[HN Gopher] Ketogenic Diets and Chronic Disease: Benefits vs. Risks
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Ketogenic Diets and Chronic Disease: Benefits vs. Risks
Author : simonebrunozzi
Score : 13 points
Date : 2022-01-25 21:57 UTC (1 hours ago)
(HTM) web link (www.frontiersin.org)
(TXT) w3m dump (www.frontiersin.org)
| Melatonic wrote:
| The big problem I have with the Keto diet is twofold:
|
| 1. People rarely compare it directly to something like a "Real
| Food" diet - they go from a lot of processed crap to mostly non
| processed stuff on the outside of the grocery store and then see
| huge benefits. But I suspect if they just switched to a Real Food
| diet in the first place they would see most of the same benefits.
|
| 2. It completely leaves out almost all legumes and many root
| vegetables and gourds which are both hugely beneficial and also
| some of the cheapest / most sustainable calories out there. There
| is a reason humans domesticated gourds early on - they are easy
| as hell to grow, tasty, healthy, balanced, and the shells often
| also provide other benefits.
|
| On top of that the three above food groups are the main sources
| of high quality prebiotics (not probiotics) which are essential
| to our gut health and producing both essential fatty acids and
| Vitamin K2. The FDA just assumes that people meet an RDA value
| for EFA and K2 based on gut fermentation but this relies on
| people consuming quality fiber and most importantly specific
| prebiotics like long chain inulin and resistant starch (which are
| very different than simple starch and normal inulin). EFA and K2
| are intricately involved in immune modulation, gut inflammation,
| inflammation in general, and all kinds of other processes.
|
| I think we all know that the average person in the west is likely
| not eating nearly enough of these prebiotics and in addition many
| have other digestion issues as well. There is a reason scientists
| call them ESSENTIAL fatty acids and not "kinda sorta important"
| fatty acids.
| nradov wrote:
| I'm always leery when I see a paper with a lead author from the
| Physicians Committee for Responsible Medicine. This is a
| political advocacy organization focused on pushing their policies
| rather than focusing on evidence based medicine. That doesn't
| necessarily make this study wrong but they have been known to
| exaggerate the evidence in favor of plant-based diets.
| JamesBarney wrote:
| Yeah you nailed it. Quote from the paper.
|
| > and diets focusing on whole plant foods and limiting animal
| foods and processed foods, such as the MIND diet, are proven to
| reduce AD risk
|
| I'm excited about the potential of the MIND diet. Here is a
| quote from the study they linked to
|
| > Results: In adjusted proportional hazards models, the second
| (hazards ratio or HR = 0.65, 95% confidence interval or CI
| 0.44, 0.98) and highest tertiles (HR = 0.47, 95% CI 0.26, 0.76)
| of MIND diet scores had lower rates of AD versus tertile 1,
| whereas only the third tertiles of the DASH (HR = 0.61, 95% CI
| 0.38, 0.97) and Mediterranean (HR = 0.46, 95% CI 0.26, 0.79)
| diets were associated with lower AD rates.
|
| That's evidence that suggests, implies, and points in the
| direction that AD _might_ be reduced by the mind diet. But
| doesn 't even come close to _prove_ it.
|
| I assume the rest of this paper is as sloppy overstating the
| evidence.
|
| I think there is a place for scientific advocacy, but own it.
| Don't pretend like you're an unbiased third party trying to
| find the truth about keto. This review would be better seen as
| a "Overview of potential risks of ketogenic diets, and possible
| alternatives."
| throwawayanon47 wrote:
| I can confirm that the bits of the paper about Seizure Disorders
| are accurate - my daughter has Dravet Syndrome and has been on
| the Ketogenic diet for 5 years. Its well established that Keto
| works well for some seizure disorders (inc Dravet) - see
| https://pubmed.ncbi.nlm.nih.gov/25524846/
| https://pubmed.ncbi.nlm.nih.gov/16146451/ - it works about as
| well as the best AEDs (anti eplileptic drugs) but with fewer side
| effects. We use it alongside AEDs as well. My daughters Ketogenic
| diet is actually prescribed and monitored by the NHS, with
| various prescription foods/ingredients provided. So its very
| mainstream, this isn't just some random experimental thing I'm
| trying as a desparate parent. (Although as an aside, as a parent
| of a dravet kid, you do often feel desparate - its a very
| challenging condition)
|
| That kind of keto is hard work though - everything my daughter
| eats is measured and weighed to the gram. Its important to get
| the right amount of calories too - not too many and not too few -
| so there's a lot to measure.
|
| What I would say though (and the paper to its credit seems
| reasonably clear on this) you need serious Keto to get those
| benefits - my daughters diet is ratio 3.5:1 which means for every
| gram of protein or carbs there are 3.5g of fat. So essentially
| the diet is about 77% fat overall, which is hard to do - kindof
| like everything has to have as much fat as pure butter. You have
| to be careful at that level - too many ketones and you're heading
| for a coma. We have a little pin-prick ketone tesing machine, an
| action plan for what to do if ketones go too high, how to look
| for the signs etc.
|
| So lets call that 'medical keto'. There's also 'popular keto'
| which is what you'll get if you google 'keto cookie recipe' -
| reasonably high fat, reasonably low carb food that may well help
| people lose weight or feel a bit better or whatever but its
| nowhere near 3:1 ratio or 4:1 ratio. If I look up a keto recipe
| and they don't even give me the ratio, I know its 'popular keto'.
| If its 'medical keto', they'll be telling me the ratio for sure.
|
| In summary: strict high ratio keto works for seizures in enough
| cases to make it competitive with meds. Its also dangerous if you
| dont track it carefully. Popular keto such as you see in trendy
| cookbooks is a different thing and may well be good for some
| stuff like diets or whatnot.
| Melatonic wrote:
| Medical Keto seems like something that is super legit and very
| interesting. "Popular" keto interests me a lot less.
|
| What is the reason it chemically or physicals works for seizure
| disorders?
|
| Not to directly compare them but I feel the same way about a
| lot of rhetoric around CBD - there are a lot of approved and
| legitimate medical uses but the amount of extra stuff that
| people claim it does seems like total BS.
| throwawayanon47 wrote:
| re: Keto for seizures: They dont actually know why it works.
| But on keto your cells are working on a completely different
| energy source so there's whole metabolic chains that are
| completely different. I think the leading theory is its one
| of the by-products of those metabolic chains, rather than the
| ketones themselves. Some say gut bacteria have a role in it
| too.
|
| Interestingly, Dravet Syndrome is also shown to react fairly
| well to CBD. If you've heard of the 'Charlottes web' strain
| of cannabis and all that stuff, that was named after
| Charlotte Figi who had Dravet Syndrome.
|
| CBD is used quite widely to treat Dravet - there's been a lot
| of research and there's now an 'official' pharmaceutical CBD
| called Epidolex
| https://www.webmd.com/drugs/2/drug-176175/epidiolex-
| oral/det... - approved by the FDA, NHS etc. You can get it on
| prescription over here.
|
| Theres a certain 'pot cures everything' lobby that have
| overblown it a bit. It does seem to work but there are side
| effects and there are other drugs that work just as well or
| better (with the caveat that with epilepsy, not every patient
| responds the same to every drug). e.g. Fenfleuramine is
| another new (or technically, repurposed) drug for Dravet that
| seems to work better than CBD for most people. Although I
| have met some Dravet parents who swear by CBD and say they've
| done great with it.
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