Talk:Ketogenic diet

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Frequently asked questions

Isn't this the trendy keto diet that's in the news?

No. The typical minimum fat content for most kids on this diet is more than the maximum fat content for adults who are on the very most extreme keto diets for weight loss and other goals. Most adults on a "keto" diet plan for 60% to 80% of calories from fat (and then they cheat). Most kids on this diet get 90% of their calories from fat (80% of their food by weight), and cheating has potentially deadly consequences. The sample menu shown at Ketogenic diet#Classic contains about 150 grams of fat, 25 grams of protein, and 10 grams of carbohydrates (including fiber). The very low-carbohydrate ketogenic diet typically recommends up to 50 grams of total carbohydrates per day, with 50 to 100 grams of protein.

Why doesn't this article talk about weight-loss or bodybuilding diets? Bodybuilders call their diets "ketogenic".

Any diet that metabolizes any fat at all is "ketogenic", because ketones are the natural, unavoidable metabolic byproduct of eating fat. Even everyday, normal diets are "ketogenic" at some level. This article is not about weight loss or body building, which produce higher levels of ketones than typical diets, but far lower levels than this medically supervised treatment for epilepsy. The average diet for epilepsy usually produces 150% of the ketones that even an extreme diet for weight loss or bodybuilding does. If you are interested in those diets, please read Low-carbohydrate diet.

Why doesn't this article talk about Inuit dietary practices? They ate a lot of fat during part of the year.

This article is not about the Inuit diet. This article is only about the medical diet for treating epilepsy. The diet for epilepsy eats far more fat than even the highest estimates for the Inuit diet. The Inuit diet is estimated to have included high levels of fat, amounting to 25% to 35% of the food by weight. A typical diet to treat epilepsy is 80% fat by weight, which is more than double the amount in the Inuit diet.

Lots of diets have been called "ketogenic" since 2015. Why did you pick this name for an epilepsy treatment?

The process for writing articles on Wikipedia is:

Pick a subject – in this case, an extremely strict dietary treatment for epilepsy.
Look at high-quality reliable sources about your subject to identify possible names for the subject – in this case, "ketogenic diet" is the most widely used name for this treatment for epilepsy, and has been for the last century.
Determine whether the common name used by sources is already used for another article – it wasn't, so we used it. Note that this article was named in 2004, a full decade before the "keto" diet trend started.

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Article history

Ketogenic diet is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.

This article appeared on Wikipedia's Main Page as Today's featured article on January 17, 2010.

Article milestones
Date	Process	Result
July 9, 2008	Good article nominee	Listed
November 12, 2009	Peer review	Reviewed
December 16, 2009	Featured article candidate	Promoted

Current status: Featured article

The ketogenic diet FAQ is wrong according to published papers and this article should be expanded to include weight loss uses

Summary: Like it or not, not only the common usage of the term "ketogenic diet", but also the use of that term in scientific literature has evolved to mean a diet which produces measurably elevated levels of blood ketones.

There is also a significant amount of emerging research that shows ketogenic diets for weight loss are not a "fad diet" but rather have proven scientific evidence showing that they work also for treatment of fatty liver disease (as one example). The use of a keto diet for weight loss should be merged into this page as the accepted medical definition of a ketogenic diet is one that produces elevated levels of blood ketones in non-diabetics. Even if those diets are not as extreme as the ones for treatment of epilepsy, words and phrases change meaning over time and this definition has been used by many peer reviewed articles and should be accepted.

I'm not going to provide an exhaustive list of sources showing this is the accepted scientific definition, but a few for example are listed below, e.g.

Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013 Oct;110(7):1178-87.

Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789.

Masood W, Annamaraju P, Khan Suheb MZ, et al. Ketogenic Diet. [Updated 2023 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499830/

A quick google search will find the plethora of other papers that does not consider the definition to be a diet used only for epilepsy treatment or 90% fat content. 2001:558:6045:10D:EC97:D297:9502:B579 (talk) 04:30, 29 April 2024 (UTC)[reply]

This is not correct. Medical organizations do not recommend the keto diet for weight loss, nor do any health guidelines. The StatPearls source you cited admits that there is no long-term health outcome data on keto and weight loss. The evidence is only short term, much more clinical data is needed if you are going to make those claims. The same source says that a ketogenic diet increases the risk of heart disease and kidney stones. Due to the increased CVD risk, cardiology organizations do not recommend keto. As for your claims about keto improving liver disease, there is not any good clinical evidence for this. Your source does list some papers but there are no good systematic reviews on this because again the evidence is limited and not conclusive. Harvard Health says that keto could be worse for the liver [1]. Psychologist Guy (talk) 08:29, 29 April 2024 (UTC)[reply]

It's the usual Wikipedia:Article titles and scopes problem.

You could just as easily write "Like it or not, not only the common usage of the term influenza, but also the use of that term in scientific literature has evolved to mean not just the influence of astrology on the body, but also a contagious disease, so we should merge Astrology into Influenza virus" – because "the accepted medical definition", and the original source of the word, was astrology, and only later did it come to mean a disease caused by a particular group of viruses, so they're all the same thing, right?

A voluntarily chosen diet for adults hoping to lose weight is not a diet for kids who are at risk of dying from uncontrolled seizures. These are different subjects. Therefore, they get separate articles. If you are jealous because the article about the pediatric epilepsy treatment got written first, and thus got this name, then that's entirely understandable but not a reason to think that kids who could die are the same as adults who want to shed a few pounds.

It might interest you to know that the names of articles can change. This one could be renamed, e.g., to Ketogenic diet (epilepsy treatment). Maybe that would stop people from thinking that "their" title is used on the "wrong" subject, or that epilepsy treatments and weight loss are the same thing. In the meantime, the information you seek is at Low-carbohydrate diet#Ketogenic diet. There is a link to this at Keto diet. WhatamIdoing (talk) 16:51, 29 April 2024 (UTC)[reply]

This has been discussed many times on this page (see archive). I don't think a name change is likely to win approval because nobody has shown any inclination to write a proper article on e.g. ketogenic diet for weight loss. It's all well and good saying Wikipedia should have an article about X(a) that should be called X, if nobody in the history of Wikipedia has written such an article. Write that article and we can discuss names. It has been noted many times that the professional literature does not discuss epilepsy treatments and weight loss treatments together (vs mentioning one in passing). Wrt Psychologist Guy's comments, I think one of the problems is the hostility shown towards weight loss options, as demonstrated by the carb article calling it a fad diet. Pejorative terms just inflame things unnecessary and there are no weight loss treatments (outside of drugs and surgery) that work long term on a reliably significant number of people, so I think pulling out KD as one option to scorn is hypocritical. The American Heart Association can recommend certain diets all it likes, but there isn't really evidence people choose them and stick to them any more than any other diet. -- Colin°^Talk 08:45, 30 April 2024 (UTC)[reply]

Confusion on grammar.

@Psychologist Guy "This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see Very low-carbohydrate ketogenic diet."

The problem is, why the word "or" should not in be case when the 2 choice available? Heres my choice:

"For information on ketogenic diets as a lifestyle choice or for weight loss, see Very low-carbohydrate ketogenic diet."

Means there are two choice

"For information on ketogenic diets as a lifestyle choice" "For information on ketogenic diets asfor weight loss," help me for the problem. 203.190.54.67 (talk) 09:53, 24 May 2024 (UTC)[reply]

"As for" is not correct grammar. The first part of the sentence as written is structured like this:

For information on ketogenic diets
- as a lifestyle choice or
- for weight loss...

Some adults follow a high-fat diet as a lifestyle choice, and some other adults follow a high-fat diet for weight loss. There are two main reasons why adults follow a high-fat diet. The word or is used to indicate that different adults have different reasons. WhatamIdoing (talk) 01:29, 26 May 2024 (UTC)[reply]

Ketones are not used by the brain at all, the brain runs on glucose even in ketosis

In the first part of the article it says that ketone bodies are used by the brain but the brain runs on glucose even in ketosis. Even when eating no carbs your body converts some of the protein you eat to glucose in order to power the brain. This is called gluconeogenesis. 174.109.243.90 (talk) 07:12, 5 August 2024 (UTC)[reply]

The article says "These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy." You need to read past the introduction. Also, "Most organs and tissues can use ketone bodies as an alternative source of energy. The brain uses them as a major source of energy during periods where glucose is not readily available. This is because, unlike other organs in the body, the brain has an absolute minimum glucose requirement." (Dhillon KK, Gupta S. Biochemistry, Ketogenesis. 2023 Feb 6. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 29630231.) Graham Beards (talk) 09:40, 5 August 2024 (UTC)[reply]

Yes, the brain always requires a minimum amount of glucose to function. Also I read the entire article, my critique is about the way it is worded in the head of the article because I feel like it is misleading people to think the brain can run on only ketones, which is impossible.

I also don't understand why the first paragraph of the article only describes ketogenetic diets as a therapy for epilepsy, when emerging evidence is showing it can be helpful in a variety of conditions, including traumatic brain injury: https://www.ncbi.nlm.nih.gov/books/NBK209323/ 174.109.243.90 (talk) 08:48, 7 August 2024 (UTC)[reply]

There is no evidence that it is helpful for traumatic brain injury, the link you cited noted no clinical trials have been done, it even says "there are no human short- or long-term studies evaluating the ketogenic diet for TBI". In other words no evidence, just speculation. The same link also notes that patients on the ketogenic diet drop out after a few years. The ketogenic diet has a very high drop out rate. Psychologist Guy (talk) 18:04, 7 August 2024 (UTC)[reply]

PG, while you are correct, I don't think there is a need to be quite so harsh on every visitor to this page who has read something promising about this diet in an area outside of epilepsy. There are lots of things one could take a hardline no-evidence/speculation approach to. Lots of very very bright people "speculate" on what the planets in our solar system or further afield are made of but good luck persuading the folk editing those articles to accept your "it is just speculation and should be deleted" approach. I think currently the "Other medical applications" section is out of step WP:WEIGHT wise, with what reliable sources say when discussing the ketogenic diet as a medical therapy. We are here to write encyclopaedically about a subject, with weight according to what reliable sources do. We aren't here to restrict information solely to what is in current clinical practice. -- Colin°^Talk 07:46, 14 August 2024 (UTC)[reply]

If the ketogenic diet was effective outside of epilepsy then it would be recommended by the American Heart Association, Academy of Nutrition and Dietetics, British Dietetic Association, European Society of Cardiology, National Lipid Association, American Cancer Society, Cancer Research UK, National Cancer Institute, World Heart Federation, European Atherosclerosis Society, European Association for the Study of Diabetes, HEART UK, World Cancer Research Fund, World Health Organization etc but as we all know it isn't. All these organizations are up to date with the latest research and most put out consensus statements. They advise against the keto diet for the general population because it raises ApoB/LDL which we know increases cancer and heart disease risk. There is no conspiracy. It's dangerous to be promoting misinformation that this diet might help traumatic brain injuries. Psychologist Guy (talk) 12:39, 14 August 2024 (UTC)[reply]

But "effective" to the degree that anything becomes a recommended therapy by multiple organisations is an extremely narrow focus for "can be mentioned at all on Wikipedia". I agree we should not be a dumping ground for every piece of speculative research ever mentioned by nutritionists and wellbeing websites. But there are serious scientists researching this diet beyond epilepsy and their work is covered by reliable secondary sources. That is what counts on Wikipedia. For example, have multiple articles on cancer research, both on prevention and cure, that cover topics that are a long long way from being proven by systematic reviews of randomised controlled double blind trials. -- Colin°^Talk 09:28, 24 August 2024 (UTC)[reply]

Adding LDH inhibition in section on mechanism of action of ketogenic diet

Proposed addition:

Inhibition of lactate dehydrogenase has been proposed as a possible mechanism of action of the ketogenic diet for seizures. Lactate dehydrogenase is a component of the astrocyte-neuron lactate shuttle. This inhibition could be pharmacologically achieved using stiripentol analogs.^[1]^[2] Allthemilescombined1 (talk) 00:57, 21 August 2024 (UTC)[reply]

I think we'd need a secondary source focused on the ketogenic diet in a quality journal before we can mention this theory. These are also both nearly 10 years old papers, so if this was a notable thing then we should be able to find current publications mentioning it. -- Colin°^Talk 09:33, 24 August 2024 (UTC)[reply]

THank you. This article says several studies indicate that STP could regulate glucose energy metabolism and inhibit lactate dehydrogenase.^[3] Allthemilescombined1 (talk) 01:21, 25 August 2024 (UTC)[reply]

References

^ Sada N, Lee S, Katsu T, Otsuki T, Inoue T. Epilepsy treatment. Targeting LDH enzymes with a stiripentol analog to treat epilepsy. Science. 2015 Mar 20;347(6228):1362-7. doi: 10.1126/science.aaa1299. PMID 25792327.
^ Cho CH. Commentary: Targeting LDH enzymes with a stiripentol analog to treat epilepsy. Front Cell Neurosci. 2015 Jul 7;9:264. doi: 10.3389/fncel.2015.00264. PMID 26217188; PMC 4493394.
^ Bacq, Alexandre; Depaulis, Antoine; Castagné, Vincent; Le Guern, Marie-Emmanuelle; Wirrell, Elaine C.; Verleye, Marc (2024-04). "An Update on Stiripentol Mechanisms of Action: A Narrative Review". Advances in Therapy. 41 (4): 1351–1371. doi:10.1007/s12325-024-02813-0. ISSN 1865-8652. PMC 10960919. PMID 38443647. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)

[1] Sada N, Lee S, Katsu T, Otsuki T, Inoue T. Epilepsy treatment. Targeting LDH enzymes with a stiripentol analog to treat epilepsy. Science. 2015 Mar 20;347(6228):1362-7. doi: 10.1126/science.aaa1299. PMID 25792327.

[2] Cho CH. Commentary: Targeting LDH enzymes with a stiripentol analog to treat epilepsy. Front Cell Neurosci. 2015 Jul 7;9:264. doi: 10.3389/fncel.2015.00264. PMID 26217188; PMC 4493394.

[3] Bacq, Alexandre; Depaulis, Antoine; Castagné, Vincent; Le Guern, Marie-Emmanuelle; Wirrell, Elaine C.; Verleye, Marc (2024-04). "An Update on Stiripentol Mechanisms of Action: A Narrative Review". Advances in Therapy. 41 (4): 1351–1371. doi:10.1007/s12325-024-02813-0. ISSN 1865-8652. PMC 10960919. PMID 38443647. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)

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