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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.{{Skeleton}}* '''Epilepsy'''. The use of the [[Ketogenic Diets for Epilepsy]] is well established. * '''Cancer'''. The Ketogenic Diet may help with the treatment of cancer. The current evidence suggests to me that the Ketogenic Diet is unlikely to be an alternative to conventional treatments, but rather a supplement. The evidence so far is limitedHowever, but animal studies as well as the case of two children with inoperable brain tumors that regressed under the ketogenic diet are promising (Nebeling, seyfried, zuccoli).** Most cancers, including brain tumors depend on glucose and they cannot metabolize ketones. ** Cancers promote the growth of new blood vessels, something the ketogenic diet inhibits, as Ketones are [http://en.wikipedia.org/wiki/Angiogenesis_inhibitor anti-angiogenic]. ** Cancer cells often don't undergo natural cell death, something the ketogenic diet also enhances. * '''Hypoxia. '''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 but 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.** '''Stroke'''. Because a stroke involves the reduction of blood flow believed to areas of the brain, the Ketogenic diet may help reduce the resulting damage. ([http://www.ncbi.nlm.nih.gov/pubmed/23050642 http://www.ncbi.nlm.nih.gov/pubmed/23050642]) ** '''Altitude Sickness'''. It is possible that the ketogenic diet may help with altitude sickness (Acute Mountain Sickness), but more research is needed. (Personally, I've found I can tolerate my lower oxygen levels during [[Altitude Training]] while on the ketogenic diet.)* '''Heart disease'''. The effect of the ketogenic diet on heart disease risk is unclear. There are some concerns that the ketogenic diet raises blood lipids, and this in turn may increase the risk for heart disease. However, some studies have shown that the ketogenic diet improves markers associated with the risk of heart disease ([http://jn.nutrition.org/content/132/7/1879.short http://jn.nutrition.org/content/132/7/1879.short]). * '''Alzheimer's disease (AD)'''. AD is a degenerative neurological condition characterized by memory loss and there is currently no treatment. There is some evidence that a ketogenic diet may not only improve the symptoms number of ADbenefits, but may modify the disease activity itself. The benefits of the ketogenic diet may also have benefits for other neurological conditions involving neuron death. A drug called Axona was introduced especially in 2009 as an FDA approved cancer<ref name="medical foodSeyfried-2011" /> and it consists of a MCT oil (caprylic acid).* '''Parkinsonneurological diseases like Alzheimer's disease'''. 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. * '''Amyotropic Lateral Sclerosis (ALS)'''. Like Parkinson's disease, there is currently only animal and anecdotal reports of success, but human studies are under way. * '''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. * '''Autism'''<ref name="Gasior-2006"/>. There are early reports from a Greek study in Crete indicating indications that the ketogenic diet may produce some improvement in some children. There are Ketogenic Diet might also anecdotal reports of epileptic children treated help with the ketogenic diet also having improvements in their autism. * '''Inflammatory disease'''.* '''Migraine'''. While a 1930's textbook talks of the possibility of the ketogenic diet helping with migrainesHeart Disease, a study of 8 teenagers with severe migraines at John Hopkins showed the ketogenic diet was ineffective.* '''Severe hyperactivity'''. There are initial reports that the ketogenic diet improves hyperactivity in animal reportsALS, 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. * '''Hyperactivity, Schizophrenia'''. There is a case report of a radical improvement in schizophrenia with the ketogenic diet, Depression and Bipolar disorder. However, this may these benefits must be due to a removal balanced against the [[Health Risks of the gluten from the diet rather than the overall dietary changesKetogenic Diet]]. * =Epilepsy='''Depression and bipolar disorderMain article: [[Ketogenic Diets for Epilepsy]]'''. There are a number of cases that have been reported where the ketogenic diet helps normalize the mood state of those with bipolar disorder.
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.
=Cancer=
''Main article: [[Ketogenic Diets for Cancer]]''
 
The Ketogenic Diet may help with the treatment of cancer, including brain tumors<ref name="Seyfried-2011"/>. 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.
=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<ref name="Prins2007"/>.
* '''Stroke'''. Because a stroke involves the reduction of blood flow to areas of the brain, the Ketogenic diet may help reduce the resulting damage<ref name="GibsonMurphy2012"/>. 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<ref name="GibsonMurphy2012"/>.
[[File:Stroke outcome in the ketogenic state.png|none|thumb|500px|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.
=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<ref name="Kwiterovich- Jr2003"/>. Another study of adults on the Ketogenic Diet for Epilepsy also showed a worsening of blood lipids<ref name="SirvenWhedon1999"/>. 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<ref name="Kossoff-2011-2512"/>. However, other studies have shown that the ketogenic diet has no adverse effects on the lipid profiles<ref name="Brehm2003"/><ref name="Sondike-2003"/><ref name="HaysDiSabatino2003"/> or actually improves the markers<ref name="Westman-2006"/><ref name="Dashti-2006"/><ref name="Yancy2004"/><ref name="Dashti-2007"/><ref name="Sharman-2002"/>. (A study of children on the [[MCT Diet]] did not indicate any adverse blood lipid changes<ref name="Huttenlocher1976"/>.) 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.
=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<ref name="Kashiwaya-2000"/>.There is some evidence that a ketogenic diet may not only improve the symptoms of AD<ref name="KrikorianShidler2012"/>, 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<ref name="RegerHenderson2004"/>. 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<ref name="HendersonVogel2009"/>. 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<ref name="Young-2005"/>.
=Parkinson's disease=
Parkinson's disease appears to generally result from an acquired defect in the mitochondria rather than genetic causes<ref name="Veech-2000"/>. 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<ref name="Vanitallie-2005"/>. Models of Parkinson's disease (and Alzheimer's) suggest that 4 mmol/L of BOHB can protect neurons and may play a therapeutic role<ref name="Kashiwaya-2000"/>. 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<ref name="Vanitallie-2005"/>.
=Amyotropic Lateral Sclerosis (ALS)=
Like Parkinson's disease, the evidence to support the use of the Ketogenic Diet for ALS is extremely limited<ref name="Paganoni-2013"/>, 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<ref name="Zhao-2006"/>. However, other studies of high fat (non-ketogenic) diets in animal models did show an improved survival time<ref name="Mattson-2007"/><ref name="DupuisOudart2004"/>.
=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.
=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.
=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.
=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.
=Schizophrenia=
There is a case report of a radical improvement in schizophrenia with the ketogenic diet<ref name="KraftWestman2009"/>. However, this may be due to a removal of the gluten from the diet rather than the overall dietary changes<ref name="Hadjivassiliou-1996"/>.
=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<ref name="El-MallakhPaskitti2001"/>. One report indicated that over 2-3 years the mood stabilization exceeded that achieved with medication<ref name="Phelps-2013"/>.
=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<ref name="Bueno-2013"/>. 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<ref name="Bueno-2013"/>.
=See Also=
{{KetoList}}
=References=
<references>
<ref name="Bueno-2013">NB. Bueno, IS. de Melo, SL. de Oliveira, T. da Rocha Ataide, Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials., Br J Nutr, volume 110, issue 7, pages 1178-87, Oct 2013, doi [http://dx.doi.org/10.1017/S0007114513000548 10.1017/S0007114513000548], PMID [http://www.ncbi.nlm.nih.gov/pubmed/23651522 23651522]</ref>
<ref name="El-MallakhPaskitti2001">R.S. El-Mallakh, M.E. Paskitti, The ketogenic diet may have mood-stabilizing properties, Medical Hypotheses, volume 57, issue 6, 2001, pages 724–726, ISSN [http://www.worldcat.org/issn/03069877 03069877], doi [http://dx.doi.org/10.1054/mehy.2001.1446 10.1054/mehy.2001.1446]</ref>
<ref name="Phelps-2013"> JR. Phelps, SV. Siemers, RS. El-Mallakh, The ketogenic diet for type II bipolar disorder., Neurocase, volume 19, issue 5, pages 423-6, 2013, doi [http://dx.doi.org/10.1080/13554794.2012.690421 10.1080/13554794.2012.690421], PMID [http://www.ncbi.nlm.nih.gov/pubmed/23030231 23030231]</ref>
<ref name="KrikorianShidler2012">Robert Krikorian, Marcelle D. Shidler, Krista Dangelo, Sarah C. Couch, Stephen C. Benoit, Deborah J. Clegg, Dietary ketosis enhances memory in mild cognitive impairment, Neurobiology of Aging, volume 33, issue 2, 2012, pages 425.e19–425.e27, ISSN [http://www.worldcat.org/issn/01974580 01974580], doi [http://dx.doi.org/10.1016/j.neurobiolaging.2010.10.006 10.1016/j.neurobiolaging.2010.10.006]</ref>
<ref name="RegerHenderson2004">Mark A. Reger, Samuel T. Henderson, Cathy Hale, Brenna Cholerton, Laura D. Baker, G.S. Watson, Karen Hyde, Darla Chapman, Suzanne Craft, Effects of β-hydroxybutyrate on cognition in memory-impaired adults, Neurobiology of Aging, volume 25, issue 3, 2004, pages 311–314, ISSN [http://www.worldcat.org/issn/01974580 01974580], doi [http://dx.doi.org/10.1016/S0197-4580(03)00087-3 10.1016/S0197-4580(03)00087-3]</ref>
<ref name="Vanitallie-2005"> TB. Vanitallie, C. Nonas, A. Di Rocco, K. Boyar, K. Hyams, SB. Heymsfield, Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study., Neurology, volume 64, issue 4, pages 728-30, Feb 2005, doi [http://dx.doi.org/10.1212/01.WNL.0000152046.11390.45 10.1212/01.WNL.0000152046.11390.45], PMID [http://www.ncbi.nlm.nih.gov/pubmed/15728303 15728303]</ref>
<ref name="Kashiwaya-2000"> Y. Kashiwaya, T. Takeshima, N. Mori, K. Nakashima, K. Clarke, RL. Veech, D-beta-hydroxybutyrate protects neurons in models of Alzheimer's and Parkinson's disease., Proc Natl Acad Sci U S A, volume 97, issue 10, pages 5440-4, May 2000, PMID [http://www.ncbi.nlm.nih.gov/pubmed/10805800 10805800]</ref>
<ref name="Veech-2000"> GA. Veech, J. Dennis, PM. Keeney, CP. Fall, RH. Swerdlow, WD. Parker, JP. Bennett, Disrupted mitochondrial electron transport function increases expression of anti-apoptotic bcl-2 and bcl-X(L) proteins in SH-SY5Y neuroblastoma and in Parkinson disease cybrid cells through oxidative stress., J Neurosci Res, volume 61, issue 6, pages 693-700, Sep 2000, PMID [http://www.ncbi.nlm.nih.gov/pubmed/10972966 10972966]</ref>
<ref name="Young-2005"> KW. Young, CE. Greenwood, R. van Reekum, MA. Binns, A randomized, crossover trial of high-carbohydrate foods in nursing home residents with Alzheimer's disease: associations among intervention response, body mass index, and behavioral and cognitive function., J Gerontol A Biol Sci Med Sci, volume 60, issue 8, pages 1039-45, Aug 2005, PMID [http://www.ncbi.nlm.nih.gov/pubmed/16127110 16127110]</ref>
<ref name="Gasior-2006"> M. Gasior, MA. Rogawski, AL. Hartman, Neuroprotective and disease-modifying effects of the ketogenic diet., Behav Pharmacol, volume 17, issue 5-6, pages 431-9, Sep 2006, PMID [http://www.ncbi.nlm.nih.gov/pubmed/16940764 16940764]</ref>
<ref name="Seyfried-2011">TN. Seyfried, MA. Kiebish, J. Marsh, LM. Shelton, LC. Huysentruyt, P. Mukherjee, Metabolic management of brain cancer., Biochim Biophys Acta, volume 1807, issue 6, pages 577-94, Jun 2011, doi [http://dx.doi.org/10.1016/j.bbabio.2010.08.009 10.1016/j.bbabio.2010.08.009], PMID [http://www.ncbi.nlm.nih.gov/pubmed/20804725 20804725]</ref>
<ref name="HendersonVogel2009">Samuel T Henderson, Janet L Vogel, Linda J Barr, Fiona Garvin, Julie J Jones, Lauren C Costantini, Study of the ketogenic agent AC-1202 in mild to moderate Alzheimer's disease: a randomized, double-blind, placebo-controlled, multicenter trial, Nutrition & Metabolism, volume 6, issue 1, 2009, pages 31, ISSN [http://www.worldcat.org/issn/1743-7075 1743-7075], doi [http://dx.doi.org/10.1186/1743-7075-6-31 10.1186/1743-7075-6-31]</ref>
<ref name="Zhao-2006"> Z. Zhao, DJ. Lange, A. Voustianiouk, D. MacGrogan, L. Ho, J. Suh, N. Humala, M. Thiyagarajan, J. Wang, A ketogenic diet as a potential novel therapeutic intervention in amyotrophic lateral sclerosis., BMC Neurosci, volume 7, pages 29, 2006, doi [http://dx.doi.org/10.1186/1471-2202-7-29 10.1186/1471-2202-7-29], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16584562 16584562]</ref>
<ref name="Paganoni-2013"> S. Paganoni, AM. Wills, High-fat and ketogenic diets in amyotrophic lateral sclerosis., J Child Neurol, volume 28, issue 8, pages 989-92, Aug 2013, doi [http://dx.doi.org/10.1177/0883073813488669 10.1177/0883073813488669], PMID [http://www.ncbi.nlm.nih.gov/pubmed/23666040 23666040]</ref>
<ref name="Mattson-2007"> MP. Mattson, RG. Cutler, S. Camandola, Energy intake and amyotrophic lateral sclerosis., Neuromolecular Med, volume 9, issue 1, pages 17-20, 2007, PMID [http://www.ncbi.nlm.nih.gov/pubmed/17114821 17114821]</ref>
<ref name="DupuisOudart2004">L. Dupuis, H. Oudart, F. Rene, J.-L. G. de Aguilar, J.-P. Loeffler, Evidence for defective energy homeostasis in amyotrophic lateral sclerosis: Benefit of a high-energy diet in a transgenic mouse model, Proceedings of the National Academy of Sciences, volume 101, issue 30, 2004, pages 11159–11164, ISSN [http://www.worldcat.org/issn/0027-8424 0027-8424], doi [http://dx.doi.org/10.1073/pnas.0402026101 10.1073/pnas.0402026101]</ref>
<ref name="KraftWestman2009">Bryan D Kraft, Eric C Westman, Schizophrenia, gluten, and low-carbohydrate, ketogenic diets: a case report and review of the literature, Nutrition & Metabolism, volume 6, issue 1, 2009, pages 10, ISSN [http://www.worldcat.org/issn/1743-7075 1743-7075], doi [http://dx.doi.org/10.1186/1743-7075-6-10 10.1186/1743-7075-6-10]</ref>
<ref name="GibsonMurphy2012">Claire L. Gibson, Anne N. Murphy, Sean P. Murphy, Stroke outcome in the ketogenic state - a systematic review of the animal data, Journal of Neurochemistry, volume 123, 2012, pages 52–57, ISSN [http://www.worldcat.org/issn/00223042 00223042], doi [http://dx.doi.org/10.1111/j.1471-4159.2012.07943.x 10.1111/j.1471-4159.2012.07943.x]</ref>
<ref name="Prins2007">Mayumi L Prins, Cerebral metabolic adaptation and ketone metabolism after brain injury, Journal of Cerebral Blood Flow &#38; Metabolism, volume 28, issue 1, 2007, pages 1–16, ISSN [http://www.worldcat.org/issn/0271-678X 0271-678X], doi [http://dx.doi.org/10.1038/sj.jcbfm.9600543 10.1038/sj.jcbfm.9600543]</ref>
<ref name="Sharman-2002">MJ. Sharman, WJ. Kraemer, DM. Love, NG. Avery, AL. Gómez, TP. Scheett, JS. Volek, A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men., J Nutr, volume 132, issue 7, pages 1879-85, Jul 2002, PMID [http://www.ncbi.nlm.nih.gov/pubmed/12097663 12097663]</ref>
<ref name="Dashti-2006"> HM. Dashti, NS. Al-Zaid, TC. Mathew, M. Al-Mousawi, H. Talib, SK. Asfar, AI. Behbahani, Long term effects of ketogenic diet in obese subjects with high cholesterol level., Mol Cell Biochem, volume 286, issue 1-2, pages 1-9, Jun 2006, doi [http://dx.doi.org/10.1007/s11010-005-9001-x 10.1007/s11010-005-9001-x], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16652223 16652223]</ref>
<ref name="Westman-2006">EC. Westman, WS. Yancy, MK. Olsen, T. Dudley, JR. Guyton, Effect of a low-carbohydrate, ketogenic diet program compared to a low-fat diet on fasting lipoprotein subclasses., Int J Cardiol, volume 110, issue 2, pages 212-6, Jun 2006, doi [http://dx.doi.org/10.1016/j.ijcard.2005.08.034 10.1016/j.ijcard.2005.08.034], PMID [http://www.ncbi.nlm.nih.gov/pubmed/16297472 16297472]</ref>
<ref name="Sondike-2003"> SB. Sondike, N. Copperman, MS. Jacobson, Effects of a low-carbohydrate diet on weight loss and cardiovascular risk factor in overweight adolescents., J Pediatr, volume 142, issue 3, pages 253-8, Mar 2003, doi [http://dx.doi.org/10.1067/mpd.2003.4 10.1067/mpd.2003.4], PMID [http://www.ncbi.nlm.nih.gov/pubmed/12640371 12640371]</ref>
<ref name="Brehm2003">B. J. Brehm, A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women, Journal of Clinical Endocrinology & Metabolism, volume 88, issue 4, 2003, pages 1617–1623, ISSN [http://www.worldcat.org/issn/0021972X 0021972X], doi [http://dx.doi.org/10.1210/jc.2002-021480 10.1210/jc.2002-021480]</ref>
<ref name="Yancy2004">William S. Yancy, A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia, Annals of Internal Medicine, volume 140, issue 10, 2004, pages 769, ISSN [http://www.worldcat.org/issn/0003-4819 0003-4819], doi [http://dx.doi.org/10.7326/0003-4819-140-10-200405180-00006 10.7326/0003-4819-140-10-200405180-00006]</ref>
<ref name="HaysDiSabatino2003">James H. Hays, Angela DiSabatino, Robert T. Gorman, Simi Vincent, Michael E. Stillabower, Effect of a High Saturated Fat and No-Starch Diet on Serum Lipid Subfractions in Patients With Documented Atherosclerotic Cardiovascular Disease, Mayo Clinic Proceedings, volume 78, issue 11, 2003, pages 1331–1336, ISSN [http://www.worldcat.org/issn/00256196 00256196], doi [http://dx.doi.org/10.4065/78.11.1331 10.4065/78.11.1331]</ref>
<ref name="Kwiterovich- Jr2003">Peter O. Kwiterovich, Jr, Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children, JAMA, volume 290, issue 7, 2003, pages 912, ISSN [http://www.worldcat.org/issn/0098-7484 0098-7484], doi [http://dx.doi.org/10.1001/jama.290.7.912 10.1001/jama.290.7.912]</ref>
<ref name="Huttenlocher1976">Peter R Huttenlocher, Ketonemia and Seizures: Metabolic and Anticonvulsant Effects of Two Ketogenic Diets in Childhood Epilepsy, Pediatric Research, volume 10, issue 5, 1976, pages 536–540, ISSN [http://www.worldcat.org/issn/0031-3998 0031-3998], doi [http://dx.doi.org/10.1203/00006450-197605000-00006 10.1203/00006450-197605000-00006]</ref>
<ref name="Dashti-2007"> HM. Dashti, TC. Mathew, M. Khadada, M. Al-Mousawi, H. Talib, SK. Asfar, AI. Behbahani, NS. Al-Zaid, Beneficial effects of ketogenic diet in obese diabetic subjects., Mol Cell Biochem, volume 302, issue 1-2, pages 249-56, Aug 2007, doi [http://dx.doi.org/10.1007/s11010-007-9448-z 10.1007/s11010-007-9448-z], PMID [http://www.ncbi.nlm.nih.gov/pubmed/17447017 17447017]</ref>
<ref name="SirvenWhedon1999">Joseph Sirven, Barbara Whedon, Deborah Caplan, Joyce Liporace, David Glosser, Joyce O'Dwyer, Michael R. Sperling, The Ketogenic Diet for Intractable Epilepsy in Adults: Preliminary Results, Epilepsia, volume 40, issue 12, 1999, pages 1721–1726, ISSN [http://www.worldcat.org/issn/0013-9580 0013-9580], doi [http://dx.doi.org/10.1111/j.1528-1157.1999.tb01589.x 10.1111/j.1528-1157.1999.tb01589.x]</ref>
<ref name="Hadjivassiliou-1996"> M. Hadjivassiliou, A. Gibson, GA. Davies-Jones, AJ. Lobo, TJ. Stephenson, A. Milford-Ward, Does cryptic gluten sensitivity play a part in neurological illness?, Lancet, volume 347, issue 8998, pages 369-71, Feb 1996, PMID [http://www.ncbi.nlm.nih.gov/pubmed/8598704 8598704]</ref>
<ref name="Kossoff-2011-2512">Eric. Kossoff, [http://www.amazon.com/Ketogenic-Diets-Eric-H-Kossoff/dp/1936303108 Ketogenic diets : treatments for epilepsy and other disorders], date 2011, publisher Demos Health, location New York, isbn 1-936303-10-8, Kindle Offset 2512</ref>
</references>

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