View source for Ketogenic Mechanism of Action

While the obvious, measurable change from the [[Ketogenic Diet]] is the increase in [[Measuring Ketones| Ketone Levels]], there are many different changes that occur and the [[Ketogenic Diet as a Treatment| benefits of the Ketogenic Diet]] could be dependent on any of these changes. 
* '''Increased Ketone Levels'''. The increase in Ketones is likely to be responsible for a number of the benefits. 
** '''AcAc'''. This is a fuel for the brain, and it's preferentially used over glucose. It also tends to acidify the blood. 
** '''BOHB'''. Unclear if there are direct benefits from BOHB. (BOHB could be thought of as a way of temporarily storing AcAc without acidifying the blood. AcAc is converted to BOHB, then back to AcAc for use.)
** '''Acetone'''. Originally thought to be an inactive waste product, this has shown to be biologically active in a number of ways. Some suggest that this might be the mechanism for action for Epilepsy treatment<ref name="Kalapos-2007"/>, but the rapidness of "breakthrough seizures" after breaking the ketogenic diet tends to undermine that argument as acetone levels will decay more slowly than other ketones<ref name="Yellen-2008"/>. 
* '''Reduced Blood Glucose'''. The Ketogenic Diet tends to reduce and stabilize blood glucose levels, and this is likely to be responsible for some of the benefits. 
** Cancer cells require glucose and can't use [[Ketones]]. 
** There is a strong (90%) correlation between reduced blood glucose and seizure reduction for Epilepsy.
* '''Reduced Insulin Levels'''. The lower carbohydrate availability reduces insulin levels and prevents insulin spikes. This may have a number of health impacts, including a reduction in the risk for diabetes and metabolic syndrome. 
* '''Food Avoidance'''. Some of the benefits of the Ketogenic Diet may come from the removal of specific foods that cause problems. 
** '''Gluten'''. There are a number of health problems linked to gluten, which is a protein found in many grains. There is wheat allergy, [http://en.wikipedia.org/wiki/Coeliac_disease celiac disease] and [http://en.wikipedia.org/wiki/Irritable_bowel_syndrome irritable bowel syndrome] (IBS), but there are also a number of other subclinical issues linked to gluten including neuropathies. This might be the mechanism behind the treatment of Schizophrenia with the ketogenic diet. 
** '''Fructose'''. Because [[Fructose]] has some potential health impacts, its removal from the diet may have some health benefits. 
* '''Modified Fiber Intake'''. Typically the [[Ketogenic Diet]] results in reduced [[Fiber]] intake, which tends to lead to constipation, a common [[Health Risks of the Ketogenic Diet| Health Risk of the Ketogenic Diet]]. It's unlikely, but possible, but this reduction in fiber might help some health condition. On the other hand, the constipation suffered with the [[Ketogenic Diet]] may require much higher levels of fiber than the comparable Standard American Diet, which may have some health benefits.
* '''Changes to digestive flora'''. The Ketogenic Diet produces changes in the intestinal bacteria, and reduces the availability of Short Chain Fatty acids, especially butyrate<ref name="Duncan-2007"/>. (This is more likely to have negative than positive effects, and contribute to the constipation problems that are common on the Ketogenic Diet.)
* '''Blood pH Levels'''. The Ketogenic Diet tends to acidify the blood slightly, and this may have some health impacts. 
* '''Increased Fat Intake'''. The Ketogenic Diet obviously involves a dramatic increase in the dietary fat intake, which may have some direct benefits, especially around ensuring an adequate supply of [[Omega 3| essential fats]]. 
* '''Thyroid Changes'''. Studies have shown a reduction in thyroid hormone production, particularly T3. This may contribute to the conservation of Glycogen during exercise. 
* '''Supplementation'''. The Ketogenic Diet requires nutrient supplements, and there maybe health benefits if an underlying deficiency has been overcome. (Note that it is not clear if the [[Ketogenic Diet]] changes the Recommended Daily Allowance of nutrients.)
* '''Nutrient Deficiency'''. While nutrient deficiency is typically a [[Health Risks of the Ketogenic Diet| Health Risk of the Ketogenic Diet]], it is possible that a deficiency could improve a health condition if patients have been getting an excess of a particular nutrient.
{{KetoSeeAlso}}
=References=
<references>
<ref name="Kalapos-2007"> MP. Kalapos, Possible mechanism for the effect of ketogenic diet in cases of uncontrolled seizures. The reconsideration of acetone theory., Med Hypotheses, volume 68, issue 6, pages 1382-8,  2007, doi [http://dx.doi.org/10.1016/j.mehy.2006.10.041 10.1016/j.mehy.2006.10.041], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17166670 17166670]</ref>
<ref name="Yellen-2008"> G. Yellen, Ketone bodies, glycolysis, and KATP channels in the mechanism of the ketogenic diet., Epilepsia, volume 49 Suppl 8, pages 80-2, Nov 2008, doi [http://dx.doi.org/10.1111/j.1528-1167.2008.01843.x 10.1111/j.1528-1167.2008.01843.x], PMID [http://www.ncbi.nlm.nih.gov/pubmed/19049596 19049596]</ref>
<ref name="Duncan-2007">SH. Duncan, A. Belenguer, G. Holtrop, AM. Johnstone, HJ. Flint, GE. Lobley, Reduced dietary intake of carbohydrates by obese subjects results in decreased concentrations of butyrate and butyrate-producing bacteria in feces., Appl Environ Microbiol, volume 73, issue 4, pages 1073-8, Feb 2007, doi [http://dx.doi.org/10.1128/AEM.02340-06 10.1128/AEM.02340-06], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17189447 17189447]</ref>
</references>