Let's not lump keto and IF together... IF from what I understand has more substantial as well as proven health benefits (related to stem cells, celluar autophagy, etc.). Whereas keto cannot make the same kind of claims; if you just keep your carbs relatively low you'll probably achieve a similar effect as keto.
Interestingly enough, in obese individuals, usually their adipose tissue cells are packed full of macrophage - it may be possible that keto and intermittent fasting put together are a good strategy for not only preventing the progression of obesity, but also promoting the autophagy of 'sick' fat cells [0]:
• Macrophages play a significant role in regulating adipose tissue functioning during health and disease
• In addition to conventional functions such as clearing cellular debris and participating in tissue immune surveillance, lipid buffering is an important function of ATMs
• Obesity-induced inflammation, characterised by an elevated number of proinflammatory macrophages in adipose tissue, has been suggested to contribute to systemic insulin resistance
> One might hypothesise that the role of macrophages shifts during the progression of obesity from a predominant role in stimulating adipogenesis at the start of adipose tissue expansion to inhibiting adipogenesis once obesity progresses. The observation that adipogenic clusters containing macrophages appear at an early stage of adipose tissue expansion during obesity, yet decline in number upon the progression of obesity, supports this hypothesis. Reduced adipogenesis at later stages of obesity would promote hypertrophy of adipocytes to allow for storage of the excess amounts of lipids entering the adipose tissue, which is in turn linked to metabolic dysfunction such as adipocyte insulin resistance. Indeed, increased adipocyte size has been found to correlate with macrophage presence in obese adipose tissue
It is the same mechanism of action -- the switch of the metabolism to using B-OHB (and other ketones) through the process of ketosis. People have been on a ketogenic diet for a long time to treat epilepsy, and it doesn't seem to have any major downfalls.
