Michael Russo @MichaelRussoMD - Twitter Profile

Mike - Low Carb Dietitian @thelowcarb_rd

over 2 years ago

Recently I was asked to write an article for a magazine all about the ketogenic diet and epilepsy. I accepted but didn't want to write just about that so I offered to also write about other clinical uses for a lower carb or ketogenic diet. They accepted. Here then is a summarized version of what I wrote: ✅ Keto In Epilepsy: Fasting has been used as a treatment for epilepsy since 500BC. In 1920 the ketogenic diet was created to mimic this. At the time 52% gained complete seizure control and a further 27% experienced improvement. More recent research favours ketogenic diet over usual care in terms of outcomes. Up to 55% of children achieve seizure freedom within 3 months whilst up to 85% see improvement. The ketogenic diet changes the gut microbiome and this in turn increases GABA and glutamate in the brain. It's thought that this is what provides protection against seizures or at least reduced severity/occurrence. ✅ Keto In Diabetes: Keto is arguably overkill here but interest is high, likely because carbohydrate restriction generally has the greatest effect on markers of blood sugar (hba1c). One meta analysis showed that keto was superior in terms of weight loss, reduction of triglycerides, reduction of Hba1c, reduction of medications and increases in HDL. The ketogenic diet group did also have higher LDL and greater drop out rates though. After 12 months however there was little difference mostly because of patients lack of adherence. This said we know even modest carbohydrate restriction can achieve diabetes remission. ✅ Keto & LCHF in PCOS: PCOS is characterized by hyperinsulinaemia, insulin resistance & androgen excess. One very small 24 week pilot study of 5 women found those on the ketogenic diet saw a 12% weight loss, a 22% reduction in testosterone and a 54% decrease in fasting insulin. Ketosis per se may not be necessary however since remission of this condition can be achieved with only modest carbohydrate restriction therapy. This remission does not occur on a low fat diet despite caloric restriction. ✅ Keto In Obesity: Any energy restricted can work but keto may offer some unique benefits. Protein reliably induces satiety which can lead to decreased portion sizes. Ketones themselves directly suppress appetite too. Add this with the increased lipolysis (breakdown of fat) and decreased lipogenisis (creation of fat) and this may be particularly effective for those who struggle with satiety. ✅ Mental Health: Does Keto Stabilize Mood? Both anxiety and depression have low GABA in common. When GABA is lows it's impossible to relax. We already know the keto diet alters the microbiome which in turns increases GABA in the brain. One 2016 study of 50 children with refractory epilepsy reported less anxiety and mood instability during the ketogenic diet. Many pre-clinical studies have shown anti-depressive and anti-anxiety results in mice but these have yet to be followed up in humans. A 2019 controlled analytic study of online reports found that those following a ketogenic diet were more likely to self-report fewer episodes of depression and less anxiety. In 2022 a retrospective analysis of 31 inpatients with treatment refractory metal illness was done and reported that depression reduced and schizophrenia and bipolar symptoms reduced. In this group 64% of people were able to reduce their medications. ✅ Summary Overall the ketogenic diet and therapeutic carbohydrate restriction demonstrates huge potential in many clinical disease other than just epilepsy. More and stronger evidence is of course needed. Considering big pharma pays for most research it is unlikely much attention will be given to this branch of lifestyle modification. It is therefore up to us as healthcare professionals to act in our patients best interest & do our own clinical audits to see if therapeutic carbohydrate restriction can work to help patients achieve disease remission.

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Michael Russo

@MichaelRussoMD

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