like receptors; IL, interleukin; TNF-α, tumor necrosis factor alpha

Fig. 2

Contrast effect of the ketogenic diet against SARS-CoV-2 infection. KD leads to a strong reduction in the development of M1 and a concomitant trigger for the development of M2. Moreover, β-OHB inhibits NLRP3/inflammasome activation and exerts anti-catabolic effects on human skeletal muscle. KDs, ketogenic diets; β-OHB, beta-hydroxybutyrate; SARS-CoV-2, severe acute respiratory syndrome coronavirus-2

Fig. 3

Potential mechanisms through which the Mediterranean diet contrast SARS-CoV-2 infection

Fig. 4

Overview of VLCKD’s three main phases and their sub-phases

Fig. 5

A proposal of a starting physical treatment protocol for post-CoVID rehabilitation after 3 weeks from symptoms for adults (18–64 years) and older adults (+ 65 years)