The Ketogenic Diet and the Gut Microbiome

Over the past decade, a growing body of evidence has validated the essential role of the gut microbiome in regulating diverse physiologic processes, spanning gut-related disease to neural function. While many factors are involved, diet is the primary driver of global microbial composition and function. Studies from animal models and humans suggest that the ketogenic diet can reshape the gut microbiome. However, the relevance of the altered microbiota is still under investigation. Since the gut microbiome is implicated in modulating brain function via metabolic, immunologic, and endocrine pathways, a possible role of the microbiota–gut–brain axis in mediating the neural response to the ketogenic diet has been proposed. This chapter outlines how the ketogenic diet affects the gut microbiota and the implications of such ketogenic diet-induced phenotypes. Special attention is paid to interactions between the diet, gut microbiota, and neurodevelopmental disorders, including epilepsy and autism spectrum disorder.