Nutritional Fundamentals for Health

 
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Ketogenic Diet – Appropriate Applications?

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With the publication of “the Atkins diet” in 1972, interest quickly grew in ketogenic diets as a strategy for achieving weight loss. I recall the diet becoming very popular in the late 1990’s. I personally do not support the use of a ketogenic diet among otherwise healthy people hoping to achieve weight loss. Many other methods with superior ability to maintain compliance, and reduced likelihood of adverse complications exist. However, our clinic has identified four specific clinical settings where we sternly recommend patients to follow a ketogenic diet:
  • Type I diabetes 
  • Type II diabetes behaving like type I diabetes (also called type 1.5 diabetes, seen in type II diabetic patients following all proven treatments, yet their glucose control continues to worsen) 
  • Epilepsy 
  • Recovery from traumatic head injury (concussion): unlike the three situations above, in this setting the diet is not life- long, yet followed as soon as possible after the injury, through two to three weeks following full symptom recovery
We have witnessed tremendously positive impact from the intervention for the first three situations listed above. Given the nature of traumatic head injury, it is impossible to establish how much impact the diet has versus other strategies, yet we remain confident the strategy is appropriate in the setting.

Interest is surfacing in applying ketogenic diets in two other important areas; advanced cancer and neurodegenerative disease (dementia and Alzheimer’s receiving the most attention). We are following developments in these areas with interest.

As a reminder, a ketogenic diet requires the individual to consume 25g of carbohydrate per day, or less. This is a very restrictive diet. It is devoid of bread, pasta, rice, potato, yet also devoid of fruit, nuts, squashes, legumes. The diet is thus based on vegetables, meat, and fats (oils). Very, very limited amounts of fruit, or nuts, or legumes can be included on a daily basis, assuming total carbohydrate content is kept below 25g per day. To apply perspective, an apple has approximately 15-20g of carbohydrate. Assuming 10-15g of carbohydrate per day from vegetables, the carbohydrate allowance to apply to fruit, nuts, or legumes is very minimal.

A recent study recruited 349 people with type II diabetes, assigning 262 to a ketogenic diet and 87 assigned to usual care (UC). The study is intended to last several years, and below are the interim one- year outcomes among those assigned to a ketogenic diet:
  • 83% of participants assigned to a ketogenic diet achieved continuing compliance. 
  • A1C decrease 7.6 to 6.3. Weight decreased 13.6kg. 
  • Almost 50% reduction in oral DMII medication, excluding metformin. 
  • Sulfonylureas entirely eliminated. 
  • Insulin reduced or eliminated in 94% of participants 
  • hs-CRP – 39%, TG – 24%, HDL +18%, LDL +10%

References: 
Hallberg SJ, et al. Diabetes Ther. 2018;9(2):583-612.