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Ketogenic Diets: Pros and Cons

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Brief History of Ketogenic Diets

The ketogenic diet (KD) is a restrictive diet originally developed for the treatment of epilepsy in children. Hugh Conklin, a physician from Michigan, first started developing a diet similar to KD when attempting to understand the effects of starvation on the brain. He found that when epileptic children were deprived of calories, their seizure frequency and severity greatly diminished.[1] The Mayo Clinic then found, in 1921, that high fat diets can mimic the neuroprotective effects of starvation.[2]

The ketogenic diet plan was developed and implemented into practice in 1924 by Dr. Russell Wilder at the Mayo Clinic.[3] After the development of anticonvulsant drugs, the ketogenic diet gathered less attention, as it was initially targeted almost exclusively toward epileptic patients. Then, in 1993, Hollywood producer Jim Abrahams took his son Charlie to John’s Hopkins for dietary treatment of his severe epilepsy. Charlie’s seizures stopped after implementing the ketogenic diet, and Charlie has been in complete remission since his treatment at John’s Hopkins.[4] Thus, the Charlie Foundation for Ketogenic was founded in 1994 to provide information and resources for people looking for novel health solutions.[5]

KD requires more research and long-term studies to be fully understood, but it may be effective in alleviating symptoms of or even inducing remission of psychiatric disorders, epilepsy, Parkinson’s disease, tumor growth, Alzheimer’s disease, Polycystic Ovary Syndrome (PCOS), and type II diabetes.[6]

Ketogenic Diets & Grains

Ketogenic diets and variations of KD can require up to 90% of calorie intake to come from fats.[7] This dietary ratio is often a major transition for those looking to start KD, as carbohydrates and cereal grains are a staple in most cultures and regions. The traditional food pyramid emphasizes that carbohydrates and cereal grains should make up most of the calories in one’s daily food intake.[8] However, recent health movements have veered away from carbohydrates as the main calorie source.

A diet consisting mostly of grains and sugars is associated with high risks of diabetes, obesity, insulin resistance, and chronic inflammation, among other pathologies. While glucose (the most basic form of sugar) is typically the main energy source for organs, excess glucose can be stored as fat and initiate inflammatory pathways.[9] Ketones are a breakdown of fats and amino acids that can easily travel through the blood and be used for fuel.[10] When glucose is absent as an energy source, the body appears to prefer ketones for metabolic processes.[11] If the body runs out of readily accessible energy sources such as glucose or ketones, muscles may start to break down to provide protein as an energy source.[12]

The metabolic state induced by KD, called ketosis, aims to mediate the toxic and inflammatory effects of glucose metabolism while preventing muscle degeneration. It is important to distinguish ketosis from ketoacidosis (DKA), a very dangerous metabolic condition. Insulin plays an important role in regulating glucose and ketone metabolism. When insulin is absent or dysregulated, such as in insulin resistance and diabetes, the body may switch to ketones for energy. In the absence of an insulin feedback loop, the buildup of ketones can acidify the bloodstream, leading to DKA.[13] In healthy individuals without blood glucose regulatory mechanism dysfunction, insulin keeps ketone levels in a normal and safe range.

Ketogenic Diets & Ketosis

The ketogenic diet is often advocated due to its potential benefits to brain and neuron health. The main ketone bodies used as cellular energy include beta-hydroxybutyrate, acetoacetate, and acetone. These molecules easily cross the blood-brain barrier, where they can be used for energy.[14] The brain, while only compromising 2% of the body’s mass, uses 20% of ingested fuel.[15]

Ketone bodies bypass glycolysis, a major step in glucose metabolism. By bypassing this important step, ketones are thought to help regulate glucose metabolism and prevent oxidative stress.[16] Once the body is in ketosis, mitochondrial biogenesis increases, excitotoxicity from glutamate decreases, and GABA levels increase.[17] Additionally, while glucose can induce inflammation, fatty acids can activate anti-inflammatory pathways.[18] Ketone bodies themselves are even thought to protect neurons from damage and degeneration.[19]

The Ketogenic Diet

Implementing the ketogenic diet has proven to be very difficult for many patients. It is recommended that ketogenic diets should only be attempted under close supervision by nutritionists or dieticians.[20] People with any type of fatty acid disorder or carnitine deficiency should not attempt KD.[21] More research needs to be conducted on ketogenic diets for those with diabetes and insulin resistance, as there are conflicting opinions as to its safety for these patients.[22] Some people suffering from epilepsy or Parkinson’s disease have found the diet to be so effective that they are able to cease taking medications for the treatment of these disorders.

It is important to keep in mind that deviating from the diet, even for one meal, can take the body out of ketosis.[23] A modified version of KD, perhaps with a fat-to-carbohydrate/protein ratio of 3:1, may be beneficial for those who are not suffering from epilepsy or a neurodegenerative disorder.[24] Due to the restrictive nature of KD, calcium, vitamin D, iron, and folic acid supplements are often necessary.

Many people who take on the ketogenic diet report higher energy levels, improved cognitive function, and heightened overall wellbeing. Eating while on the ketogenic diet can still be a fun and flavorful experience, as well. Check out https://ketocook.com/ for ketogenic recipes, and look out for Sanesco’s next blog on the ketogenic diet for specifics on who can benefit from ketosis.

Learn more bout the neuroprotective effects of the KD.

[1] Freeman, J. M., Kossoff, E. H., & Hartman, A. L. (2007). The ketogenic diet: one decade later. Pediatrics, 119(3), 535-543.

[2] Freeman, Ibid.

[3] The Charlie Foundation for Ketogenic Therapies. (n.d.). Retrieved September 01, 2017, from https://www.charliefoundation.org/

[4] The Charlie Foundation for Ketogenic Therapies, Ibid.

[5] Freeman, op. cit.

[6] Freeman, op. cit.

[7] Gasior, M., Rogawski, M. A., & Hartman, A. L. (2006). Neuroprotective and disease-modifying effects of the ketogenic diet. Behavioural pharmacology, 17(5-6), 431.

[8] Korczak, R., Jones, J. M., Peña, R. J., & Braun, H. J. (2016). CIMMYT Series on Carbohydrates, Wheat, Grains, and Health: Carbohydrates and Their Grain Sources: A Review on Their Relationships to Brain Health 1, 2. Cereal Foods World, 61(4), 143-156.

[9] Korczak, op. cit.

[10] Vieira, G. (2017, July 15). Why DKA & Nutritional Ketosis Are Not The Same. Retrieved September 07, 2017, from https://www.diabetesdaily.com/blog/2014/11/dka-nutritional-ketosis-are-not-the-same/

[11] Gasior, op. cit.

[12] LaManna, J. C., Salem, N., Puchowicz, M., Erokwu, B., Koppaka, S., Flask, C., & Lee, Z. (2009). Ketones suppress brain glucose consumption. In Oxygen Transport to Tissue XXX (pp. 301-306). Springer, Boston, MA.

[13] Vieira, op. cit.

[14] Gasior, op. cit.

[15] Korczak, op. cit.

[16] LaManna, op. cit.

[17] Gasior, op. cit.

[18] Gasior, Ibid.

[19] LaManna, op. cit.

[20] Ketogenic Diet. (n.d.). Retrieved September 01, 2017, from http://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet

[21] The Charlie Foundation for Ketogenic Therapies, op. cit.

[22] Vieira, op. cit.

[23] Ketogenic Diet, op. cit.

[24] Hartman, A. L., & Vining, E. P. (2007). Clinical aspects of the ketogenic diet. Epilepsia, 48(1), 31-42.

Clinical Contributor

Sophie Thompson

Clinical Support Specialist at Sanesco International, Inc.

Sophie recently obtained her degree in Biology from UNCA in Asheville. Born and raised in Asheville, her hobbies include painting, writing and spending quality time with her dog and her family.

 

Ramona Richard, MS, NC

Ramona Richard, MS, NC

Ramona Richard graduated with honors from the University of California with a Bachelor’s Degree in psychology and graduated summa cum laude with a Master’s Degree in Health and Nutrition Education. She also holds a Standard Designated Teaching Credential from the State of California, is a California state-certified Nutrition Consultant and a member of the National Association of Nutrition Professionals.

Ramona has participated in nutrition education in both public and private venues, including high school and college presentations, radio and public speaking for the past 20 years. She is the owner of Radiance, a nutrition consulting company, the Director of Education for Sanesco International, and a medical technical writer.

Disclaimer: The information provided is only intended to be general educational information to the public. It does not constitute medical advice. If you have specific questions about any medical matter or if you are suffering from any medical condition, you should consult your doctor or other professional healthcare provider.

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