Furore over ketogenic diet

KETOGENIC DIET PHOTO CREDIT: https://ketosource.co.uk

It is the latest weight loss fad in town. Some Nigerians have successfully used ketogenic or keto diet to achieve weight loss, but leaving them with sagging skin. Recent studies have shown that ketogenic diet, which is high in fat, could also help beat epilepsy and seizures, increase lifespan, and boost memory. However, there are fears that these benefits may come at a cost- constipation and kidney stones. CHUKWUMA MUANYA (Assistant Editor) and STANLEY AKPUNONU write.

Can a low-carb, high fat diet help you lose weight, improve health, and beat diseases such as diabetes, cancer, epilepsy and Alzheimer’s disease?

Assistant Director, Dietetics, Obafemi Awolowo University Teaching Hospital (OAUTH), Ile Ife, Dr. Obinna Ogbonna, said that naturally, the ketogenic diet has its own advantages especially for children having common seizures like epileptic seizures, as it has been proven to help in frequent seizure.

Ogbonna lamented that recently, so many adults are now going in to it because they want to use it as a weight reduction measure. The dietician, however, said one of the problems it might create is that the immediate effect would not be known because it is more fatty oriented.

Ogbonna explained: “You must balance your diet because various nutrients have its functions in the body and fats are not supposed to be used as a form of energy really.

“We discovered that in the keto, it is more of the fat, the fatty level is high and the carbohydrate is lesser than what it should be. The carbohydrate should be used as energy, so during the process the body might be tasked to use other forms of energy, we call it gluco-neogenesis. It produces more of its energy through that fats and that is not the best.

“The long term effect is what people have not known and it is hazardous. The immediate result is what people are looking at because the physiology of weight loss is clear. When the intake rate is reduced and activities rate increase, naturally you have to lose weight. Instead of people to take normal carbohydrate level for the functionality of the body to be stable, they body now tend to use the fat more. The nature of the body has been programmed but they are distorting the physiological make up of the body and with time the side effects will manifest.”

Ogbonna said, the long term effects includes: wasting of the muscles, accelerated ageing process, wrinkles on the face and hands, prone to infections due to inadequate protein as result of the diversion of protein to source of energy called protein sparing action of carbohydrates (gluconeogenesis) and also there would be hormonal changes in the body.

“My advice is that people should go about it the right way, see the dietician, see your physiotherapist for lifestyle changes and diet changes in other to achieve the weight reduction you are hoping to achieve because it might be dangerous through keto because I will not prescribe it for my patients,” he said.

According to Wikipedia, the ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source.

An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures. Almost half of children, and young people, with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.

There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.

The Atkins diet, also known as the Atkins nutritional approach, is a low-carbohydrate fad diet promoted by Robert Atkins and inspired by a research paper he read in The Journal of the American Medical Association. Alfred W. Pennington published the paper, titled “Weight Reduction”, in 1958.

The Atkins diet is classified as a fad diet. There is only weak evidence supporting its effectiveness in helping achieve sustainable weight loss.

Several studies have shown that the most common adverse effect of ketogenic diet is constipation, affecting about 30 per cent of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones, and is no longer considered beneficial.

The ketogenic diet may be a successful treatment for several rare metabolic diseases. Case reports of two children indicate that it may be a possible treatment for astrocytoma, a type of brain tumour. Autism, depression, migraine headaches, polycystic ovary syndrome and diabetes mellitus type 2 have also been shown to improve in small case studies.

There is evidence from uncontrolled clinical trials and studies in animal models that the ketogenic diet can provide symptomatic and disease-modifying activity in a broad range of neurodegenerative disorders including amyotrophic lateral sclerosis, Alzheimer’s disease and Parkinson’s disease, and may be protective in traumatic brain injury and stroke.

Because tumour cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer, including glioma, as well as multiple sclerosis and other neurological disorders.

A 2013 review said that there is enough suggestion of potential benefit from ketogenic diets in cancer therapy that establishing clinical trials is probably warranted.

Meanwhile, a recent mouse study at the University of California (UC) Davis School of Veterinary Medicine, United States (US), sheds light on those questions by demonstrating that a high-fat, or ketogenic, diet not only increases longevity, but improves physical strength.

“The results surprised me a little,” said nutritionist Jon Ramsey, senior author of the paper that appears in the September issue of Cell Metabolism. “We expected some differences, but I was impressed by the magnitude we observed — a 13 percent increase in median life span for the mice on a high-fat versus high-carb diet. In humans, that would be seven to 10 years. But equally important, those mice retained quality of health in later life.”

Ramsey has spent the past 20 years looking at the mechanics that lead to aging, a contributing factor to most major diseases that impact rodents and humans alike. While calorie restriction has been shown in several studies to slow ageing in many animals, Ramsey was interested in how a high-fat diet may impact the aging process.

Ketogenic diets have gained popularity for a variety of health benefit claims, but scientists are still teasing out what happens during ketosis, when carbohydrate intake is so low that the body shifts from using glucose as the main fuel source to fat burning and producing ketones for energy.

The study mice were split into three groups: a regular rodent high-carb diet, a low-carb/high-fat diet, and a ketogenic diet (89-90 percent of total calorie intake). Originally concerned that the high-fat diet would increase weight and decrease life span, the researchers kept the calorie count of each diet the same.

“We designed the diet not to focus on weight loss, but to look at metabolism,” Ramsey said. “What does that do to ageing?”

In addition to significantly increasing the median life span of mice in the study, the ketogenic diet increased memory and motor function (strength and coordination), and prevented an increase in age-related markers of inflammation. It had reduced the incidence of tumors, as well.

“In this case, many of the things we’re looking at aren’t much different from humans,” Ramsey said. “At a fundamental level, humans follow similar changes and experience a decrease in overall function of organs during aging. This study indicates that a ketogenic diet can have a major impact on life and health span without major weight loss or restriction of intake. It also opens a new avenue for possible dietary interventions that have an impact on ageing.”

Researchers do not know at this time if there is an optimum fat for a ketogenic diet.

A companion study published by the Buck Institute for Research on Aging in the same issue of Cell Metabolism shows that a ketogenic diet extends longevity and improves memory in aging mice.