I have always read it as systemic. Which is why low carb diets seem to do wonders for a lot of people's cardiovascular systems, somewhat paradoxically. If you go really low carb (<20g / day), the first week or two you can lose a ton of weight, but much of it is water, which detractors point to as "well, you're not losing fat!" But, imagine what this does for inflammation. That is 7 pounds of fluid you are no longer carrying and pumping against. It's basically a gallon. The first round of keto I did, I lost a ton of weight the first month (~20 lbs), and my blood pressure plummeted to the point where I was dizzy all the time, and I had to supplement with salt and magnesium. I remember a study I read probably 15 years ago where they looked at cross-sections of arteries before and after starting a ketogenic diet, and there was significant reduction in inflammation after just a few weeks, IIRC. I just tried finding it on pubmed, but can't find the right incantation of search terms to dredge it up. There are countless studies like this.
I've been mostly on a keto diet since 2014, and it is probably the most important health choice I've ever made. At the time I worked in Neurology at a Children's hospital, and a keto diet is one of the treatment options for epilepsy. I talked with the clinical dietician at the time, and asked if these kids were having heart attacks in their 20s. On the contrary, much of the department was on the diet, or a low glycemic diet, as was much of the oncology dept. Obviously, this is an N of 1, and I'm not an MD, but every single aspect of my physiological and mental health has improved over the last 10+ years.
"But, imagine what this does for inflammation. That is 7 pounds of fluid you are no longer carrying and pumping against. It's basically a gallon. The first round of keto I did, I lost a ton of weight the first month (~20 lbs), and my blood pressure plummeted to the point where I was dizzy all the time, and I had to supplement with salt and magnesium."
Are you saying losing the waterweight decreased your blood pressure?
AFAIK the water lost was bound to the carbohydrates being stored. It's not in liquid form.
“Dietary Intervention to Reverse Carotid Atherosclerosis” (Circulation, 2010) — participants were randomized to low-fat, Mediterranean, or low-carbohydrate diets; carotid arteries were imaged with 3-D ultrasound cross-sections at baseline and follow-up. After 2 years there was a ~5% regression in carotid vessel-wall volume, with similar regression across all diets (i.e., including the low-carb arm). [1]
Volek et al., 2009 (Metabolism) — 12-week very-low-carb vs low-fat trial; ultrasound of the brachial artery showed improved post-prandial flow-mediated dilation (a marker of endothelial function/inflammation) in the low-carb group. Not carotid 3-D slices, but still vascular imaging with before/after comparisons. [2]
What exactly does your diet consist in? What other adjustments have you made, e.g. in sleep or exercise?
From what I've read[1] the risk with a long-term keto diet is an increase in cholesterol (LDL and total), which can be attributed to lower micronutrient and fiber intake, replaced by more animal-derived foods.
Reducing inflammation is interesting, I'll have to look into it.
I've been mostly on a keto diet since 2014, and it is probably the most important health choice I've ever made. At the time I worked in Neurology at a Children's hospital, and a keto diet is one of the treatment options for epilepsy. I talked with the clinical dietician at the time, and asked if these kids were having heart attacks in their 20s. On the contrary, much of the department was on the diet, or a low glycemic diet, as was much of the oncology dept. Obviously, this is an N of 1, and I'm not an MD, but every single aspect of my physiological and mental health has improved over the last 10+ years.