The Ketogenic Diet: Making a Comeback

Abstract

Americans have embraced a large number of diets in an attempt to manage obesity, improve quality of life, and address specific health problems. Among diets developed to address health problems, the ketogenic diet has had a long and variable history. Developed in the 1920s by a faith healer to help children with epilepsy, this diet induces a state that mimics carbohydrate starvation. As medications became available and effectively addressed seizures, the diet fell out of favor. During the last few decades, researchers and clinicians have learned that it can be useful in children and adults with refractory epilepsy and a variety of other conditions. Once again, pharmacists may encounter patients who are employing dietary management of serious health problems. This very high-fat diet almost eliminates carbohydrates from the patient's food selection. The result is the substitution of ketone bodies as a source of energy. Today's ketogenic diet has been modified with scientifically proven adjustments to increase palatability and help with adherence. Effective for some forms of epilepsy, the ketogenic diet also seems to have some utility in Alzheimer's disease, Parkinson's disease, and glaucoma, and many Americans are using it to lose weight. Consultant pharmacists may field questions about this diet, its potential to correct or alleviate health conditions, and its limitations. The article discusses the ketogenic diet's strengths, limitations, potential mechanisms, and use in a number of conditions with an emphasis on the elderly.

Going the Extra (Synaptic) Mile: Excitotoxicity as the Road Toward Neurodegenerative Diseases

“…This pathway is vital for several brain functions, including for long-term memory formation (Suzuki et al, 2011), which might indicate a compromise of several neural functions, as a consequence of disrupted energy homeostasis. Due to the accumulating evidence of metabolic disruption in epilepsy, treatment strategies targetting cell metabolism have been gaining more attention, including the revival of the ketogenic diet (Walczyk and Wick, 2017). Pyruvate has been proposed as a possible treatment for epilepsy on account of being an anaplerotic mitochondrial fuel and because of its protective features, including acting as a potent ROS scavenger and normalizing cytosolic redox state.…”

The mystery of the ketogenic diet: benevolent pseudo-diabetes

“…KDs are typically LC-HF diets, which cause ketosis (elevated blood levels of ketones namely acetoacetic acid and beta-hydroxybutyric acid) [6][7][8][9][10][11][12][13]. In the absence of glucose, the brain metabolizes ketones [6,13,14], which are produced in the liver from fatty acids and serve as substitutes for glucose as an energy source. The numerous variants of the KD are not well defined.…”

“…KDs are successfully being used in the treatment of obesity, non-alcoholic fatty liver disease, neurological diseases and cancer [6,7,[9][10][11]16]. They are also being used in the treatment of type 2 diabetes [8,9,[11][12][13][17][18][19][20][21][22][23]. When consuming the same numbers of calories, KDs are more effective than standard calorie restrictive diets for body weight reduction and improvement of glycemic control in diabetic patients [24][25][26][27][28], and enable discontinuation or reduction of medications in some diabetic patients [18,27,29].…”

Nutrition – facts and myths

“…Very popular types of diets today, such as high protein/low carb diet and ketogenic diet can be beneficial in some diseases, such as epilepsy (28), but in the long-term result in acidosis and potential intoxication of the body. Outside its application as an epilepsy therapy, the ketogenic diet has been considered a potential treatment for a variety of other neurological and metabolic disorders such as Alzheimer's disease, Parkinson's disease, and glaucoma (29). Studies on an experimental animal are showing promising results in these areas (30).…”

“…Studies on an experimental animal are showing promising results in these areas (30). However, many issues such acidosis, gastrointestinal system disturbances, reduced appetite are associated with ketogenic nutrition patterns are still subject of debates and myths associated with them can be dispersed only when the evidence-based, long-term human studies will be completed (29).…”