In a rat model of diet‑induced obesity, switching from a high‑fat diet to a low‑carbohydrate ketogenic diet reduced metabolic derangements, neuroinflammation and oxidative stress, and improved memory performance more than a low‑carbohydrate non‑ketogenic diet.
Study and findings
Male Sprague‑Dawley rats were fed a standard chow for 16 weeks (control) or a high‑fat diet (HFD) for 8 weeks followed by one of four 8‑week interventions: continuation of HFD, normal chow, a high‑carbohydrate diet (HCD), a low‑carbohydrate diet (LCD) or a low‑carbohydrate ketogenic diet (LCKD). The HFD and HFD + HCD groups displayed higher final body weight, insulin resistance (HOMA‑IR), fasting glucose, insulin, free fatty acids, triglycerides and total cholesterol. In the hippocampus, these groups showed elevated mRNA and nuclear levels of pro‑inflammatory mediators (TNF‑α, IL‑6, NF‑κB), oxidative marker malondialdehyde, and acetylcholinesterase, together with reduced acetylcholine, glutathione, superoxide dismutase and Nrf2 (nuclear factor erythroid 2‑related factor 2) expression. Histology revealed severe dentate gyrus degeneration, especially after HCD. Both LCD and LCKD mitigated the metabolic, inflammatory, oxidative and structural abnormalities and improved performance on a memory test. Notably, only the LCKD increased hippocampal Nrf2 mRNA and nuclear translocation, indicating activation of an antioxidant‑anti‑inflammatory pathway.
Clinical interpretation
The data suggest that, in the context of diet‑induced obesity, a low‑carbohydrate ketogenic regimen can reverse several hallmarks of hippocampal injury that are linked to cognitive decline. The observed normalization of insulin resistance and lipid profiles aligns with the metabolic improvements required for neuronal health. Activation of Nrf2 by the ketogenic diet provides a mechanistic clue: enhancing endogenous antioxidant defenses may underlie the superior protection of dentate gyrus architecture and memory function compared with a non‑ketogenic low‑carbohydrate diet. While the study is pre‑clinical, the findings support the hypothesis that ketogenic modulation of inflammation and oxidative stress could be a therapeutic avenue for obesity‑related cognitive impairment.
Limitations and open questions
The experiment was limited to male rats and a single obesity model; sex differences and other models of metabolic dysfunction remain untested. The dietary interventions were relatively short (8 weeks) and did not assess long‑term sustainability or potential adverse effects of sustained ketosis. Because the study measured mRNA and protein markers at a single time point, the temporal sequence of metabolic versus neuroprotective changes cannot be resolved. Translating these results to humans will require clinical trials that examine whether ketogenic low‑carbohydrate diets can similarly activate hippocampal Nrf2 pathways and improve cognition in obese individuals.
Source
Jawharji MT, Alshammari GM, Binobead MA, Saleh A, Al-Harbi LN, Yahya MA. Ketogenic diet reverses obesity-associated hippocampal dysfunction and cognitive impairment in rats: a dietary comparison study. Nutr Neurosci. 2026:1-19. doi: 10.1080/1028415x.2026.2734187. PMID: 42775478.