New Evidence on Medical Uses of the Ketogenic Diet – Which Patients Benefit?

Many diets / eating programs claim to protect against disease, whereas the ketogenic diet, discovered in the 1920s, claims to treat or contribute to treatment. Historically, it lost popularity because many studies failed to show therapeutic effects despite a few supporting them; recently, identifying appropriate patient groups has renewed interest.

The ketogenic diet does not simply say “eat better” or “lose weight”; it imposes major restrictions to “shake up” metabolism. Users often have serious illnesses and advocate a nonpharmacological approach to changing outcomes or disease course. For years, its commonest use has been controlling epileptic seizures . Over the past decade, however, new laboratory findings and early clinical trials have suggested possible roles in obesity, diabetes and other chronic diseases.

What is the ketogenic diet?

Low carb diet is another name for the classic keto diet, consisting mainly of fat (%80-90), protein (%8-15) and minimal carbohydrate (%2-5). The aim is to mimic fasting without impairing growth. Restricting carbohydrates and metabolized protein makes fat the energy source. As glucose falls, ketosis allows fat-derived ketone bodies to become the body’s main fuel.

Besides classic keto, three common versions exist: the medium-chain triglyceride diet, modified Atkins diet and low glycemic index treatment. They offer palatable variations by changing protein and fat proportions.

Important risks include nutritional deficiencies, hypovolemia (low fluid volume), hypokalemia (low potassium), kidney stones and gout. Appropriate approaches aim to reduce these risks.

Food list: what is in the ketogenic diet?

The keto diet is known for restrictions , with a long list of foods to limit or avoid, including:

• Grains and grain products (rice, wheat, rye, oats, barley, quinoa, pasta, cereal, pizza)
• Legumes and beans
• Vegetables and roots (peas, corn, potatoes)
• High-carbohydrate fruit; dried fruit (bananas, apples, oranges)
• Low-fat dairy
• Refined fats and oils; vegetable oil
• Sugar
• Alcohol

The diet still offers choices such as beef, meat of other fatty large livestock, poultry, fish, eggs, cheese, avocado, olive oil and coconut oil. It also includes various starchy vegetables such as greens, cabbage and broccoli.

Recent clinical research on keto in various diseases

Epilepsy: new benefits and risks of an old treatment

Keto may be attracting attention now, but its medical roots go back almost a century. It was first designed for epilepsy in 1921. A systematic review reported seizure reductions of up to %85 after keto treatment.

Why it works so well remains unclear. Recent studies suggest ketones and fatty acids may prevent nerve cell overexcitation. However, keto is not risk-free. In 2008, after 3 years on the diet, sudden cardiac arrest was reported in two children.

Type-2 diabetes / obesity: breaking a cycle

The historical promotion of low-fat diets and preference for high-carbohydrate foods with increasing glycemic load is seen as the main cause of the obesity epidemic .

Studies show keto suppresses appetite and produces greater weight loss than low-fat eating.

For these reasons, keto has become a focus in type-2 (late-onset/adult) diabetes treatment research. Briefly, type-2 diabetes is carbohydrate intolerance. After years of excess energy and other risks, carbohydrate eating rapidly raises glucose, which pancreatic insulin can no longer lower adequately. Some researchers therefore think reducing or eliminating carbohydrates may at least reduce medication needs and perhaps reverse the underlying metabolic problem. Recent studies report ketogenic drink supplements may improve insulin sensitivity.

Researchers nevertheless state that current trials are not of sufficient quality to establish long-term safety and effectiveness .

Diabetic patients restricting carbohydrate are at risk of hypoglycemia (severely low glucose); insulin and other diabetes drug doses must be adjusted if this diet is used.

Cancer: things become more complicated here

Not only cancer cells but all cells need energy, often from glucose, to survive or proliferate. But cancer cells have altered metabolism to obtain energy even without much glucose. This is one of the 10 hallmarks of cancer . Some ignore this fact and argue that sugar restriction works against cancer, but research findings have refuted these claims. Some studies even suggest high-fat eating may be more dangerous in cancer, because fat molecules may be a more efficient fuel for cancer cells.

Cancer is a heterogeneous, highly complex group of diseases. Keto studies in different cancers have been inconsistent, appearing helpful in some and not others. Until reasoning supporting its use is confirmed by rigorous randomized clinical trials , keto remains an unfounded intervention for cancer.

Other neurological disorders

Its epilepsy effectiveness has raised the question of use in other neurological disorders. The basis is that this therapy might have broad neuroprotective effects.

Results are early but some are impressive. Migraine, thought partly to involve an energy disorder, responded favorably to ketone supplementation in a preliminary study. People with mild-to-moderate Alzheimer’s showed improved cognitive test scores after 3 months of supplementation. Behavioral improvements were also recorded in children with autism spectrum disorder receiving keto. However, the diet has not been observed to cure these neurological conditions completely.

Does the ketogenic diet improve athletic endurance?

Keto is also studied in athletes seeking performance improvement. According to Lorna Doyle, a sports nutrition lecturer and researcher at Ireland’s Waterford Institute of Technology, studies have notshown significant endurance performance improvement.

However, keto preserved muscle mass during high-intensity interval training, probably through mitochondrial adaptations increasing fat utilization.

Conclusion

It is fair to say science is still discovering for whom and how a treatment dating to 1921 might work and for whom it may be risky. This is often how science proceeds: reasoning often proves wrong, chance favors prepared minds, and some ideas await scientific and technological maturity for confirmation.

Keto’s effect on epilepsy is undisputed, and growing evidence supports its promise in obesity and type 2 diabetes. Cancer, with altered cellular energy metabolism and far greater heterogeneity and complexity, appears a difficult field for keto, though research continues. Uncertain interventions often risk more harm than benefit.

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