Ketogenic Diets and Chronic Disease: Benefits vs. Risks

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.

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.

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.

re: CBD: 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. Others say that CBD on its own isn't enough, you need proper cannabis.

I did strict, high ratio, keto for 6 months. I did it pretty "clean" too. I almost never strayed above 50g carbs a day and usually stayed under 20g. My fat ratio made up 70% of my diet. No processed foods. Lots of veggies.

My years of indigestion went away (and never came back - it's been 3.5 years since this experiment) Lost 60lbs from 220 to 160. Slept like a log. Like a solid 7-9hrs a night once I was a month in.

All my markers - lipids, metabolic, blood Glucose, etc..went from shit to within norms with LDL slightly elevated.

I had more energy during the day, and way more focus (I'm adhd).

I had to quit bc even when upping my calories to 2,500-3k a day. I was still losing weight.

Also I developed Orthorexia during this process. I became obsessed with making keto versions of bread, taco shells, home made cereal, and started to spend endless amounts of time in the kitchen. When eggs, meat and big ass salads would have done just fine. Even when quitting keto.. Taking nutrition to absurd degrees was common for years. It became a total OCD.

How many vitamins are in non-fortified grains?

A quarter-cup serving of wheat berries contains approximately:

    158 calories
    33 grams carbohydrates
    7 grams protein
    1 gram fat
    6 grams dietary fiber
    2 milligrams manganese (97 percent DV)
    34 micrograms selenium (49 percent DV)
    0.25 milligram thiamine (16 percent DV)
    159 milligrams phosphorus (16 percent DV)
    60 milligrams magnesium (15 percent DV)
    2.8 milligrams niacin (14 percent DV)
    0.2 milligram copper (10 percent DV)
    1.7 milligrams iron (10 percent DV)
    1.3 milligrams zinc (9 percent DV)
    0.2 milligram vitamin B6 (8 percent DV)
    21 milligrams folate (5 percent DV)

https://draxe.com/nutrition/wheat-berries/