Keto food regimen: healthy or harmful?

Given the multitude of popular food regimen trends circulating in society today, it might probably be difficult to acknowledge the various facets of every. As a healthcare skilled, it can be crucial to grasp these fads because nutrition plays a major role in a patient’s health. One common food regimen is the ketogenic food regimen, or “keto” food regimen, which consists of a high-fat, low-carbohydrate, and moderate-protein (1 gram/kg) food regimen. How it’s working? Our cells typically use glucose from carbohydrates to provide energy. Without glucose, the means of ketosis begins, during which cells break down fat into ketone bodies to provide energy. This shift towards fat metabolism causes weight reduction.

The keto food regimen is nothing recent, somewhat it’s an efficient dietary therapy that has been used to treat epilepsy for the reason that Nineteen Twenties. This treatment was based on the speculation that the liver produces ketone bodies (acetoacetate, acetone and beta-hydroxybutyrate) from long- and medium-chain fatty acids, which have an anticonvulsant effect after crossing the blood-brain barrier (Kossoff, 2019).

Four varieties of ketogenic dietary therapies (KDT) (Kohli and Samour, 2013)

• • Fat comes from long-chain triglycerides present in the food regimen and provides 90 percent of calories.
  • Protein is calculated based on the quantity needed for adequate growth.
  • Carbohydrates are limited.
  • The ratio of fat to non-lipid substances is 4:1 (4 parts fat to 1 part protein and carbohydrates).
  • Optional twenty-four hour fasting period before initiation.
  • Studies have shown a discount of seizures by over 50% (Kossoff, 2019).
• • Oil supplements (e.g. coconut) are the fundamental source of fat and supply 60% of calories.
  • It produces more ketones, that are more easily absorbed and transferred on to the liver.
  • Less total fat is required and more protein and carbohydrates could be used.
  • Similar effectiveness in reducing epilepsy in comparison with the classic ketogenic food regimen.
• • An alternative to KDT and allows for more protein.
  • Carbohydrates are limited to 10 grams per day.
  • The ratio of lipids to non-lipids is 1:1 or 2:1.
  • Ketosis occurs inside the first month of starting treatment and should correlate with seizure control.
  • The food regimen is more tolerable and the outcomes are much like the classic ketogenic food regimen when it’s followed for longer than six months (Kossoff, 2019).
• • Limits carbohydrates to 40-60 grams per day and only those with a low glycemic index (<50).
  • No fluid or protein restrictions and loose monitoring of fat and calories.
  • Lower effectiveness in comparison with other keto diets.

Epilepsy Treatment (Kossoff, 2019)

Several epilepsy syndromes which have seen improvement with KDT include: Doose syndrome, Dravet syndrome, GLUT-1 deficiency, infantile spasms, pyruvate dehydrogenase deficiency tuberous sclerosis syndrome, and superrefractory status epilepticus.

• Epilepsy patients treated with KDT needs to be under the supervision of a trained dietitian and neurologist.
• These diets could be began in a hospital setting or in a clinic.
• Pediatric patients are often given multivitamin preparations with added minerals (selenium), calcium and vitamin D.
• Clinical response could be observed inside a number of weeks and a discount in seizure frequency inside two to 3 months.
• Follow-up visits needs to be scheduled after 1 month, then at 3, 6, 9 and 12 months through the first yr of treatment.
• For the primary yr, monitor laboratory tests every three months, including: complete blood count with platelets, metabolic profile, fasting lipid profile, calcium, vitamin D and magnesium levels. Treatment is generally really useful for a maximum of two years.
• Monitor your patients for uncomfortable side effects corresponding to gastrointestinal symptoms, dyslipidemia, hypoglycemia, constipation, growth failure, bone disease, kidney stones, and selenium deficiency.

KDT is utilized in patients with (Kossoff, 2019):

• Metabolic disorders that interfere with the oxidation of long-chain fatty acids and cause a catabolic crisis. These include deficiencies of primary carnitine, carnitine palmitoyltransferase I or II, carnitine translocase, medium-chain acyl dehydrogenase, long-chain acyl dehydrogenase, short-chain acyl dehydrogenase, long-chain 3-hydroxyacyl-CoA, or medium-chain 3-hydroxyacyl-CoA.

• Beta-oxidative defects of fatty acids.
• Porphyria: KDT may worsen acute intermittent porphyria or metabolic disorders attributable to changes within the activity of enzymes related to heme production. Porphyria is an absolute contraindication to KDT.

Keto diets may exacerbate chronic health problems corresponding to kidney stones, hypercholesterolemia, liver disease, gastroesophageal reflux disease, constipation, cardiomyopathy, and chronic metabolic acidosis (Kossoff, 2019).

Overall weight reduction

Short-term use of low-carbohydrate diets could be an efficient approach to losing a few pounds. These diets may profit patients with type 2 diabetes and metabolic syndrome, insulin resistance leading to obesity, dyslipidemia (high triglycerides, low HDL cholesterol), hypertension, high blood glucose, inflammation and vascular dysfunction (Volek and Phinney, 2013) . However, returning to your previous carbohydrate intake may negate any advantages gained.

Application

The effects of the keto food regimen will vary from individual to individual and will not be suitable for each patient. If your patient doesn’t have epilepsy, type 2 diabetes, or metabolic syndrome and is considering a keto food regimen, be sure you provide them with support and data to assist them make the choice.
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Kohli, A., and Samour, P. Q. (2013). Use of the ketogenic food regimen in adults. . 28 section 2, 105-119. DOI: 10.1097/TIN.0b013e31828d7866

Kossoff, E. (2019). Ketogenic dietary therapies within the treatment of epilepsy. Current. Downloaded from https://www.uptodate.com/contents/ketogenic-dietary-therapies-for-the-leczenie-padaczki

Volek, J. S., & Phinney, S. D. (2013). A brand new take a look at restricted carbohydrate diets: separating fact from fiction. . 48 section 2, E1-E7.