Ketogenic Diet for Obesity Hypoventilation Syndrome
- Conditions
- Obesity Hypoventilation SyndromeHypercapnic Respiratory FailureKetogenic Dieting
- Interventions
- Dietary Supplement: Ketogenic Diet
- Registration Number
- NCT04108819
- Lead Sponsor
- Johns Hopkins University
- Brief Summary
Obesity hypoventilation syndrome (OHS) is a condition that occurs in small percentage of obese people that causes high carbon dioxide and low oxygen levels in the blood. OHS is associated with respiratory failure, pulmonary hypertension, and death. The cause of OHS is unclear. Since not all obese people develop OHS, it is believed that hormone imbalances can contribute to the breathing problem.
Some diets can change the body's hormones. For example, low-carbohydrate, high fat "ketogenic" diets (KD) may decrease insulin and glucose levels and increase sensitivity to other hormones. The investigators hypothesize that a KD will improve breathing in OHS patients, even in the absence of weight loss.
- Detailed Description
Obesity hypoventilation syndrome (OHS) is a condition that occurs in small percentage of obese people, that leads to high carbon dioxide levels and low oxygen levels in the blood. OHS is associated with respiratory failure, pulmonary hypertension, hospital admissions, and death. Unfortunately, there is no treatment for OHS besides massive weight loss which often requires bariatric surgery.
In this study, the investigators are examining whether switching from a regular diet to a ketogenic diet will improve breathing, oxygen, and carbon dioxide levels in OHS patients. After a few days-weeks on KD, hormone changes are known to occur and the investigators are examining whether these hormonal changes could stimulate breathing.
This is a pilot study to examine the effects of a 12 day KD on OHS. The outcomes of the study include blood oxygen, carbon dioxide levels, plasma levels of hormones such as insulin, leptin, sleep studies, body composition a, weight, and metabolic rate.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 24
- Obesity (BMI≥30 kg/m2)
- Hypercapnia (PaCO2>45 or PvCO2>50) on blood gas, OR a sleep study with end-tidal/transcutaneous CO2 monitoring showing an awake CO2 level >50
- Participants without blood gas data may also have suspected OHS on the basis of serum bicarbonate >=28 mEq/L
- Lack of an alternative pulmonary diagnosis that adequately explains hypercapnia. Note that a documented pulmonary diagnosis (e.g. chronic obstructive pulmonary disease (COPD) or asthma) per se will not necessarily exclude subjects, since OHS is often misdiagnosed as obstructive lung disease. Functional or radiographic data must corroborate the presence of the alternate diagnosis.
- Subjects must have had a sleep study and clinical evaluation for sleep apnea. Most subjects with OHS are expected to have concomitant obstructive sleep apnea (OSA). This information is necessary to determine whether continuous positive airway pressure (CPAP)/noninvasive ventilation (NIV) will be used on the research sleep studies.
- Concomitant participation in another weight loss or diet program
- Patients with diabetes taking Sodium-glucose Cotransporter-2 (SGLT2) inhibitors (due to risk of diabetic ketoacidosis)
- Patients with type 1 diabetes
- Any patients with a history of diabetic ketoacidosis
- Patients with incomplete sleep apnea diagnosis or management (i.e. those still acclimating to CPAP, or pending therapeutic decisions about OSA management)
- Known or suspected abuse of narcotics or alcohol
- Liver cirrhosis
- Uncontrolled gout
- History of chronic renal insufficiency requiring dialysis
- Females who are pregnant, breast-feeding, or intending to become pregnant
- Food allergies or diet restrictions that research nutritionists cannot accommodate
FOLLOW THIS LINK TO SEE IF YOU QUALIFY:
https://mrprcbcw.hosts.jhmi.edu/redcap/surveys/?s=RYX7DELK9Y
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Ketogenic Diet Ketogenic Diet Participants will receive the ketogenic diet.
- Primary Outcome Measures
Name Time Method Change in Awake venous carbon dioxide (PvCO2) Level Baseline (pre keto diet) and 2 weeks post keto diet Measured in mmHg.
- Secondary Outcome Measures
Name Time Method Change in Glucose level Once per week, over 4 weeks Measured in g/dL.
Change in beta-Hydroxybutyrate level Once per week, over 4 weeks Measured in mg/dL.
Change in Blood Pressure Once per week, over 4 weeks Measured in mmHg.
Change in Venous pH Once per week, over 4 weeks Measured in moles per liter.
Change in Insulin level Once per week, over 4 weeks Measured in mIU/L.
Change in Body weight (kg) Once per week, over 4 weeks Change in LDL Cholesterol Once per week, over 4 weeks Measured in mg/dL.
Change in percentage of body fat Once every 2 weeks, over 4 weeks The investigators will measure percentage body fat using the Bioelectrical impedance analysis (BIA).
Change in Apnea Hypopnea Index Once every 2 weeks, over 4 weeks The apnea hypopnea index (AHI) is derived from combined information from EEG signals, flow sensors, respiratory belts, and carbon dioxide censors and is a measure of severity of sleep apnea. AHI \< 5 is considered normal. AHI 5-15 is considered mild sleep apnea. AHI 15-30 is considered moderate sleep apnea. AHI \>30 is considered severe sleep apnea.
Change in Triglyceride level Once per week, over 4 weeks Measured in mg/dL.
Change in leptin level Once per week, over 4 weeks Measured in ng/mL.
Glucose profile Continuously measured over 4 weeks Using continuous glucose monitoring (CGM), to measured glucose level (g/dL) each day at home.
Change in Oxygen saturation Once per week, over 4 weeks Measured as a percentage.
Change in HDL Cholesterol Once per week, over 4 weeks Measured in mg/dL.
Trial Locations
- Locations (1)
Johns Hopkins Bayview Medical Center
🇺🇸Baltimore, Maryland, United States