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Surugiu R, Iancu MA, Vintilescu ȘB, Stepan MD, Burdusel D, Genunche-Dumitrescu AV, Dogaru CA, Dumitra GG. Molecular Mechanisms of Healthy Aging: The Role of Caloric Restriction, Intermittent Fasting, Mediterranean Diet, and Ketogenic Diet-A Scoping Review. Nutrients 2024; 16:2878. [PMID: 39275194 PMCID: PMC11397047 DOI: 10.3390/nu16172878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 08/21/2024] [Accepted: 08/23/2024] [Indexed: 09/16/2024] Open
Abstract
As the population ages, promoting healthy aging through targeted interventions becomes increasingly crucial. Growing evidence suggests that dietary interventions can significantly impact this process by modulating fundamental molecular pathways. This review focuses on the potential of targeted dietary strategies in promoting healthy aging and the mechanisms by which specific nutrients and dietary patterns influence key pathways involved in cellular repair, inflammation, and metabolic regulation. Caloric restriction, intermittent fasting, the Mediterranean diet, as well as the ketogenic diet showed promising effects on promoting healthy aging, possibly by modulating mTORC1 AMPK, an insulin signaling pathway. By understanding the intricate interplay between diet and molecular pathways, we can develop personalized dietary strategies that not only prevent age-related diseases, but also promote overall health and well-being throughout the aging process.
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Affiliation(s)
- Roxana Surugiu
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, St. Petru Rares, No. 2-4, 200433 Craiova, Romania
| | - Mihaela Adela Iancu
- Department of Internal Medicine (Cardiology, Gastroenterology, Hepatology, Rheumatology, Geriatrics), Family Medicine, Labor Medicine, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ștefănița Bianca Vintilescu
- Department of Infant Care-Pediatrics-Neonatology, University of Medicine and Pharmacy of Craiova, St. Petru Rares, No. 2-4, 200433 Craiova, Romania
| | - Mioara Desdemona Stepan
- Department of Infant Care-Pediatrics-Neonatology, University of Medicine and Pharmacy of Craiova, St. Petru Rares, No. 2-4, 200433 Craiova, Romania
| | - Daiana Burdusel
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, St. Petru Rares, No. 2-4, 200433 Craiova, Romania
| | | | - Carmen-Adriana Dogaru
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, St. Petru Rareș, No. 2-4, 200349 Craiova, Romania
| | - Gheorghe Gindrovel Dumitra
- Department of Family Medicine, University of Medicine and Pharmacy of Craiova, St. Petru Rareș, No. 2-4, 200349 Craiova, Romania
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Roslund KJ, Ramsey JJ, Rutkowsky JM, Zhou Z, Slupsky CM. Two-month ketogenic diet alters systemic and brain metabolism in middle-aged female mice. GeroScience 2024:10.1007/s11357-024-01314-w. [PMID: 39180613 DOI: 10.1007/s11357-024-01314-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 08/07/2024] [Indexed: 08/26/2024] Open
Abstract
The ketogenic diet (KD) is a very low-carbohydrate, high-fat diet that reduces glucose catabolism and enhances β-oxidation and ketogenesis. While research in female rodents is limited, research in male rodents suggests that ketogenic interventions initiated at midlife may slow age-related cognitive decline, as well as preserve muscle mass and physical function later in life. This study aimed to investigate the effects of a KD on global metabolic changes in middle-aged females to inform potential mechanisms behind the anti-aging effects of this diet in an understudied sex. Targeted 1H-NMR metabolomics was conducted on serum, the liver, the kidney, and the gastrocnemius muscle, as well as the cortex and the hippocampal brain regions in 16-month-old female mice after a 2-month KD. Analysis of the serum and liver metabolome revealed that the 2-month KD resulted in increased concentrations of fatty acid catabolism metabolites, as well as system-wide elevations in ketones, consistent with the ketogenic phenotype. Metabolites involved in the glucose-alanine cycle were altered in the gastrocnemius muscle, serum and the liver. Other tissue-specific alterations were detected, including distinct effects on hepatic and renal one-carbon metabolism, as well as region specific differences in metabolism across hippocampal and cortical parts of the brain. Alterations to hippocampal metabolites involved in myelinogenesis could relate to the potential beneficial effects of a KD on memory.
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Affiliation(s)
- Kirsten J Roslund
- Department of Nutrition, University of California Davis, Davis, CA, USA
| | - Jon J Ramsey
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Jennifer M Rutkowsky
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Zeyu Zhou
- Department of Molecular Biosciences, School of Veterinary Medicine, University of California Davis, Davis, CA, USA
| | - Carolyn M Slupsky
- Department of Nutrition, University of California Davis, Davis, CA, USA.
- Department of Food Science & Technology, University of California Davis, Davis, CA, USA.
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Rong L, Peng Y, Shen Q, Chen K, Fang B, Li W. Effects of ketogenic diet on cognitive function of patients with Alzheimer's disease: a systematic review and meta-analysis. J Nutr Health Aging 2024; 28:100306. [PMID: 38943982 DOI: 10.1016/j.jnha.2024.100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/09/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Ketogenic diets (KD) have shown remarkable effects in many disease areas. It has been demonstrated in numerous animal experiments that KD is effective in the treatment of Alzheimer's disease (AD). But the clinical effect of treating AD is uncertain. OBJECTIVE To systematically review the impact of KD on cognitive function in AD. METHODS We conducted a search of three international databases-PubMed, Cochrane Library, and Embase-to retrieve RCTs on the KD intervention for AD from the inception of the databases through October 2023. Two reviewers searched and screened the literature, extracted and checked relevant data independently, and assessed the risk of bias of the included studies. The meta-analysis was carried out utilizing RevMan 5.3 software. RESULTS A total of 10 RCTS involving 691 patients with AD were included. There were 357 participants in the intervention group and 334 participants in the control group. The duration of the KD intervention ranged from a minimum of 3 months to a maximum of 15 months. Meta-analysis results showed that KD could effectively improve the mental state of the elderly (NM scale) [MD = 7.56, 95%CI (3.02, 12.10), P = 0.001], MMSE [MD = 1.25, 95%CI (0.46, 2.04), P = 0.002], and ADAS-Cog [MD = -3.43, 95%CI (-5.98, -0.88), P = 0.008]. The elevation of ketone body (β-hydroxybutyric) [MD = 118.84, 95%CI (15.20, 222.48), P = 0.02] may also lead to the elevation of triglyceride [MD = 0.19, 95%CI (0.03, 0.35), P = 0.02] and low density lipoprotein [MD = 0.31, 95%CI (0.04, 0.58), P = 0.02]. CONCLUSION Research conducted has indicated that the KD can enhance the mental state and cognitive function of those with AD, albeit potentially leading to an elevation in blood lipid levels. In summary, the good intervention effect and safety of KD are worthy of promotion and application in clinical treatment of AD.
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Affiliation(s)
- Liyang Rong
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China; Sanya Hospital of Traditional Chinese Medicine, Sanya, China
| | - Yating Peng
- School of Basic Medical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Qi Shen
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Keying Chen
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bangjiang Fang
- Department of Emergency, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Weirong Li
- Science and Technology Innovation Center, Guangzhou University of Chinese Medicine, Guangzhou, China.
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Frenser M, Fischer T, Albrecht I, Marquardt T. Influence of Carbohydrate Intake on Caprylic Acid (C8:0)-Induced Ketogenesis-A Systematic Review and Meta-Analysis. Nutrients 2024; 16:2456. [PMID: 39125337 PMCID: PMC11314469 DOI: 10.3390/nu16152456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 07/23/2024] [Accepted: 07/24/2024] [Indexed: 08/12/2024] Open
Abstract
The ketogenic diet is used worldwide to treat various diseases, especially drug-resistant epilepsies. Medium-chain triglycerides or medium-chain fatty acids, primarily the major ketogenic compound caprylic acid (C8; C8:0), can significantly support ketogenesis. This review examines the effects of concurrent carbohydrate intake on C8-induced ketogenesis. A systematic literature search (PubMed and Web of Science) with subsequent data extraction was performed according to PRISMA guidelines and the Cochrane Handbook. Studies investigating the metabolic response to C8-containing MCT interventions with carbohydrate intake were included. The studies did not include a ketogenic diet. Three intervention groups were created. The quality of the studies was assessed using the RoB II tool, and the meta-analysis was performed using the Cochrane RevMan software. A total of 7 trials, including 4 RCTs, met the inclusion criteria. Ketone production was lower when C8 was combined with carbohydrates compared to MCT intake alone. The lower C8 dose group (11 g) did not show a significantly lower ketogenic effect than the higher dose group (19 g). Forest plot analysis showed heterogeneous data. The data suggest a non-linear relationship between C8, carbohydrate intake and ketone production. Further studies are needed to investigate the influence of different carbohydrates on C8-induced ketogenesis. Limitations include heterogeneous intervention conditions, such as different types of dispersions, caffeine intake, limited number of studies and variability in study design.
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Affiliation(s)
- Marius Frenser
- Department of Food, Nutrition, and Facilities, FH Muenster, University of Applied Sciences Muenster, 48149 Muenster, Germany
| | - Tobias Fischer
- Department of Food, Nutrition, and Facilities, FH Muenster, University of Applied Sciences Muenster, 48149 Muenster, Germany
| | - Isabel Albrecht
- Department of Food, Nutrition, and Facilities, FH Muenster, University of Applied Sciences Muenster, 48149 Muenster, Germany
| | - Thorsten Marquardt
- Department of General Pediatrics, Metabolic Diseases, University Hospital Muenster, 48149 Muenster, Germany
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Ren Q, Fu J, Duan X, Sun L, Mu Z, Liang W, Li Y, Wang Z, Xiu S. The Effects of Ketogenic Diet on Brain Gene Expressions in Type 2 Diabetes Background. Neuroscience 2024; 549:101-109. [PMID: 38734303 DOI: 10.1016/j.neuroscience.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/07/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024]
Abstract
Type 2 diabetes mellitus (T2DM) is a major risk factor of a number of neurodegenerative diseases (NDDs). Ketogenic diet (KD) has significant beneficial effects on glycemic control and may act effectively against NDDs, but the mechanism remains unclear. In this study, we aimed to investigate the potential effects of KD on gene expressions in the brains of T2DM model mice. Male db/db mice at the age of 9 weeks were fed with KD or normal diet to the age of 6 months, and the whole brains were subjected to mRNA-seq analysis for differentially expressed genes. KD significantly lowered fasting glucose and body weights in db/db mice (P < 0.05), and the expression of 189 genes in the brain were significantly changed (P < 0.05, |log2| > 1). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes enrichment analyses revealed that the differentially expressed genes upon KD are involved in inflammatory responses and the functions of biosynthesis. In inflammatory responses, NF-κB signaling pathway, viral protein interaction with cytokine and cytokine receptor, and cytokine-cytokine receptor interaction pathways were enriched, and in biosynthesis pathways, genes functioning in lipid and amino acid metabolism, protein synthesis, and energy metabolism were enriched. Moreover, consistent with the gene set enrichment analysis results, proteasomal activity measured biochemically were enhanced in KD-fed T2DM mice. These data may facilitate the understanding of how KD can be protective to the brain in T2DM background. KD could be a new strategy for the prevention of NDDs in T2DM patients.
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Affiliation(s)
- Qianxu Ren
- The National Clinical Research Center for Geriatric Disease, Department of Neurology, Advanced Innovation Center for Human Brain Protection, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junling Fu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xiaoye Duan
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Lina Sun
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Zhijing Mu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Wenping Liang
- The National Clinical Research Center for Geriatric Disease, Department of Neurology, Advanced Innovation Center for Human Brain Protection, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yu Li
- The National Clinical Research Center for Geriatric Disease, Department of Neurology, Advanced Innovation Center for Human Brain Protection, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhe Wang
- The National Clinical Research Center for Geriatric Disease, Department of Neurology, Advanced Innovation Center for Human Brain Protection, Xuanwu Hospital, Capital Medical University, Beijing, China.
| | - Shuangling Xiu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
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Wang Q, Liu Q, Zhong G, Xu T, Zhang X. Wearable Vertical Graphene-Based Microneedle Biosensor for Real-Time Ketogenic Diet Management. Anal Chem 2024; 96:8713-8720. [PMID: 38745346 DOI: 10.1021/acs.analchem.4c00960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Ketogenic diets have attracted substantial interest in the treatment of chronic diseases, but there are health risks with long-term regimes. Despite the advancements in diagnostic and therapeutic methods in modern medicine, there is a huge gap in personalized health management of this dietary strategy. Hence, we present a wearable microneedle biosensor for real-time ketone and glucose monitoring. The microneedle array possesses excellent mechanical properties, allowing for consistent sampling of interstitial biomarkers while reducing the pain associated with skin puncture. Vertical graphene with outstanding electrical conductivity provides the resulting sensor with a high sensitivity of 234.18 μA mM-1 cm-2 and a low limit detection of 1.21 μM. When this fully integrated biosensor was used in human volunteers, it displayed an attractive analytical capability for tracking the dynamic metabolite levels. Moreover, the results of the on-body evaluation established a significant correlation with commercial blood measurements. Overall, this cost-effective and efficient sensing platform can accelerate the application of a ketogenic diet in personal nutrition and wellness management.
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Affiliation(s)
- Qiyu Wang
- School of Biomedical Engineering, Institute for Advanced Study, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, P. R. China
| | - Qingzhou Liu
- Guangdong Laboratory of Artificial Intelligence and Digital Economy (SZ), Shenzhen University, Shenzhen 518060, China
| | - Geng Zhong
- School of Biomedical Engineering, Institute for Advanced Study, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, P. R. China
| | - Tailin Xu
- School of Biomedical Engineering, Institute for Advanced Study, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, P. R. China
| | - Xueji Zhang
- School of Biomedical Engineering, Institute for Advanced Study, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, P. R. China
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Samia P, Naanyu V, Helen Cross J, Idro R, Boon P, Wilmshurst J, Luchters S. Ketogenic dietary therapy utilization in Kenya: A qualitative exploration of dietitian's perceptions. Epilepsy Behav Rep 2024; 26:100661. [PMID: 38560597 PMCID: PMC10978472 DOI: 10.1016/j.ebr.2024.100661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/04/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
This study utilized a qualitative design to explore dietitians' perceptions regarding Ketogenic Diet Therapy (KDT) for patients with drug-resistant epilepsy in Kenya. Dietitians from Kenya were selected and consented. Audio-recorded interviews were conducted, followed by thematic analysis of verbatim transcripts to identify recurring patterns. The study enrolled 18 dietitians, fourteen of whom correctly described their understanding of KDT for managing drug-resistant epilepsy. There was a lack of confidence in their capacity to initiate the KDT with all expressing the need for further training and facilitation. Only one dietitian reported having initiated and maintained KDT. There was an overall positive view regarding KDT and willingness to implement KDT for patients with drug-resistant epilepsy. Dietitians expressed concerns regarding the availability of national policies, inadequate staffing to support families who require KDT, and the cost of implementing this intervention. Dietitians expressed interest in virtual training to enhance their understanding of KDT. Dietitians in Kenya are mostly aware of KDT utilization for the management of drug-resistant epilepsy. However, they cited poor capability and various barriers to implementation. There is a need for policies to facilitate KDT as a treatment option for the benefit of patients with drug-resistant epilepsy.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, 3rd Parklands Avenue, University Centre, Nairobi, Kenya
- Brain and Mind Institute, Aga Khan University, 3rd Parklands Avenue, University Centre, Nairobi, Kenya
- Department of Public Health and Primary Care, Ghent University, Sint-Pietersnieuwstraat 25, Gent, Ost-Flandern, Belgium
| | - Violet Naanyu
- School of Arts & Social Sciences, Moi University, Main Campus, Eldoret, Kenya
- AMPATH Research, AMPATH Centre, Nandi Road, Eldoret, Kenya
| | - J Helen Cross
- UCL BRC NIHR Great Ormond Street, Institute of Child Health, London, United Kingdom
| | - Richard Idro
- Makerere University, Department of Paediatrics and Child Health, University Road, Kampala, Uganda
| | - Paul Boon
- Department of Neurology, Ghent University, Sint-Pietersnieuwstraat 25, Gent, Ost-Flandern, Belgium
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, South Africa
- Institute of Neurosciences, University of Cape Town, Woolsack Drive, Cape Town, South Africa
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Sint-Pietersnieuwstraat 25, Gent, Ost-Flandern, Belgium
- The Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Road, Harare, Zimbabwe
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, United Kingdom
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Díez-Arroyo C, García-García M, Soto-Méndez MJ, Molina-Montes E, Gil-Campos M, Gil Á, Gutiérrez-Jimeno M, Hernández-Ruiz Á. Effect of the ketogenic diet as a treatment for refractory epilepsy in children and adolescents: a systematic review of reviews. Nutr Rev 2024; 82:487-502. [PMID: 37400987 DOI: 10.1093/nutrit/nuad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
CONTEXT Epilepsy is one of the most prevalent neurological disorders in childhood. Antiepileptic drugs are the preferred treatment. However, 30% of children continue suffering seizures. A ketogenic diet (KD) is one of the emerging alternative treatments. OBJECTIVE This review aims to analyze the current evidence regarding the use of a KD for the treatment of refractory epilepsy (RE) in childhood. DATA SOURCES A systematic review of reviews was performed, based on MEDLINE (PubMed) as at January 2021. DATA EXTRACTION The data extracted included the first author's last name; the year of publication; the country; the study design; the population; the diagnosis, concept, and description of KD types; and major outcome. RESULTS Twenty-one reviews were included, 8 with systematic methodology (2 of them included a meta-analysis) and 13 with unsystematic methodology. The main difference between the 2 types of reviews is the reproducibility of their methodology. Therefore, the results of each type of review were analyzed separately. Each type of review described 4 categories of KD: classic KD, modified Atkins diet (MAD), use of medium-chain triglycerides (MCTs), and low glycemic index treatment (LGIT). In terms of effectiveness, the considered systematic reviews reported reductions in the frequency of seizures greater than 50% in about half of the patients. Reviews without systematic methodology reported that 30%-60% of the children showed a 50% or greater reduction in seizures. The most frequently described adverse effects in the 8 systematic reviews were: vomiting (6/8), constipation (6/8), and diarrhea (6/8); and in the unsystematic reviews: vomiting and nausea (10/13), constipation (10/13), and acidosis (9/13). CONCLUSION KD can be an effective treatment for RE, with a more than 50% reduction in the frequency of seizures and cognitive improvement being achieved in half of the pediatric patients. The effectiveness of the various types of KD is comparable, and the KD can be adapted to the needs of the patient. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42021244142.
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Affiliation(s)
- Cristina Díez-Arroyo
- Nursing Department, Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Unidad de Hospitalización de Medicina Interna, Hospital Tres Mares, Reinosa, Cantabria, Spain
| | - Mónica García-García
- Nursing Department, Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Servicio de Emergencias Sanitarias de SACYL, Valladolid, Spain
| | | | - Esther Molina-Montes
- Department of Nutrition and Food Science, University of Granada, Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix," Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Armilla, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- CIBERESP (Epidemiology and Publich Health), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Mercedes Gil-Campos
- CIBEROBN, (Physiopathology of Obesity and Nutrition), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Metabolism and Investigation Unit, Reina Sofia University Hospital, Maimónides Institute of Biomedicine Research of Córdoba (IMIBIC), University of Córdoba, Córdoba, Spain
| | - Ángel Gil
- Iberoamerican Nutrition Foundation (FINUT), Armilla, Granada, Spain
- Institute of Nutrition and Food Technology "José Mataix," Biomedical Research Center, University of Granada, Parque Tecnológico de la Salud, Armilla, Granada, Spain
- Instituto de Investigación Biosanitaria ibs. GRANADA, Granada, Spain
- CIBEROBN, (Physiopathology of Obesity and Nutrition), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Department of Biochemistry and Molecular Biology, II University of Granada, University of Granada, Granada, Spain
| | - Miriam Gutiérrez-Jimeno
- Departamento de Pediatría del Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángela Hernández-Ruiz
- Nursing Department, Faculty of Nursing, University of Valladolid, Valladolid, Spain
- Iberoamerican Nutrition Foundation (FINUT), Armilla, Granada, Spain
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Tagliabue A, Armeno M, Berk KA, Guglielmetti M, Ferraris C, Olieman J, van der Louw E. Ketogenic diet for epilepsy and obesity: Is it the same? Nutr Metab Cardiovasc Dis 2024; 34:581-589. [PMID: 38326186 DOI: 10.1016/j.numecd.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
The term "ketogenic diet" (KD) is used for a wide variety of diets with diverse indications ranging from obesity to neurological diseases, as if it was the same diet. This terminology is confusing for patients and the medical and scientific community. The term "ketogenic" diet implies a dietary regimen characterized by increased levels of circulating ketone bodies that should be measured in blood (beta-hydroxybutyrate), urine (acetoacetate) or breath (acetone) to verify the "ketogenic metabolic condition". Our viewpoint highlights that KDs used for epilepsy and obesity are not the same; the protocols aimed at weight loss characterized by low-fat, low-CHO and moderate/high protein content are not ketogenic by themselves but may become mildly ketogenic when high calorie restriction is applied. In contrast, there are standardized protocols for neurological diseases treatment for which ketosis has been established to be part of the mechanism of action. Therefore, in our opinion, the term ketogenic dietary therapy (KDT) should be reserved to the protocols considered for epilepsy and other neurological diseases, as suggested by the International Study Group in 2018. We propose to adjust the abbreviations in VLCHKD for Very Low CarboHydrate Ketogenic Diet and VLEKD for Very Low Energy Ketogenic Diet, to clarify the differences in dietary composition. We recommend that investigators describe the researchers describing efficacy or side effects of KDs, to clearly specify the dietary protocol used with its unique acronym and level of ketosis, when ketosis is considered as a component of the diet's mechanism of action.
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Affiliation(s)
- A Tagliabue
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health Experimental and Forensic Medicine, University of Pavia, Italy
| | - M Armeno
- Ketogenic Diet Team Unit, Clinical Nutrition Department, Hospital Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - K A Berk
- Department of Internal Medicine, Division of Dietetics, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - M Guglielmetti
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health Experimental and Forensic Medicine, University of Pavia, Italy.
| | - C Ferraris
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health Experimental and Forensic Medicine, University of Pavia, Italy
| | - J Olieman
- Department of Internal Medicine, Division of Dietetics, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - E van der Louw
- Department of Internal Medicine, Division of Dietetics, Erasmus MC University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Samad N, Manzoor N, Batool A, Noor A, Khaliq S, Aurangzeb S, Bhatti SA, Imran I. Protective effects of niacin following high fat rich diet: an in-vivo and in-silico study. Sci Rep 2023; 13:21343. [PMID: 38049514 PMCID: PMC10696033 DOI: 10.1038/s41598-023-48566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
Niacin had long been understood as an antioxidant. There were reports that high fat diet (HFD) may cause psychological and physical impairments. The present study was aimed to experience the effect of Niacin on % growth rate, cumulative food intake, motor activity and anxiety profile, redox status, 5-HT metabolism and brain histopathology in rats. Rats were administered with Niacin at a dose of 50 mg/ml/kg body weight for 4 weeks following normal diet (ND) and HFD. Behavioral tests were performed after 4 weeks. Animals were sacrificed to collect brain samples. Biochemical, neurochemical and histopathological studies were performed. HFD increased food intake and body weight. The exploratory activity was reduced and anxiety like behavior was observed in HFD treated animals. Activity of antioxidant enzymes was decreased while oxidative stress marker and serotonin metabolism in the brain of rat were increased in HFD treated animals than ND fed rats. Morphology of the brain was also altered by HFD administration. Conversely, Niacin treated animals decreased food intake and % growth rate, increased exploratory activity, produced anxiolytic effects, decreased oxidative stress and increased antioxidant enzyme and 5-HT levels following HFD. Morphology of brain is also normalized by the treatment of Niacin following HFD. In-silico studies showed that Niacin has a potential binding affinity with degradative enzyme of 5-HT i.e. monoamine oxidase (MAO) A and B with an energy of ~ - 4.5 and - 5.0 kcal/mol respectively. In conclusion, the present study showed that Niacin enhanced motor activity, produced anxiolytic effect, and reduced oxidative stress, appetite, growth rate, increased antioxidant enzymes and normalized serotonin system and brain morphology following HFD intake. In-silico studies suggested that increase 5-HT was associated with the binding of MAO with Niacin subsequentially an inhibition of the degradation of monoamine. It is suggested that Niacin has a great antioxidant potential and could be a good therapy for the treatment of HFD induced obesity.
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Affiliation(s)
- Noreen Samad
- Department of Biochemistry, Faculty of Science, Bahauddin Zakariya University, Multan, 60800, Pakistan.
| | - Natasha Manzoor
- Department of Biochemistry, Faculty of Science, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Ammara Batool
- Department of Biochemistry, Faculty of Science, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Aqsa Noor
- Department of Biochemistry, Faculty of Science, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Saima Khaliq
- Department of Biochemistry, Faculty of Science, Science and Technology, Federal Urdu University of Arts, Karachi, 75270, Pakistan
| | - Sana Aurangzeb
- Department of Biochemistry, Faculty of Science, University of Karachi, Karachi, 75270, Pakistan
| | - Sheraz Ahmed Bhatti
- Department of Pathobiology, Faculty of Veterinary Science, Bahauddin Zakariya University, Multan, 60800, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, 60800, Pakistan
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11
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Phelan JM, Joyce JM, Bode K, Rosenkranz SK. Opportunities for Maximizing the Dietary Quality of Fad Diets. Nutrients 2023; 15:4526. [PMID: 37960179 PMCID: PMC10649867 DOI: 10.3390/nu15214526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 11/15/2023] Open
Abstract
The quality of American diets, measured by the Healthy Eating Index (HEI), has remained stable and low since 2005. The Dietary Guidelines for Americans 2020-2025 call for research analyzing dietary patterns to determine how guidelines might be altered to increase healthy eating. The present paper seeks to determine the dietary quality of popular fad dietary patterns among Americans. A definition of "fad diet" was created, and Google Trends© was searched for popular diets to determine popular dietary patterns based on the fad diet definition. Finally, eight dietary patterns were identified for inclusion. One-week sample menus were created for each dietary pattern, maximizing alignment with the DGAs but staying within the dietary pattern parameters, and then scored according to the HEI 2015 to determine the dietary quality. Total HEI scores ranged from 26.7 (Carnivore) to 89.1 (Low-FODMAP); the six highest total HEI scores were in the range of 77.1-89.1 out of 100 points. This analytical approach showed that some of the included popular fad dietary patterns have the potential to attain a high dietary quality. Rather than suggesting one "best" diet or dietary pattern, there is opportunity to maximize dietary quality in the context of dietary patterns that are considered fad diets.
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Affiliation(s)
- Jessica M. Phelan
- Department of Food Nutrition Dietetics and Health, Kansas State University, Manhattan, KS 66506, USA
- Department of Health and Human Performance, Fort Hays State University, Hays, KS 67550, USA
| | - Jillian M. Joyce
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK 74078, USA; (J.M.J.)
| | - Katherine Bode
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK 74078, USA; (J.M.J.)
| | - Sara K. Rosenkranz
- Department of Kinesiology and Nutrition Sciences, University of Nevada, Las Vegas, NV 89154, USA;
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12
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Halma MTJ, Tuszynski JA, Marik PE. Cancer Metabolism as a Therapeutic Target and Review of Interventions. Nutrients 2023; 15:4245. [PMID: 37836529 PMCID: PMC10574675 DOI: 10.3390/nu15194245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/20/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Cancer is amenable to low-cost treatments, given that it has a significant metabolic component, which can be affected through diet and lifestyle change at minimal cost. The Warburg hypothesis states that cancer cells have an altered cell metabolism towards anaerobic glycolysis. Given this metabolic reprogramming in cancer cells, it is possible to target cancers metabolically by depriving them of glucose. In addition to dietary and lifestyle modifications which work on tumors metabolically, there are a panoply of nutritional supplements and repurposed drugs associated with cancer prevention and better treatment outcomes. These interventions and their evidentiary basis are covered in the latter half of this review to guide future cancer treatment.
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Affiliation(s)
- Matthew T. J. Halma
- Department of Physics and Astronomy, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
- EbMC Squared CIC, Bath BA2 4BL, UK
| | - Jack A. Tuszynski
- Department of Physics, University of Alberta, 11335 Saskatchewan Dr NW, Edmonton, AB T6G 2M9, Canada
- Department of Data Science and Engineering, The Silesian University of Technology, 44-100 Gliwice, Poland
- DIMEAS, Politecnico di Torino, Corso Duca degli Abruzzi 24, I-1029 Turin, Italy
| | - Paul E. Marik
- Frontline COVID-19 Critical Care Alliance, Washington, DC 20036, USA
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13
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Najjar RS. The Impacts of Animal-Based Diets in Cardiovascular Disease Development: A Cellular and Physiological Overview. J Cardiovasc Dev Dis 2023; 10:282. [PMID: 37504538 PMCID: PMC10380617 DOI: 10.3390/jcdd10070282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in the United States, and diet plays an instrumental role in CVD development. Plant-based diets have been strongly tied to a reduction in CVD incidence. In contrast, animal food consumption may increase CVD risk. While increased serum low-density lipoprotein (LDL) cholesterol concentrations are an established risk factor which may partially explain the positive association with animal foods and CVD, numerous other biochemical factors are also at play. Thus, the aim of this review is to summarize the major cellular and molecular effects of animal food consumption in relation to CVD development. Animal-food-centered diets may (1) increase cardiovascular toll-like receptor (TLR) signaling, due to increased serum endotoxins and oxidized LDL cholesterol, (2) increase cardiovascular lipotoxicity, (3) increase renin-angiotensin system components and subsequent angiotensin II type-1 receptor (AT1R) signaling and (4) increase serum trimethylamine-N-oxide concentrations. These nutritionally mediated factors independently increase cardiovascular oxidative stress and inflammation and are all independently tied to CVD development. Public policy efforts should continue to advocate for the consumption of a mostly plant-based diet, with the minimization of animal-based foods.
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Affiliation(s)
- Rami Salim Najjar
- Institute for Biomedical Sciences, Georgia State University, Atlanta, GA 30303, USA
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14
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Erkent I, Ilgaz F, Dericioglu N. Difficulties in the implementation of the ketogenic diet in adult patients with refractory epilepsy. Epilepsy Behav 2023; 144:109234. [PMID: 37192580 DOI: 10.1016/j.yebeh.2023.109234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Ketogenic diet therapies (KDT) are appropriate therapeutic options for pediatric and adult patients with intractable epilepsy. The application of KDT among adult patients with refractory epilepsy is limited compared to children for several reasons, including poor compliance. We present the significant reasons for the lack of adherence to KDT in our adult patients with intractable epilepsy. METHODS This study was conducted retrospectively in adult patients with drug-resistant epilepsy who wereofferedand accepted toimplementKDT between 2014 and 2021. Demographic and clinical data were collected via electronic health records. The eventual outcome of KDT results was obtained from the consultant dietitian. The prevalence and reasons for the failure to implement KDT were investigated. We also obtained detailed information about patients who successfully applied the KDT. RESULTS A total of 33 patients (18F; median age 28) who wereoffered and accepted to implement KDT were included. Baseline seizure frequency was >4 per week in 49%, and more than half of the patients used >3 anti-seizure medications (ASM). Epilepsy types were temporal in 10 (30%), extratemporal in 10 (30%), generalized in 6 (18%), and unclassified in 7 (22%) patients.Only 3 patients (9%) were able to maintain KDT in the long term. One of them (33%) benefited from this therapy.In the remaining 30 patients, the reasons for failure were inability to contact the dietitian in 5, failure to apply KDT for a particular reason in 7, inappropriate blood test results or any medical/surgical comorbidities in 6, improvement in seizure burden due to change in ASM in 5, still insufficient knowledge of KDT in 3, unresponsiveness to diet due to incorrect implementation in 1 and unidentified reasons in 3 patients. CONCLUSIONS A significant percentage of adult patients with refractory seizures failed to use KDTin our study(91%).Strategies to improve compliance and minimize the side effects might increase the number of drug-refractory epilepsy patients who could benefit from this therapy.
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Affiliation(s)
- Irem Erkent
- Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Fatma Ilgaz
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Hacettepe University, Ankara, Turkey.
| | - Nese Dericioglu
- Clinical Neurophysiology, Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
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15
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Mentzelou M, Dakanalis A, Vasios GK, Gialeli M, Papadopoulou SK, Giaginis C. The Relationship of Ketogenic Diet with Neurodegenerative and Psychiatric Diseases: A Scoping Review from Basic Research to Clinical Practice. Nutrients 2023; 15:nu15102270. [PMID: 37242153 DOI: 10.3390/nu15102270] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The ketogenic diet (KD) has become widespread for the therapy of epileptic pathology in childhood and adulthood. In the last few decades, the current re-emergence of its popularity has focused on the treatment of obesity and diabetes mellitus. KD also exerts anti-inflammatory and neuroprotective properties, which could be utilized for the therapy of neurodegenerative and psychiatric disorders. PURPOSE This is a thorough, scoping review that aims to summarize and scrutinize the currently available basic research performed in in vitro and in vivo settings, as well as the clinical evidence of the potential beneficial effects of KD against neurodegenerative and psychiatric diseases. This review was conducted to systematically map the research performed in this area as well as identify gaps in knowledge. METHODS We thoroughly explored the most accurate scientific web databases, e.g., PubMed, Scopus, Web of Science, and Google Scholar, to obtain the most recent in vitro and in vivo data from animal studies as well as clinical human surveys from the last twenty years, applying effective and characteristic keywords. RESULTS Basic research has revealed multiple molecular mechanisms through which KD can exert neuroprotective effects, such as neuroinflammation inhibition, decreased reactive oxygen species (ROS) production, decreased amyloid plaque deposition and microglial activation, protection in dopaminergic neurons, tau hyper-phosphorylation suppression, stimulating mitochondrial biogenesis, enhancing gut microbial diversity, restoration of histone acetylation, and neuron repair promotion. On the other hand, clinical evidence remains scarce. Most existing clinical studies are modest, frequently uncontrolled, and merely assess the short-term impacts of KD. Moreover, several clinical studies had large dropout rates and a considerable lack of compliance assessment, as well as an increased level of heterogeneity in the study design and methodology. CONCLUSIONS KD can exert substantial neuroprotective effects via multiple molecular mechanisms in various neurodegenerative and psychiatric pathological states. Large, long-term, randomized, double-blind, controlled clinical trials with a prospective design are strongly recommended to delineate whether KD may attenuate or even treat neurodegenerative and psychiatric disease development, progression, and symptomatology.
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Affiliation(s)
- Maria Mentzelou
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Antonios Dakanalis
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
| | - Georgios K Vasios
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Maria Gialeli
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
| | - Sousana K Papadopoulou
- Department of Nutritional Sciences and Dietetics, School of Health Sciences, International Hellenic University, 57400 Thessaloniki, Greece
| | - Constantinos Giaginis
- Department of Food Science and Nutrition, School of Environment, University of Aegean, 81400 Myrina, Greece
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16
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Cao H, Cai Q, Guo W, Su Q, Qin H, Wang T, Xian Y, Zeng L, Cai M, Guan H, Chen S, Liang H, Xu F. Malonylation of Acetyl-CoA carboxylase 1 promotes hepatic steatosis and is attenuated by ketogenic diet in NAFLD. Cell Rep 2023; 42:112319. [PMID: 37002924 DOI: 10.1016/j.celrep.2023.112319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Protein post-translational modifications (PTMs) participate in important bioactive regulatory processes and therefore can help elucidate the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Here, we investigate the involvement of PTMs in ketogenic diet (KD)-improved fatty liver by multi-omics and reveal a core target of lysine malonylation, acetyl-coenzyme A (CoA) carboxylase 1 (ACC1). ACC1 protein levels and Lys1523 malonylation are significantly decreased by KD. A malonylation-mimic mutant of ACC1 increases its enzyme activity and stability to promote hepatic steatosis, whereas the malonylation-null mutant upregulates the ubiquitination degradation of ACC1. A customized Lys1523ACC1 malonylation antibody confirms the increased malonylation of ACC1 in the NAFLD samples. Overall, the lysine malonylation of ACC1 is attenuated by KD in NAFLD and plays an important role in promoting hepatic steatosis. Malonylation is critical for ACC1 activity and stability, highlighting the anti-malonylation effect of ACC1 as a potential strategy for treating NAFLD.
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Affiliation(s)
- Huanyi Cao
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China; Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China
| | - Qingxian Cai
- Department of Hepatopathy, the Third People's Hospital of Shenzhen, the Second Affiliated Hospital of Southern University of Science and Technology, Shenzhen 518112, P.R. China
| | - Wanrong Guo
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China
| | - Qiao Su
- Animal Experiment Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, P.R. China
| | - Hancheng Qin
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China
| | - Tian Wang
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China
| | - Yingxin Xian
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China
| | - Longyi Zeng
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China
| | - Mengyin Cai
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, P.R. China
| | - Sifan Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Guangdong-Hong Kong Joint Laboratory for RNA Medicine, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, P.R. China; Medical Research Center, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou 510120, P.R. China
| | - Hua Liang
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China.
| | - Fen Xu
- Department of Endocrinology and Metabolism, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, P.R. China; Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, P.R. China.
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17
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Ferraris C, Guglielmetti M, Neri LDCL, Allehdan S, Mohsin Albasara JM, Fareed Alawadhi HH, Trentani C, Perna S, Tagliabue A. A Review of Ketogenic Dietary Therapies for Epilepsy and Neurological Diseases: A Proposal to Implement an Adapted Model to Include Healthy Mediterranean Products. Foods 2023; 12:foods12091743. [PMID: 37174282 PMCID: PMC10178865 DOI: 10.3390/foods12091743] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Based on the growing evidence of the therapeutic role of high-fat ketogenic dietary therapies (KDTs) for neurological diseases and on the protective effect of the Mediterranean diet (MD), it could be important to delineate a Mediterranean version of KDTs in order to maintain a high ketogenic ratio, and thus avoid side effects, especially in patients requiring long-term treatment. This narrative review aims to explore the existing literature on this topic and to elaborate recommendations for a Mediterranean version of the KDTs. It presents practical suggestions based on MD principles, which consist of key elements for the selection of foods (both from quantitative and qualitative prospective), and indications of the relative proportions and consumption frequency of the main food groups that constitute the Mediterranean version of the KDTs. We suggest the adoption of a Mediterranean version of ketogenic diets in order to benefit from the multiple protective effects of the MD. This translates to: (i) a preferential use of olive oil and vegetable fat sources in general; (ii) the limitation of foods rich in saturated fatty acids; (iii) the encouragement of high biological value protein sources; (iv) inserting fruit and vegetables at every meal possible, varying their choices according to seasonality.
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Affiliation(s)
- Cinzia Ferraris
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Monica Guglielmetti
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
- Laboratory of Food Education and Sport Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy
| | - Lenycia de Cassya Lopes Neri
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
| | - Sabika Allehdan
- Department of Biology, College of Science, University of Bahrain, Sakhir P.O. Box 32038, Bahrain
| | | | | | - Claudia Trentani
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
| | - Simone Perna
- Division of Human Nutrition, Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20122 Milano, Italy
| | - Anna Tagliabue
- Ketogenic Metabolic Therapy Laboratory, Department of Public Health, Experimental and Forensics Medicine, University of Pavia, 27100 Pavia, Italy
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18
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Corsello A, Trovato CM, Di Profio E, Cardile S, Campoy C, Zuccotti G, Verduci E, Diamanti A. Ketogenic Diet in Children and Adolescents: the Effects on Growth and Nutritional Status. Pharmacol Res 2023; 191:106780. [PMID: 37088260 DOI: 10.1016/j.phrs.2023.106780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/12/2023] [Accepted: 04/21/2023] [Indexed: 04/25/2023]
Abstract
The ketogenic diet is known to be a possible adjuvant treatment in several medical conditions, such as in patients with severe or drug-resistant forms of epilepsy. Its use has recently been increasing among adolescents and young adults due to its supposed weight-loss effect, mediated by lipolysis and lowered insulin levels. However, there are still no precise indications on the possible use of ketogenic diets in pediatric age for weight loss. This approach has also recently been proposed for other types of disorder such as inherited metabolic disorders, Prader-Willi syndrome, and some specific types of cancers. Due to its unbalanced ratio of lipids, carbohydrates and proteins, a clinical evaluation of possible side effects with a strict evaluation of growth and nutritional status is essential in all patients following a long-term restrictive diet such as the ketogenic one. The prophylactic use of micronutrients supplementation should be considered before starting any ketogenic diet. Lastly, while there is sufficient literature on possible short-term side effects of ketogenic diets, their possible long-term impact on growth and nutritional status is not yet fully understood, especially when started in pediatric age.
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Affiliation(s)
- Antonio Corsello
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy.
| | - Chiara Maria Trovato
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Rome, Italy.
| | - Elisabetta Di Profio
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
| | - Sabrina Cardile
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Rome, Italy.
| | - Cristina Campoy
- Department of Paediatrics, School of Medicine, University of Granada, Granada, Spain; EURISTIKOS Excellence Centre for Paediatric Research, Biomedical Research Centre, University of Granada, Granada, Spain; Spanish Network of Biomedical Research in Epidemiology and Public Health (CIBERESP), Granada's node, Institute of Health Carlos III, Madrid, Spain.
| | - Gianvincenzo Zuccotti
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy; Pediatric Clinical Research Center, Fondazione Romeo ed Enrica Invernizzi, University of Milan, Milan, Italy.
| | - Elvira Verduci
- Department of Paediatrics, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy; Department of Health Sciences, University of Milan, Milan, Italy.
| | - Antonella Diamanti
- Hepatology Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, Rome, Italy.
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19
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O'Malley K, Willits-Smith A, Rose D. Popular diets as selected by adults in the United States show wide variation in carbon footprints and diet quality. Am J Clin Nutr 2023; 117:701-708. [PMID: 36868999 PMCID: PMC10131583 DOI: 10.1016/j.ajcnut.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Carbon footprints of vegetarian, pescatarian, and other popular diets have been studied previously, but mostly as idealized versions modeled to meet dietary recommendations. Less is known about the footprints of popular diets as they are consumed by US adults, and thus the potential trade-offs with diet quality for free-living individuals. OBJECTIVES This study estimated the carbon footprint and diet quality of popular diets as selected by a nationally representative sample of US consumers, including the recently trending keto- and paleo-style diets. METHODS The 2005-2010 NHANES 24-h recall data were used to categorize individual adult diets (n = 16,412) into 6 types: vegan, vegetarian, pescatarian, paleo, keto, and all other diets, referred to here as omnivore diets. Average daily greenhouse gas emissions in kilograms of carbon dioxide equivalents per 1000 kcal (kg CO2-eq/1000 kcal) were calculated for each diet by matching our previously developed database to NHANES individual diet data. Diet quality was determined using the Healthy Eating Index (HEI) and the Alternate Healthy Eating Index. Survey-weighted ordinary least-squares regression was used to assess mean differences in diets. RESULTS The average carbon footprints of vegan (0.69 ± 0.05 kg CO2-eq/1000 kcal) and vegetarian (1.16 ± 0.02) diets were lower (P < 0.05) than those of the pescatarian (1.66 ± 0.04), omnivore (2.23 ± 0.01), paleo (2.62 ± 0.33), or keto (2.91 ± 0.27) diets. Mean HEI scores were highest for pescatarian diets (58.76 ± 0.79) and higher (P < 0.05) for vegetarian (51.89 ± 0.74) than for omnivore (48.92 ± 0.33) or keto (43.69 ± 1.61) diets. CONCLUSIONS Our results highlight the nuances when evaluating the nutritional quality of diets and their carbon footprints. On average, pescatarian diets may be the healthiest, but plant-based diets have lower carbon footprints than other popular diets, including keto- and paleo-style diets.
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Affiliation(s)
- Keelia O'Malley
- Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Amelia Willits-Smith
- Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Donald Rose
- Tulane Nutrition, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
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20
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Abstract
Despite the emergence of stronger nutritional science over the past two decades, fad diets remain highly popular. However, growing medical evidence has led to the endorsement of healthy eating patterns by medical societies. This thus allows fad diets to be compared to the emerging scientific evidence as to which diets promote or damage health. In this narrative review, the most popular current fad diets are critically analyzed, including low-fat diets, vegan and vegetarian diets, low-carbohydrate diets, ketogenic diets, Paleolithic diets, and intermittent fasting. Each of these diets has some scientific merit, but each has potential deficiencies relative to the findings of nutritional science. This article also presents the common themes that emerge among the dietary guidance of leading health organizations, such as the American Heart Association and the American College of Lifestyle Medicine. While there are important distinctions between dietary recommendations emanating from various medical societies, each recommends eating more unrefined, plant-based foods, while eating fewer highly processed foods and added sugars, and avoiding excessive calorie consumption as an important nutritional strategy for the prevention and management of chronic conditions and promotion of overall health.
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Affiliation(s)
- Kayli Anderson
- Food as Medicine Course, The American College of Lifestyle Medicine, PO Box 1188, Salida, CO 81201, United States of America.
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21
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Bedlack R, Barkhaus PE, Barnes B, Beauchamp M, Bertorini T, Bromberg MB, Carter GT, Chaudry V, Cudkowicz M, Jackson C, Levitsky G, Lund I, McDermott C, Novella S, Olby N, Ostrow L, Pattee GL, Heiman-Patterson T, Ratner D, Salmon K, Steves S, Terrelonge M, Wicks P, Wills AM. ALSUntangled #63: ketogenic diets. Amyotroph Lateral Scler Frontotemporal Degener 2023; 24:159-163. [PMID: 34645313 DOI: 10.1080/21678421.2021.1990346] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/28/2021] [Indexed: 01/26/2023]
Abstract
ALSUntangled reviews alternative and off label treatments with a goal of helping patients make more informed decisions about them. Here we review ketogenic diets. We shows that these have plausible mechanisms, including augmenting cellular energy balance and reducing excitotoxicity, neuroinflammation and oxidative stress. We review a mouse model study, anecdotal reports and trials in ALS and other diseases. We conclude that there is yet not enough data to recommend ketogenic diets for patients with ALS, especially in light of the many side effects these can have.
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Affiliation(s)
- Richard Bedlack
- Neurology Department, Duke University, Durham, NC, United States
| | - Paul E Barkhaus
- Neurology Department, Froedtert & the Medical College of Wisconsin, Kenosha, WI, United States
| | - Benjamin Barnes
- Neurology Department, Augusta University Medical College of Georgia, Augusta, GA, United States
| | | | - Tulio Bertorini
- Neurology Department, The University of Tennessee Health Science Center VolShop Memphis, Memphis, TN, United States
| | - Mark B Bromberg
- Neurology Department, University of Utah Health Hospitals and Clinics, Salt Lake City, UT, United States
| | - Gregory T Carter
- St Lukes Rehabilitation Hospital, Physical Medicine and Rehabilitation, Chesterfield, MO, United States
| | - Vinay Chaudry
- Neurology Department, University of North Carolina School of Medicine Neuroscience Center, Chapel Hill, NC, United States
| | - Merit Cudkowicz
- Neurology Department, Mass General Brigham Inc., Boston, MA, United States
| | - Ce Jackson
- Neurology Department, The University of Texas Health Science Center at San Antonio - Greehey Academic and Research Campus, San Antonio, TX, United States
| | | | - Isaac Lund
- Green Hope High School, Cary, NC, United States
| | - Christopher McDermott
- The University of Sheffield Institute for Translational Neuroscience, Sheffield, United Kingdom
| | - Steven Novella
- Neurology Department, Yale University, New Haven, CT, United States
| | - Natasha Olby
- Neurology Department, North Carolina State University, Raleigh, NC, United States
| | - Lyle Ostrow
- Neurology Department, Johns Hopkins University, Baltimore, MD, United States
| | - Gary L Pattee
- Neurology Department, University of Nebraska Medical Center College of Medicine, Omaha, NE, United States
| | | | - Dylan Ratner
- Longmeadow High School, Longmeadow, MA, United States
| | - Kristiana Salmon
- Neurology Department, McGill Centre for Research in Neuroscience, Montreal, Canada
| | - Susan Steves
- Nutrition Department, Duke University, Durham, NC, United States
| | - Mark Terrelonge
- Neurology Department, University of California San Francisco, San Francisco, CA, United States
| | | | - Anne-Marie Wills
- Neurology Department, Mass General Brigham Inc., Boston, MA, United States
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22
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Sharma S, Whitney R, Kossoff EH, RamachandranNair R. Does the ketogenic ratio matter when using ketogenic diet therapy in pediatric epilepsy? Epilepsia 2023; 64:284-291. [PMID: 36471628 DOI: 10.1111/epi.17476] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
The ketogenic diet (KD) is a widely used therapeutic option for individuals with medically refractory epilepsy. As the diet's name implies, ketosis is a historically important component of the diet, but it is not well understood how important ketosis is for seizure control. The ketogenic ratio is defined as the ratio of fat to carbohydrate plus protein by weight in the diet (grams). Traditionally, the classic KD contains a 4:1 ratio, and a very high proportion of fat in the diet. The classic KD, with its high proportion of fat and limited carbohydrate intake can be restrictive for patients with epilepsy. Recently, there is experience with use of lower ketogenic ratios and less-restrictive diets such as the modified Atkins diet and the low glycemic index treatment. In this narrative review, we examine the role of ketosis and ketogenic ratios in determining the efficacy of the KD in children with epilepsy.
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Affiliation(s)
- Suvasini Sharma
- Neurology Division, Department of Pediatrics, Lady Harding Medical College and Associated Kalawati Saran Children Hospital, New Delhi, India
| | - Robyn Whitney
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Eric H Kossoff
- Departments of Neurology and Pediatrics, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rajesh RamachandranNair
- Division of Neurology, Department of Paediatrics, McMaster University, Hamilton, Ontario, Canada
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23
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Saris CGJ, Timmers S. Ketogenic diets and Ketone suplementation: A strategy for therapeutic intervention. Front Nutr 2022; 9:947567. [PMID: 36458166 PMCID: PMC9705794 DOI: 10.3389/fnut.2022.947567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 10/13/2022] [Indexed: 07/24/2023] Open
Abstract
Ketogenic diets and orally administered exogenous ketone supplements are strategies to increase serum ketone bodies serving as an alternative energy fuel for high energy demanding tissues, such as the brain, muscles, and the heart. The ketogenic diet is a low-carbohydrate and fat-rich diet, whereas ketone supplements are usually supplied as esters or salts. Nutritional ketosis, defined as serum ketone concentrations of ≥ 0.5 mmol/L, has a fasting-like effect and results in all sorts of metabolic shifts and thereby enhancing the health status. In this review, we thus discuss the different interventions to reach nutritional ketosis, and summarize the effects on heart diseases, epilepsy, mitochondrial diseases, and neurodegenerative disorders. Interest in the proposed therapeutic benefits of nutritional ketosis has been growing the past recent years. The implication of this nutritional intervention is becoming more evident and has shown interesting potential. Mechanistic insights explaining the overall health effects of the ketogenic state, will lead to precision nutrition for the latter diseases.
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Affiliation(s)
- Christiaan G. J. Saris
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
- Radboud Center for Mitochondrial Medicine, Nijmegen, Netherlands
| | - Silvie Timmers
- Department of Human and Animal Physiology, Wageningen University, Wageningen, Netherlands
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24
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Quiroga-Padilla PJ, Briceño C, Mayor LC. Effect of the modified Atkins diet in adults with drug-resistant epilepsy: A controlled study. Epilepsy Behav 2022; 136:108936. [PMID: 36215831 DOI: 10.1016/j.yebeh.2022.108936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/21/2022] [Accepted: 09/24/2022] [Indexed: 12/14/2022]
Abstract
The objective of this study was to be a proof of concept of an analysis strategy to assess the effectiveness of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE). This retrospective cohort study included participants aged >16 years with at least two failed antiseizure medications (ASMs). The variables were self-reported and gathered from medical records or phone calls. Two groups are compared: MAD adjuvant to ASM (diet group) and ASM only (control). To make both groups comparable, diet and control groups were matched (1:2) by predictors of seizure remission (PSR) in adults with DRE. A systematic review of the literature was conducted to establish PSR. A total of 127 patients were eligible. Forty-six participants (36 %) initiated the MAD, but only 28 (22 %) continued the diet after 3 months. The number of past and new ASMs, epilepsy type, and follow-up time were selected as PSR. Twelve patients were included in the diet group and 24 in the control group, matched by PSR. Compared with the control group, the diet group had 4.5 greater odds of achieving ≥50 % seizure frequency reduction at 1-3 months (OR 5.5; 90 % confidence interval 1.1-26.65). Mean seizure frequency and other secondary outcomes did not differ significantly between the groups. In summary, the MAD showed a modest effect over seizure control compared with only ASM. Matching by PSR could be an alternative analysis approach to determine the effectiveness of the ketogenic diet in controlled studies. Additional studies are required to validate the analysis proposed.
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Affiliation(s)
- Pedro J Quiroga-Padilla
- Diabetes, Lipids and Metabolism Laboratory, Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
| | - Claudia Briceño
- Department of Nutrition, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia
| | - Luis C Mayor
- Epilepsy Clinic, Department of Neurology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia; Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
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25
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Knight E, Geetha T, Burnett D, Babu JR. The Role of Diet and Dietary Patterns in Parkinson's Disease. Nutrients 2022; 14:4472. [PMID: 36364733 PMCID: PMC9654624 DOI: 10.3390/nu14214472] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 07/30/2023] Open
Abstract
Parkinson's Disease (PD) is a neurodegenerative disorder associated with diminished nutrition status and decreased quality of life. While the prevalence of PD is expected to increase, no preventative or curative therapy for PD exists at this time. Although nutrition and diet represent modifiable risk factors for reducing chronic disease risk, research on the impact of single nutrients on PD has yielded mixed results. As a result, this single-nutrient approach may be the driving force behind the inconsistency, and a holistic dietary approach may overcome this inconsistency by accounting for the interactions between nutrients. The following review aims to examine the impact of a generally healthy dietary pattern, the protein-restricted diet (PRD), the ketogenic diet (KD), the Mediterranean diet (MD), and the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet on PD risk, progression, and severity. While most of the included studies support the role of diet and dietary patterns in reducing the risk of PD or alleviating PD severity, the inconsistent results and need for further evidence necessitate more research being conducted before making dietary recommendations. Research on the potential beneficial effects of dietary patterns on PD should also investigate potential risks.
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Affiliation(s)
- Emily Knight
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
| | - Thangiah Geetha
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA
| | - Donna Burnett
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA
| | - Jeganathan Ramesh Babu
- Department of Nutritional Sciences, Auburn University, Auburn, AL 36849, USA
- Boshell Metabolic Diseases and Diabetes Program, Auburn University, Auburn, AL 36849, USA
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26
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A Review of the Multi-Systemic Complications of a Ketogenic Diet in Children and Infants with Epilepsy. CHILDREN 2022; 9:children9091372. [PMID: 36138681 PMCID: PMC9498174 DOI: 10.3390/children9091372] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/23/2022]
Abstract
Ketogenic diets (KDs) are highly effective in the treatment of epilepsy. However, numerous complications have been reported. During the initiation phase of the diet, common side effects include vomiting, hypoglycemia, metabolic acidosis and refusal of the diet. While on the diet, the side effects involve the following systems: gastrointestinal, hepatic, cardiovascular, renal, dermatological, hematologic and bone. Many of the common side effects can be tackled easily with careful monitoring including blood counts, liver enzymes, renal function tests, urinalysis, vitamin levels, mineral levels, lipid profiles, and serum carnitine levels. Some rare and serious side effects reported in the literature include pancreatitis, protein-losing enteropathy, prolonged QT interval, cardiomyopathy and changes in the basal ganglia. These serious complications may need more advanced work-up and immediate cessation of the diet. With appropriate monitoring and close follow-up to minimize adverse effects, KDs can be effective for patients with intractable epilepsy.
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27
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Epigenome Modulation Induced by Ketogenic Diets. Nutrients 2022; 14:nu14153245. [PMID: 35956421 PMCID: PMC9370515 DOI: 10.3390/nu14153245] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 11/17/2022] Open
Abstract
Ketogenic diets (KD) are dietary strategies low in carbohydrates, normal in protein, and high, normal, or reduced in fat with or without (Very Low-Calories Ketogenic Diet, VLCKD) a reduced caloric intake. KDs have been shown to be useful in the treatment of obesity, metabolic diseases and related disorders, neurological diseases, and various pathological conditions such as cancer, nonalcoholic liver disease, and chronic pain. Several studies have investigated the intracellular metabolic pathways that contribute to the beneficial effects of these diets. Although epigenetic changes are among the most important determinants of an organism’s ability to adapt to environmental changes, data on the epigenetic changes associated with these dietary pathways are still limited. This review provides an overview of the major epigenetic changes associated with KDs.
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28
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Taylor SR, Falcone JN, Cantley LC, Goncalves MD. Developing dietary interventions as therapy for cancer. Nat Rev Cancer 2022; 22:452-466. [PMID: 35614234 DOI: 10.1038/s41568-022-00485-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 12/11/2022]
Abstract
Cancer cells acquire distinct metabolic preferences based on their tissue of origin, genetic alterations and degree of interaction with systemic hormones and metabolites. These adaptations support the increased nutrient demand required for increased growth and proliferation. Diet is the major source of nutrients for tumours, yet dietary interventions lack robust evidence and are rarely prescribed by clinicians for the treatment of cancer. Well-controlled diet studies in patients with cancer are rare, and existing studies have been limited by nonspecific enrolment criteria that inappropriately grouped together subjects with disparate tumour and host metabolic profiles. This imprecision may have masked the efficacy of the intervention for appropriate candidates. Here, we review the metabolic alterations and key vulnerabilities that occur across multiple types of cancer. We describe how these vulnerabilities could potentially be targeted using dietary therapies including energy or macronutrient restriction and intermittent fasting regimens. We also discuss recent trials that highlight how dietary strategies may be combined with pharmacological therapies to treat some cancers, potentially ushering a path towards precision nutrition for cancer.
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Affiliation(s)
- Samuel R Taylor
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-I MD-PhD program, New York, NY, USA
| | - John N Falcone
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lewis C Cantley
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA
| | - Marcus D Goncalves
- Division of Endocrinology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
- Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
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29
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Şimşek H, Uçar A. Is Ketogenic Diet Therapy a Remedy for Alzheimer’s Disease or Mild Cognitive Impairments?: A Narrative Review of Randomized Controlled Trials. ADVANCES IN GERONTOLOGY 2022. [DOI: 10.1134/s2079057022020175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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30
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Lan Y, Jin C, Kumar P, Yu X, Lenahan C, Sheng J. Ketogenic Diets and Hepatocellular Carcinoma. Front Oncol 2022; 12:879205. [PMID: 35600387 PMCID: PMC9115558 DOI: 10.3389/fonc.2022.879205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 12/16/2022] Open
Abstract
The ketogenic diet (KD) is a low-carbohydrate, high-fat diet regarded as a potential intervention for cancers owing to its effects on tumor metabolism and behavior. Hepatocellular carcinoma (HCC) is the most prevalent type of liver cancer, and its management is worth investigating because of the high fatality rate. Additionally, as the liver is the glucose and lipid metabolism center where ketone bodies are produced, the application of KD to combat HCC is promising. Prior studies have reported that KD could reduce the energy supply and affect the proliferation and differentiation of cancer cells by lowering the blood glucose and insulin levels. Furthermore, KD can increase the expression of hydroxymethylglutaryl-CoA synthase 2 (HMGCS2) in hepatocytes and regulate lipid metabolism to inhibit the progression of HCC. In addition, β-hydroxybutyrate can induce histone hyperacetylation and reduce the expression of inflammatory factors to alleviate damage to hepatocytes. However, there are few relevant studies at present, and the specific effects and safety of KD on HCC warrant further research. Optimizing the composition of KD and combining it with other therapies to enhance its anti-cancer effects warrant further exploration.
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Affiliation(s)
- Yan Lan
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chaonan Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department for BioMedical Research, Hepatology, University of Bern, Bern, Switzerland
| | - Pavitra Kumar
- Department for BioMedical Research, Hepatology, University of Bern, Bern, Switzerland
| | - Xia Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Cameron Lenahan
- Department of Biomedical Science, Burrell College of Osteopathic Medicine, Las Cruces, NM, United States
| | - Jifang Sheng
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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31
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Lowe J, Brown J, Klier K, Doll White J, Briceno Alliegro L, Sewak S, Mele-Hayes D. Research Involvement in a Group of Registered Dietitian Nutritionists Specializing in Ketogenic Diet Therapies for Epilepsy. J Acad Nutr Diet 2022; 122:2330-2336.e5. [PMID: 35589069 DOI: 10.1016/j.jand.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND There is a growing need for studies on ketogenic diet (KD) therapies. Registered dietitian nutritionists (RDNs) should lead efforts to better understand nutritional risks and benefits of the KD to inform evidence-based practices. OBJECTIVE The purpose of this study was to explore participation in research amongst RDNs practicing in KD therapies for epilepsy and identify barriers to participation. DESIGN This cross-sectional study collected professional experience, research involvement and output, and perceived barriers to conducting research. PARTICIPANTS/SETTING This study surveyed 66 RDNs practicing in KD therapies for epilepsy. MAIN OUTCOME MEASURE Research involvement was assessed using the Dietitian Research Involvement Survey (DRIS) score. Research output was reported as type and number of publications. Barriers to research included lack of time, resources, administrative support, training, and/or skill. STATISTICAL ANALYSES Data were summarized using descriptive statistics such as means and standard deviations, medians and interquartile ranges, counts and percentages, as appropriate. RESULTS The median DRIS score was 31 out of 60 (range: 16-60). Thirty-two participants (48.5%) reported publishing or presenting data, and only 13.6% published a manuscript on ketogenic diet therapies as a leading author. The main barriers to participating in research were insufficient time (83.3%), insufficient funding (81.8%), and priority of work (70.8%). Research involvement scores were not affected by lack of time and resources, however scores were lower in RDNs reporting lack of interest, training, and skill in research. CONCLUSIONS While ketogenic RDNs participated in research, most were not leading projects or publications. To increase research involvement amongst RDNs, focus should include overcoming structural barriers while facilitating knowledge acquisition for those lower on the research continuum.
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Affiliation(s)
- Jessica Lowe
- Researcher and Clinical Dietitian, Department of Neurology, Keck School of Medicine, University of Southern California, 2010 Zonal Avenue, Los Angeles, CA 90033
| | - Jessica Brown
- Clinical Dietitian, Clinical Nutrition and Lactation, CHOC Children's Hospital of Orange County, 1201 West La Veta Ave., Orange, CA 92868
| | - Katie Klier
- Clinical Dietitian, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #8, Los Angeles, CA 90027
| | - Jennifer Doll White
- Clinical Dietitian, UCLA Ronald Reagan Medical Center, Mattel Children's Hospital at UCLA
| | - Lucia Briceno Alliegro
- Clinical Dietitian, Children's Hospital Los Angeles, 4650 Sunset Blvd., MS #8, Los Angeles, CA 90027
| | - Sarika Sewak
- Clinical Dietitian, UCLA Ronald Reagan Medical Center, Mattel Children's Hospital at UCLA
| | - Danine Mele-Hayes
- Consultant Dietitian, My Keto Weigh, 20338 Roslin Ave Torrance CA 90503
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32
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Teng L, Lee VW, Murugesu S, Lee J, Ibrahim NS, Ishak MF, Mohamed AR, Khoo T. The Glycemic Biomarkers in Children with Drug‐Resistant Epilepsy on Various Types of Ketogenic Diet Therapies: A Cross‐sectional study. Epilepsia 2022; 63:2011-2023. [DOI: 10.1111/epi.17292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lip‐Yuen Teng
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Vanessa Wan‐Mun Lee
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Sumitha Murugesu
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Jun‐Xiong Lee
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Nur Sakinah Ibrahim
- Department of Dietetics and Food Services Hospital Tunku Azizah Kuala Lumpur Malaysia
| | - Mohd Fatahudin Ishak
- Department of Dietetics and Food Services Hospital Tunku Azizah Kuala Lumpur Malaysia
| | | | - Teik‐Beng Khoo
- Paediatric Neurology Unit Department of Paediatrics Hospital Tunku Azizah Kuala Lumpur Malaysia
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33
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Russell RD, Black LJ, Begley A. Nutrition Education Programs for Adults with Neurological Diseases Are Lacking: A Scoping Review. Nutrients 2022; 14:nu14081577. [PMID: 35458139 PMCID: PMC9030740 DOI: 10.3390/nu14081577] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/04/2022] Open
Abstract
The nutrition recommendation for most common neurological diseases is to follow national dietary guidelines. This is to mitigate malnutrition, reduce the risk of diet-related diseases, and to help manage some common symptoms, including constipation. Nutrition education programs can support people in adhering to guidelines; hence the aim of this scoping review was to explore what programs have been implemented for adults with neurological diseases. We conducted this review according to a published a priori protocol. From 2555 articles screened, 13 were included (dementia n = 6; multiple sclerosis n = 4; stroke survivors n = 2; Parkinson’s n = 1). There were no programs for epilepsy, Huntington’s, and motor neurone disease. Program duration and number of sessions varied widely; however, weekly delivery was most common. Just over half were delivered by dietitians. Most did not report using a behavior change theory. Commonly used behavior change techniques were instruction on how to perform a behavior, credible source, and behavioral practice/rehearsal. Evidence of nutrition education programs for adults with neurological diseases is lacking. Of those that are published, many do not meet best practice principles for nutrition education regarding delivery, educator characteristics, and evaluation. More programs aligning with best practice principles are needed to assess characteristics that lead to behavior change.
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Affiliation(s)
- Rebecca D. Russell
- Curtin School of Population Health, Curtin University, Perth, WA 6102, Australia; (R.D.R.); (L.J.B.)
| | - Lucinda J. Black
- Curtin School of Population Health, Curtin University, Perth, WA 6102, Australia; (R.D.R.); (L.J.B.)
- Curtin Health Innovation Research Institute, Curtin University, Perth, WA 6102, Australia
| | - Andrea Begley
- Curtin School of Population Health, Curtin University, Perth, WA 6102, Australia; (R.D.R.); (L.J.B.)
- Correspondence: ; Tel.: +61-8-9266-2773
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34
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Tong X, Deng Y, Liu L, Tang X, Yu T, Gan J, Cai Q, Luo R, Xiao N. Clinical Implementation of Ketogenic Diet in Children with Drug-Resistant Epilepsy: Advantages, Disadvantages, and Difficulties. Seizure 2022; 99:75-81. [DOI: 10.1016/j.seizure.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
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35
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USE OF KETOGENIC DIET THERAPY IN EPILEPSY WITH MITOCHONDRIAL DYSFUNCTION: A SYSTEMATIC AND CRITICAL REVIEW. BIOTECHNOLOGIA ACTA 2022. [DOI: 10.15407/biotech15.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
With the development of molecular techniques over time more than %60 of epilepsy has associated with mitochondrial (mt) dysfunction. Ketogenic diet (KD) has been used in the treatment of epilepsy since the 1920s. Aim. To evaluate the evidence behind KD in mt dysfunction in epilepsy. Methods. Databases PubMed, Google Scholar and MEDLINE were searched in an umbrella approach to 12 March 2021 in English. To identify relevant studies specific search strategies were devised for the following topics: (1) mitochondrial dysfunction (2) epilepsy (3) KD treatment. Results. From 1794 papers, 36 articles were included in analysis: 16 (%44.44) preclinical studies, 11 (%30.55) case reports, 9 (%25) clinical studies. In all the preclinic studies, KD regulated the number of mt profiles, transcripts of metabolic enzymes and encoding mt proteins, protected the mice against to seizures and had an anticonvulsant mechanism. Case reports and clinical trials have reported patients with good results in seizure control and mt functions, although not all of them give good results as well as preclinical. Conclusion. Healthcare institutions, researchers, neurologists, health promotion organizations, and dietitians should consider these results to improve KD programs and disease outcomes for mt dysfunction in epilepsy.
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36
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Quiroga-Padilla PJ, Briceño C, Mayor LC. Factors associated with initiation of the modified Atkins diet in adults with drug-resistant epilepsy. Epilepsy Behav 2022; 129:108620. [PMID: 35220027 DOI: 10.1016/j.yebeh.2022.108620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Abstract
Ketogenic diets are promising therapies for drug-resistant epilepsy (DRE). Diet adherence is a major concern in adults, so a less restrictive diet like the modified Atkins diet (MAD) is preferred. The objective of this study was to explore factors associated with MAD initiation in adults with DRE. It is a retrospective cohort study that includes participants aged ≥ 16 years with at least two failing antiseizure medications (ASM). We compared clinical and demographic variables between those patients who initiated the MAD and those who did not. A total of 136 patients were included and 52 participants initiated a MAD. After 3 months, only 28 patients (58%) continued on the MAD. For those who initiated a MAD trial: 1) the average number of current ASMs (3 ± 1 vs 2 ± 1, p < 0.008) and the average lifetime ASMs (6 ± 3 vs 5 ± 2, p < 0.008) was higher, 2) they had an earlier age of epilepsy onset (9 vs 13 years, p < 0.006) and 3) there was a greater proportion of patients with a history of status epilepticus (OR = 3.89, 95% CI = 1.16-13.01). In contrast, temporal lobe epilepsy onset had a negative association with MAD trial initiation (OR = 0.32, 95% CI = 0.12-0.88). In conclusion, five factors are associated with MAD initiation in adults with DRE. Chronic DRE may be the major motivation for MAD initiation. Nonetheless, adults with a history of status epilepticus could be a target population to initiate the MAD early.
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Affiliation(s)
- Pedro J Quiroga-Padilla
- Diabetes, Lipids and Metabolism Laboratory, Faculty of Medicine, Universidad de los Andes, Bogotá D.C. 111021, Colombia.
| | - Claudia Briceño
- Department of Nutrition, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia
| | - Luis C Mayor
- Epilepsy Clinic, Department of Neurology, Hospital Universitario Fundación Santa Fé de Bogotá, Bogotá D.C. 110111, Colombia
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McGaugh E, Barthel B. A Review of Ketogenic Diet and Lifestyle. MISSOURI MEDICINE 2022; 119:84-88. [PMID: 36033148 PMCID: PMC9312449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The ketogenic diet has become increasing popular in recent years. With 25.4 million unique searches, the keto diet was the most Googled diet in the United States in 2020.1 With increased consumer interest, the "keto" food industry has grown rapidly, and as a result, the global ketogenic diet market was valued at $9.57 billion in 2019.2 The ketogenic diet has been discussed in popular culture by celebrities, health magazines, and documentaries. The popularity of this diet, and diets in general may be explained by the obesity epidemic in the United States and Missouri.
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Affiliation(s)
- Erin McGaugh
- Graduate of University of Missouri-Kansas City School of Medicine (UMKC SOM)
| | - Brandon Barthel
- Assistant Professor of Medicine in Internal Medicine and Endocrinology, Truman Medical Center at UMKC SOM, Kansas City, Missouri
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Samia P, Naanyu V, Cross JH, Idro R, Boon P, Wilmshurst J, Luchters S. Qualitative exploration of feasibility and acceptability of the modified Atkins diet therapy for children with drug resistant epilepsy in Kenya. Epilepsy Behav 2021; 125:108362. [PMID: 34740092 DOI: 10.1016/j.yebeh.2021.108362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Approximately one-third of children with epilepsy have clinical syndromes characterized by drug resistance. Modified Atkins dietary therapy (MADT) can reduce seizures and improve health outcomes for these children. This intervention is yet to be consistently offered as standard of care in sub-Saharan Africa. OBJECTIVES This study aimed to assess feasibility and acceptability of MADT for children with drug-resistant epilepsy and identify enabling strategies for implementation and adherence to the MADT. METHODS This qualitative inquiry utilized in-depth interviews with purposively selected caregivers and adolescent patients having used MADT for drug-resistant epilepsy. A qualified team consisting of a social scientist and an interviewer carried out the interviews with consenting participants. Thematic analysis was done independent of the clinicians. RESULTS This study enrolled 17 participants including 14 caregivers of children aged 1-17 years, and three adolescents. Caregivers were predominantly trained professionals living in urban areas who had attended the epilepsy clinic for at least one year. Duration of continuous MADT use ranged from two weeks to two years. Among participants who indicated that they could afford to provide the MADT, it was less costly to provide for younger children and for those living in rural areas. At the time of the study, majority of the caregivers had ceased administration of the MADT, more than half of whom reported barriers including cost of food, child refusal of foods, and inconsistent dietician support. Social support was a key enabler to successful implementation and continuation of the diet. Majority of the participants considered MADT to be an effective and acceptable intervention for management of epilepsy. CONCLUSIONS Among participants in this focused Kenyan group, implementation of MADT was found to be feasible particularly for younger children living in rural areas. Majority of participants evaluated MADT to be an effective and acceptable intervention for management of epilepsy. Cultural factors did not influence feasibility or acceptability of MADT in this study.
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Affiliation(s)
- Pauline Samia
- Department of Paediatrics and Child Health, Medical College, Aga Khan University, Nairobi, Kenya; Brain and Mind Institute, Aga Khan University, Kenya; Department of Public Health and Primary Care, Ghent University, Belgium.
| | - Violet Naanyu
- School of Arts & Social Sciences, Moi University, Kenya; AMPATH Research, Eldoret, Kenya
| | - J Helen Cross
- UCL BRC NIHR Great Ormond Street, Institute of Child Health, London, United Kingdom
| | - Richard Idro
- Makerere University, Department of Paediatrics and Child Health, Kampala, Uganda
| | - Paul Boon
- Department of Neurology, Ghent University, Belgium
| | - Jo Wilmshurst
- Department of Paediatric Neurology, Red Cross War Memorial Children's Hospital, Cape Town, South Africa; Institute of Neurosciences, University of Cape Town, South Africa
| | - Stanley Luchters
- Department of Public Health and Primary Care, Ghent University, Belgium; Department of Population Health, Medical College, Aga Khan University, Nairobi, Kenya; Department of Epidemiology and Preventive Medicine, Monash University, Australia
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Crosby L, Davis B, Joshi S, Jardine M, Paul J, Neola M, Barnard ND. Ketogenic Diets and Chronic Disease: Weighing the Benefits Against the Risks. Front Nutr 2021; 8:702802. [PMID: 34336911 PMCID: PMC8322232 DOI: 10.3389/fnut.2021.702802] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 06/10/2021] [Indexed: 12/11/2022] Open
Abstract
Very-low-carbohydrate ketogenic diets have been long been used to reduce seizure frequency and more recently have been promoted for a variety of health conditions, including obesity, diabetes, and liver disease. Ketogenic diets may provide short-term improvement and aid in symptom management for some chronic diseases. Such diets affect diet quality, typically increasing intake of foods linked to chronic disease risk and decreasing intake of foods found to be protective in epidemiological studies. This review examines the effects of ketogenic diets on common chronic diseases, as well as their impact on diet quality and possible risks associated with their use. Given often-temporary improvements, unfavorable effects on dietary intake, and inadequate data demonstrating long-term safety, for most individuals, the risks of ketogenic diets may outweigh the benefits.
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Affiliation(s)
- Lee Crosby
- Physicians Committee for Responsible Medicine, Washington, DC, United States
| | - Brenda Davis
- Brenda Davis Nutrition Consulting, Kelowna, BC, Canada
| | - Shivam Joshi
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States.,Department of Medicine, New York City Health + Hospitals/Bellevue, New York, NY, United States
| | - Meghan Jardine
- Physicians Committee for Responsible Medicine, Washington, DC, United States
| | - Jennifer Paul
- Physicians Committee for Responsible Medicine, Washington, DC, United States.,College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, United States.,School of Public Health, Loma Linda University, Loma Linda, CA, United States
| | - Maggie Neola
- Physicians Committee for Responsible Medicine, Washington, DC, United States
| | - Neal D Barnard
- Physicians Committee for Responsible Medicine, Washington, DC, United States.,Adjunct Faculty, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
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Falsaperla R, D'Angelo G, Praticò AD, Mauceri L, Barbagallo M, Pavone P, Catanzaro S, Gitto E, Corsello G, Ruggieri M. Ketogenic diet for infants with epilepsy: A literature review. Epilepsy Behav 2020; 112:107361. [PMID: 33181904 DOI: 10.1016/j.yebeh.2020.107361] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 12/20/2022]
Abstract
The ketogenic diet (KD) is an established, nonpharmacological treatment for drug-resistant epilepsy (DRE). Actually, KD and its variants have been shown to be elective and resolute for patients with glucose transporter type 1 (GLUT1) deficiency. The aim of this review was to study the use of KD and its variants in infancy, including the neonatal age, and demonstrate the safety and efficacy of this treatment in patients with the age of 0-23 months affected by DRE already subjected to pharmacological approach attempts. A literature search was conducted using PubMed as the medical database source. We used the age limit of 0-23 months, and we considered only articles published between the years 2015 and 2018, in light of increasing interest worldwide in the use of KD and its variants to manage DRE. We included 52 publications: 1 Cochrane study, 22 retrospective studies, 9 prospective studies, 4 randomized controlled trials (RCTs), 12 clinical cases, and 4 clinical reviews. Literature data showed that KD and its variants are safe and useful in patients with the age of 0-23 months with DRE. Classical KD is of first choice in the treatment of GLUT1 deficiency. Earlier introduction of KD in GLUT1 promises a better outcome and a decrease in seizure frequency in these patients.
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Affiliation(s)
- Raffaele Falsaperla
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Gabriella D'Angelo
- Neonatal and Pediatric Intensive Care Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy
| | - Andrea D Praticò
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Italy.
| | - Laura Mauceri
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Massimo Barbagallo
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Piero Pavone
- General Pediatrics and Pediatric Acute and Emergency Unit, Policlinico-Vittorio-Emanuele University Hospital, University of Catania, Catania, Italy
| | - Stefano Catanzaro
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Italy
| | - Eloisa Gitto
- Neonatal and Pediatric Intensive Care Unit, Department of Human Pathology of Adult and Childhood "G. Barresi", University Hospital "G. Martino", Messina, Italy
| | - Giovanni Corsello
- Department of Maternal and Child Health, University of Palermo, Palermo, Italy
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Italy
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Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned. Nutrients 2020; 12:nu12092616. [PMID: 32867258 PMCID: PMC7551948 DOI: 10.3390/nu12092616] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 01/22/2023] Open
Abstract
Ketogenic diet (KD) has been used to treat epilepsy for 100 years. It is a high-fat, low-carbohydrate, and sufficient-protein-for-growth diet that mimics the metabolic changes occurring during starvation. Except for classic KD, its modified counterparts, including modified Atkins diet and low-glycemic-index treatment, have gained grounds to increase palatability and adherence. Strong evidence exists that the KD offers protection against seizures in difficult-to-treat epilepsy and possesses long-lasting anti-epileptic activity, improving long-term disease outcome. The KD can also provide symptomatic and disease-modifying activity in a wide range of neurodegenerative diseases. In an era of highly available new anti-seizure medications (ASMs), the challenge of refractory epilepsy has still not been solved. This metabolic therapy is increasingly considered due to unique mechanisms and turns out to be a powerful tool in the hands of a skillful team. Despite decades of extensive research to explain the mechanism of its efficacy, the precise mechanism of action is to date still largely unknown. The key feature of this successful diet is the fact that energy is derived largely from fat but not from carbohydrates. Consequently, fundamental change occurs regarding the method of energy production that causes alterations in numerous biochemical pathways, thus restoring energetic and metabolic homeostasis of the brain. There are barriers during the use of this special and individualized therapy in many clinical settings worldwide. The aim of this review is to revisit the current state of the art of therapeutic application of KD in refractory epilepsy.
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Wells J, Swaminathan A, Paseka J, Hanson C. Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy-A Review. Nutrients 2020; 12:nu12061809. [PMID: 32560503 PMCID: PMC7353240 DOI: 10.3390/nu12061809] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Epilepsy in the pediatric and adolescent populations is a devastating condition where individuals are prone to recurrent epileptic seizures or changes in behavior or movement that is the direct result of a primary change in the electrical activity in the brain. Although many children with epilepsy will have seizures controlled with antiseizure medications (ASMs), a large percentage of patients are refractory to drug therapy and may consider initiating a ketogenic diet. The term Ketogenic Diet or Ketogenic Diet Therapy (KDT) refers to any diet therapy in which dietary composition results in a ketogenic state of human metabolism. Currently, there are 4 major Ketogenic diet therapies—the classic ketogenic diet (cKD), the modified Atkins diet (MAD), the medium chain triglyceride ketogenic diet (MCTKD) and the low glycemic index treatment (LGIT). The compositions of the 4 main KDTs differ and limited evidence to distinguish the efficacy among different diets currently exists. Although it is apparent that more randomized controlled trials (RCTs) and long-term studies are needed to evaluate efficacy, side effects and individual response to the diet, it is imperative to study and understand the metabolic profiles of patients with epilepsy in order to isolate which dietary restrictions are necessary to maximize clinical benefit.
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Affiliation(s)
- Jana Wells
- College of Allied Health Professions, University of Nebraska Medical Center, 984045 Nebraska Medical Center, Omaha, NE 68198-4045, USA;
- Correspondence:
| | - Arun Swaminathan
- Department of Neurological Sciences, University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE 68198-8440, USA;
| | - Jenna Paseka
- Department of Pharmaceutical and Nutrition Care, Nebraska Medicine 4350 Dewey Ave, Omaha, NE 68105, USA;
| | - Corrine Hanson
- College of Allied Health Professions, University of Nebraska Medical Center, 984045 Nebraska Medical Center, Omaha, NE 68198-4045, USA;
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43
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Felix G, Kossoff E, Barron B, Krekel C, Testa EG, Scheimann A. The modified Atkins diet in children with Prader-Willi syndrome. Orphanet J Rare Dis 2020; 15:135. [PMID: 32493369 PMCID: PMC7268481 DOI: 10.1186/s13023-020-01412-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 05/18/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Prader-Willi Syndrome (PWS) is the most common genetic cause of obesity. Various dietary strategies have been used for weight management for people with PWS. METHODS This was a clinical feasibility study to test the use of the Modified Atkins Diet (low carbohydrate and high fat) for children with PWS ages 6-12 years who were overweight/obese. Participants went on the Modified Atkins Diet for 4 months and then returned to have anthropometry repeated including repeat labs and behavior questionnaires. RESULTS Seven children (ages 6-12) were enrolled in the study. Four participants completed the 4-month diet trial; two were unable to comply with the diet and stopped prematurely. One patient lost 2.9 kg; the others maintained their weight. Adverse effects were increases in LDL (expected based on larger studies) and hypercalciuria (with no renal stones) for one patient. Positive effects on hyperphagia and behavior were noted subjectively by families. CONCLUSION The Modified Atkins Diet can be a feasible low carbohydrate option for children with Prader-Willi Syndrome for weight management. Long-term use of the diet in patients with Prader-Willi Syndrome needs to be studied further.
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Affiliation(s)
- Grace Felix
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Pediatric Specialists of Virginia/INOVA Children's Hospital, Fairfax, Virginia, USA
| | - Eric Kossoff
- Department of Pediatric Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bobbie Barron
- Institute of Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin Krekel
- Institute of Clinical and Translational Research, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth Getzoff Testa
- Department of Psychology, Center for Pediatric Weight Management & Healthy Living, Mt. Washington Pediatric Hospital, Baltimore, MD, USA
| | - Ann Scheimann
- Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,Division of Pediatric Gastroenterology and Nutrition, Johns Hopkins Hospital, 600 N. Wolfe Street Brady 320, Baltimore, MD, 21287-2631, USA.
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44
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Gauthier A, Simic N, Jones KC, RamachandranNair R. Modified Atkins Diet with slow reduction of carbohydrate. Epilepsy Behav Rep 2020; 13:100353. [PMID: 32337504 PMCID: PMC7176585 DOI: 10.1016/j.ebr.2019.100353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 11/18/2022] Open
Abstract
Typically, the amount of daily carbohydrate in the Modified Atkins diet (MAD) is restricted to 10–20 g from the beginning of the therapy. It is possible to gradually reduce the daily carbohydrate amount to this target to increase acceptability of the diet. We report the use of the MAD with slow carbohydrate reduction in a patient with Glucose Transporter 1 Deficiency, including results of neuropsychological assessments. Seizures were controlled at 45 g of carbohydrates daily. This case report illustrates that a liberalized form of MAD with slow reduction of carbohydrate may be a therapeutic option in some children with epilepsy. It is possible that other children with epilepsy could achieve seizure control at higher carbohydrate level than current MAD recommendations. Some patients may find it difficult to lower the carbohydrate content abruptly in Modified Atkins Diet (MAD). This could affect compliance and ease of following the diet. A liberalized form of MAD with slow reduction of carbohydrate may be a therapeutic option in children with epilepsy. Some children could achieve good seizure control at higher carbohydrate level than current MAD recommendations
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Affiliation(s)
| | - Nevena Simic
- Comprehensive Pediatric Epilepsy Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Kevin C. Jones
- Comprehensive Pediatric Epilepsy Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Rajesh RamachandranNair
- Comprehensive Pediatric Epilepsy Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
- Corresponding author at: Comprehensive Pediatric Epilepsy Program, McMaster Children's Hospital, 3A, 1280 Main St West, Hamilton, ON L8S4K1, Canada.
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45
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Kraeuter AK, Guest PC, Sarnyai Z. Protocol for the Use of the Ketogenic Diet in Preclinical and Clinical Practice. Methods Mol Biol 2020; 2138:83-98. [PMID: 32219741 DOI: 10.1007/978-1-0716-0471-7_4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many age-related diseases are associated with metabolic abnormalities, and dietary interventions may have some benefit in alleviating symptoms or in delaying disease onset. Here, we review the commonly used best practices involved in applications of the ketogenic diet to facilitate its translation into clinical use. The findings reveal that better education of physicians is essential for applying the optimum diet and monitoring its effects in clinical practice. In addition, investigators should carefully consider potential confounding factors prior to commencing studies involving a ketogenic diet. Most importantly, current studies should improve their reporting on ketone levels as well as on the intake of both macro- and micronutrients. Finally, more detailed studies on the mechanism of action are necessary to help identify potential biomarkers for response prediction and monitoring, and to uncover new drug targets to aid the development of novel treatments.
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Affiliation(s)
- Ann-Katrin Kraeuter
- Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia
- Discipline of Biomedicine, College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Paul C Guest
- Laboratory of Neuroproteomics, Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Zoltán Sarnyai
- Laboratory of Psychiatric Neuroscience, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.
- Discipline of Biomedicine, College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, QLD, Australia.
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46
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Meyers R. A Wish List for Drug Development in Pediatrics. J Pharm Sci 2019; 109:939-943. [PMID: 31676269 DOI: 10.1016/j.xphs.2019.10.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/02/2019] [Accepted: 10/16/2019] [Indexed: 11/16/2022]
Abstract
This commentary illustrates and summarizes some of the many issues with dosage forms and drug delivery that arise in everyday practice for clinicians caring for pediatric patients. While advances in drug development for children and expansion of labeling information in this age group have made great strides in improving care, there is much to be desired in the area of dosage forms. From liquids that are unpalatable to the need for extemporaneous compounding of parenteral doses in syringes that are meant for immediate use but used to store medications for hours to weeks, the list of challenges is long. Many of these problems exist for drugs which have long been generic, but some problems have arisen from new drugs as well. Pediatric clinicians and dosage form developers should work together to create solutions.
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Affiliation(s)
- Rachel Meyers
- Department of Pharmacy, Saint Barnabas Medical Center, Livingston, New Jersey 07039; Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey 08854.
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47
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Ketogenic Diet: A New Light Shining on Old but Gold Biochemistry. Nutrients 2019; 11:nu11102497. [PMID: 31627352 PMCID: PMC6836190 DOI: 10.3390/nu11102497] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/08/2019] [Accepted: 10/10/2019] [Indexed: 12/11/2022] Open
Abstract
Diets low in carbohydrates and proteins and enriched in fat stimulate the hepatic synthesis of ketone bodies (KB). These molecules are used as alternative fuel for energy production in target tissues. The synthesis and utilization of KB are tightly regulated both at transcriptional and hormonal levels. The nuclear receptor peroxisome proliferator activated receptor α (PPARα), currently recognized as one of the master regulators of ketogenesis, integrates nutritional signals to the activation of transcriptional networks regulating fatty acid β-oxidation and ketogenesis. New factors, such as circadian rhythms and paracrine signals, are emerging as important aspects of this metabolic regulation. However, KB are currently considered not only as energy substrates but also as signaling molecules. β-hydroxybutyrate has been identified as class I histone deacetylase inhibitor, thus establishing a connection between products of hepatic lipid metabolism and epigenetics. Ketogenic diets (KD) are currently used to treat different forms of infantile epilepsy, also caused by genetic defects such as Glut1 and Pyruvate Dehydrogenase Deficiency Syndromes. However, several researchers are now focusing on the possibility to use KD in other diseases, such as cancer, neurological and metabolic disorders. Nonetheless, clear-cut evidence of the efficacy of KD in other disorders remains to be provided in order to suggest the adoption of such diets to metabolic-related pathologies.
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48
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Kirkpatrick CF, Bolick JP, Kris-Etherton PM, Sikand G, Aspry KE, Soffer DE, Willard KE, Maki KC. Review of current evidence and clinical recommendations on the effects of low-carbohydrate and very-low-carbohydrate (including ketogenic) diets for the management of body weight and other cardiometabolic risk factors: A scientific statement from the National Lipid Association Nutrition and Lifestyle Task Force. J Clin Lipidol 2019; 13:689-711.e1. [PMID: 31611148 DOI: 10.1016/j.jacl.2019.08.003] [Citation(s) in RCA: 208] [Impact Index Per Article: 41.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023]
Abstract
Historically, low-carbohydrate (CHO) and very-low-CHO diets have been used for weight loss. Recently, these diets have been promoted for type 2 diabetes (T2D) management. This scientific statement provides a comprehensive review of the current evidence base available from recent systematic reviews and meta-analyses on the effects of low-CHO and very-low-CHO diets on body weight, lipoprotein lipids, glycemic control, and other cardiometabolic risk factors. In addition, evidence on emerging risk factors and potential safety concerns of low-CHO and very-low-CHO diets, especially for high-risk individuals, such as those with genetic lipid disorders, was reviewed. Based on the evidence reviewed, low-CHO and very-low-CHO diets are not superior to other dietary approaches for weight loss. These diets may have advantages related to appetite control, triglyceride reduction, and reduction in the use of medication in T2D management. The evidence reviewed showed mixed effects on low-density lipoprotein cholesterol levels with some studies showing an increase. There was no clear evidence for advantages regarding effects on other cardiometabolic risk markers. Minimal data are available regarding long-term (>2 years) efficacy and safety. Clinicians are encouraged to consider the evidence discussed in this scientific statement when counseling patients on the use of low-CHO and very-low-CHO diets.
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Affiliation(s)
- Carol F Kirkpatrick
- Wellness Center, Kasiska Division of Health Sciences, Idaho State University, Pocatello, ID, USA.
| | - Julie P Bolick
- Dietitian Nutritionist Specialist II and Clinical Lipid Specialist, Intermountain Health Care, Live Well Center, Salt Lake City, UT, USA
| | - Penny M Kris-Etherton
- Distinguished Professor of Nutrition, Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Geeta Sikand
- Associate Clinical Professor of Medicine (Cardiology Division) and Director of Nutrition, University of California Irvine Preventive Cardiology Program, Irvine, CA, USA
| | - Karen E Aspry
- Brown University Alpert Medical School, Lipid and Prevention Program, Lifespan Cardiovascular Institute, East Greenwich, RI, USA
| | - Daniel E Soffer
- University of Pennsylvania, Preventive Cardiology Heart and Vascular Center, Philadelphia, PA, USA
| | - Kaye-Eileen Willard
- Physician Advisor for Patient Quality and Safety, Ascension Wisconsin All Saints, Racine, WI, USA
| | - Kevin C Maki
- Midwest Biomedical Research, Center for Metabolic & Cardiovascular Health, Addison, IL, USA
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Stocker RK, Reber Aubry E, Bally L, Nuoffer JM, Stanga Z. [Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases]. PRAXIS 2019; 108:541-553. [PMID: 31185843 DOI: 10.1024/1661-8157/a003246] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Ketogenic Diet and its Evidence-Based Therapeutic Implementation in Endocrine Diseases Abstract. Abstract: The ketogenic diet (KD) is a high-fat and very low-carb diet, which has been used primarily for treatment of therapy-resistant epilepsy in children. Implementation of the KD in other target populations is increasingly being discussed. This literature review provides first indications for a clinical benefit of the KD in diabetes mellitus type 2 (T2DM) and polycystic ovarian syndrome (PCOS). In many analysed studies, KD led to significant weight loss and had beneficial effects on lipoprotein profile and insulin resistance. In half of the comparative studies with T2DM, the KD lead to signifiantly greater reductions in HbA1c-levels (HbA1c difference: -0.5 to -1.5 %) compared to reference diets (HbA1c difference: +0.2 to -0.5 %). Nevertheless, study results are too heterogenic for a general recommendation of the KD in this patient population.
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Affiliation(s)
- Rahel Kristina Stocker
- 1 Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin & Metabolismus (UDEM), Inselspital Bern
| | - Emilie Reber Aubry
- 1 Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin & Metabolismus (UDEM), Inselspital Bern
| | - Lilly Bally
- 1 Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin & Metabolismus (UDEM), Inselspital Bern
| | | | - Zeno Stanga
- 1 Universitätsklinik für Diabetologie, Endokrinologie, Ernährungsmedizin & Metabolismus (UDEM), Inselspital Bern
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Food and Food Products on the Italian Market for Ketogenic Dietary Treatment of Neurological Diseases. Nutrients 2019; 11:nu11051104. [PMID: 31108981 PMCID: PMC6566354 DOI: 10.3390/nu11051104] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/12/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022] Open
Abstract
The ketogenic diet (KD) is the first line intervention for glucose transporter 1 deficiency syndrome and pyruvate dehydrogenase deficiency, and is recommended for refractory epilepsy. It is a normo-caloric, high-fat, adequate-protein, and low-carbohydrate diet aimed at switching the brain metabolism from glucose dependence to the utilization of ketone bodies. Several variants of KD are currently available. Depending on the variant, KDs require the almost total exclusion, or a limited consumption of carbohydrates. Thus, there is total avoidance, or a limited consumption of cereal-based foods, and a reduction in fruit and vegetable intake. KDs, especially the more restrictive variants, are characterized by low variability, palatability, and tolerability, as well as by side-effects, like gastrointestinal disorders, nephrolithiasis, growth retardation, hyperlipidemia, and mineral and vitamin deficiency. In recent years, in an effort to improve the quality of life of patients on KDs, food companies have started to develop, and commercialize, several food products specific for such patients. This review summarizes the foods themselves, including sweeteners, and food products currently available for the ketogenic dietary treatment of neurological diseases. It describes the nutritional characteristics and gives indications for the use of the different products, taking into account their metabolic and health effects.
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