Ketogenic Diet as a Treatment

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The Ketogenic Diet may have benefits for a number of medical conditions, many of them serious or life threatening. The research for the use of the Ketogenic Diet in epilepsy is well established, but for other illnesses it is still emerging. However, the Ketogenic Diet is believed to have a number of benefits, especially in cancer[1] and neurological diseases like Alzheimer's and Parkinson's[2]. There are indications that the Ketogenic Diet might also help with Heart Disease, ALS, Autism, Hyperactivity, Schizophrenia, Depression and Bipolar disorder. However, these benefits must be balanced against the Health Risks of the Ketogenic Diet.

1 Epilepsy

Main article: Ketogenic Diets for Epilepsy

The use of the Ketogenic Diets for Epilepsy is well established. Generally, around of 50% of patients have a 50% reduction in seizures, 25% have 90% reduction in seizures, and around 10% become seizure free.

2 Cancer

Main article: Ketogenic Diets for Cancer

The Ketogenic Diet may help with the treatment of cancer, including brain tumors[1]. Currently most of the available research is based on animal studies, with just a few human case studies. However, the research to date looks promising.

3 Hypoxia, including Stroke

There are a number of medical conditions that reduce the supply of oxygen (hypoxia), and the Ketogenic Diet may reduce the damage that occurs as a result.

  • Head trauma. Head trauma often results in a rapid increase in cerebral glucose metabolism, followed by a prolonged decrease. Administering glucose to patients tends to result in hyperglycemia (high blood sugar) that worsens the outcome. In animal studies, fasting or a ketogenic diet improves tissue preservation, but further research is needed[3].
  • Stroke. Because a stroke involves the reduction of blood flow to areas of the brain, the Ketogenic diet may help reduce the resulting damage[4]. Animal studies have looked at the ketogenic diet, ketone administration, and calorie restriction, which all raise ketone levels, and all have shown to be beneficial in animal stroke models[4].
The analysis of 19 animal (rodent) studies on the changes in outcome following cerebral ischemia with the ketogenic state. Pathological outcomes included lesion volume, brain water content, and neuronal counts, whereas functional outcomes included all measures of behavior.
  • Altitude Sickness. It is possible that the ketogenic diet may help with altitude sickness (Acute Mountain Sickness), but I've found not studies to support this.

4 Heart disease

There are some concerns that the ketogenic diet raises blood lipids, and this in turn may increase the risk for heart disease. One study of children using the Ketogenic Diet for Epilepsy showed a deterioration of blood lipid profiles, and only one in six were in the commonly accepted levels for a pediatric population[5]. Another study of adults on the Ketogenic Diet for Epilepsy also showed a worsening of blood lipids[6]. It's also been reported that around 30% of children on the ketogenic diet have elevated cholesterol, but it's also noted that this is normally transient, and the levels return to baseline after 6-12 months[7]. However, other studies have shown that the ketogenic diet has no adverse effects on the lipid profiles[8][9][10] or actually improves the markers[11][12][13][14][15]. (A study of children on the MCT Diet did not indicate any adverse blood lipid changes[16].) It seems possible that the structure of the Ketogenic Diet when it's used for epilepsy is in some way different, causing this split in results.

5 Alzheimer's disease (AD)

AD is a degenerative neurological condition characterized by memory loss and there is currently no treatment. Models of Alzheimer's disease (and Parkinson's) suggest that 4 mmol/L of BOHB can protect neurons and may play a therapeutic role[17].There is some evidence that a ketogenic diet may not only improve the symptoms of AD[18], but may also modify the disease activity itself. These benefits may also apply to other neurological conditions involving neuron death. There is evidence that raising Ketone levels through MCT supplementation without carbohydrate restriction may also improve memory function in AD sufferers[19]. In a study of 152 subjects with mild to moderate AD, half were given an MCT based treatment over a period of 90 days and had significantly improved cognitive scores compared with the placebo control group[20]. A drug called Axona was introduced in 2009 as an FDA approved "medical food" and it consists of an MCT oil (caprylic acid). There is also some evidence that a higher carbohydrate intake is associated with poorer memory, and increased aberrant motor behavior in subjects with probable AD[21].

6 Parkinson's disease

Parkinson's disease appears to generally result from an acquired defect in the mitochondria rather than genetic causes[22]. Animal studies and anecdotal reports suggest that the ketogenic diet may reverse the symptoms of Parkinson's disease, but there are no published human studies. It is possible to treat Parkinson's disease for a time with dopamine , but free radical damage lessens the effectiveness of this therapy over time[23]. Models of Parkinson's disease (and Alzheimer's) suggest that 4 mmol/L of BOHB can protect neurons and may play a therapeutic role[17]. A 28 day study of five Parkinson's patients on the Ketogenic Diet with blood BOHB levels averaging 6.6 mmol/L (range 4.8 to 8.9) had an average decrease in Unified Parkinson's Disease Rating Scale (UPDRS) scores of 43.4% (range 21% to 81%), but the study had too few subjects and no controls, so conclusions could be drawn about effectiveness[23].

7 Amyotropic Lateral Sclerosis (ALS)

Like Parkinson's disease, the evidence to support the use of the Ketogenic Diet for ALS is extremely limited[24], but human studies are under way. One study showed that the Ketogenic Diet alters the progression of ALS in a mouse model, but it did not extend the survival time[25]. However, other studies of high fat (non-ketogenic) diets in animal models did show an improved survival time[26][27].

8 Type 1 diabetes

At one time, type 1 diabetes (previously called childhood diabetes) was expected to be fatal within a year. The first approach was a starvation diet of 450 calories per day, which lead Fredrick M Allen to use a 70% fat, 8% carbohydrate diet that was the standard treatment before the discovery of insulin.

9 Autism

There are early reports from a Greek study in Crete indicating that the ketogenic diet may produce some improvement in some children. There are also anecdotal reports of epileptic children treated with the ketogenic diet also having improvements in their autism.

10 Migraine

While a 1930's textbook talks of the possibility of the ketogenic diet helping with migraines, a study of 8 teenagers with severe migraines at John Hopkins showed the ketogenic diet was ineffective.

11 Severe hyperactivity

There are initial reports that the ketogenic diet improves hyperactivity in animal reports, and some anecdotal reports of the benefit in humans. As with Autism, there are also reports of epileptic children treated with the ketogenic diet also having improvements in their hyperactivity.

12 Schizophrenia

There is a case report of a radical improvement in schizophrenia with the ketogenic diet[28]. However, this may be due to a removal of the gluten from the diet rather than the overall dietary changes[29].

13 Depression and bipolar disorder

There are a number of cases that have been reported where the ketogenic diet helps normalize the Mood State of those with bipolar disorder[30]. One report indicated that over 2-3 years the mood stabilization exceeded that achieved with medication[31].

14 Obesity

A recent analysis of 13 trials comparing the Ketogenic Diet (KD) with a Low Fat Diet (LFD) showed that the KD resulted in greater weight loss (an extra 0.9Kg/2 pounds), reduced triglycerides and blood pressure, but increased cholesterol[32]. However, while the extra weight loss was statistically significant, the loss of an additional 0.9Kg/2 pounds has limited real world value when the Health Risks of the Ketogenic Diet are considered[32].

15 See Also

16 References

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