4

votes

Is the ketogenic diet "dangerous"?

Answered on August 19, 2014
Created March 27, 2013 at 6:33 PM

http://jama.jamanetwork.com/article.aspx?articleid=197131

Effect of a High-Fat Ketogenic Diet on Plasma Levels of Lipids, Lipoproteins, and Apolipoproteins in Children

Context Little prospective long-term information is available on the effect of a ketogenic diet on plasma lipoproteins in children with difficult-to-control seizures.

Objective To determine the effect in children with intractable seizures of a high-fat ketogenic diet on plasma levels of the major apolipoprotein B (apoB)???containing lipoproteins, low-density lipoprotein (LDL) and very LDL (VLDL); and the major apolipoprotein A-I (apoA-I)???containing lipoprotein, high-density lipoprotein (HDL).

Design, Setting, and Patients A 6-month prospective cohort study of 141 children (mean [SD] age, 5.2 [3.8] years for 70 boys and 6.1 [4.4] years for 71 girls) with difficult-to-treat seizures who were hospitalized for initiation of a high-fat ketogenic diet and followed up as outpatients. This cohort constituted a subgroup of the 371 patients accepted into the ketogenic diet program between 1994 and 2001. A subset of the cohort was also studied after 12 (n = 59) and 24 (n = 27) months.

Intervention A ketogenic diet consisting of a high ratio of fat to carbohydrate and protein combined (4:1 [n = 102], 3.5:1 [n = 7], or 3:1 [n = 32]). After diet initiation, the calories and ratio were adjusted to maintain ideal body weight for height and maximal urinary ketosis for seizure control.

Main Outcome Measures Differences at baseline and 6-month follow-up for levels of total, VLDL, LDL, HDL, and non-HDL cholesterol; triglycerides; total apoB; and apoA-I.

Results At 6 months, the high-fat ketogenic diet significantly increased the mean plasma levels of total (58 mg/dL [1.50 mmol/L]), LDL (50 mg/dL [1.30 mmol/L]), VLDL (8 mg/dL [0.21 mmol/L]), and non-HDL cholesterol (63 mg/dL [1.63 mmol/L]) (P<.001 vs baseline for each); triglycerides (58 mg/dL [0.66 mmol/L]) (P<.001); and total apoB (49 mg/dL) (P<.001). Mean HDL cholesterol decreased significantly (P<.001), although apoA-I increased (4 mg/dL) (P = .23). Significant but less marked changes persisted in children observed after 12 and 24 months.

Conclusions A high-fat ketogenic diet produced significant increases in the atherogenic apoB???containing lipoproteins and a decrease in the antiatherogenic HDL cholesterol. Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions.

800e726cb5dff569fd8edf604c3e2793

(1655)

on September 07, 2013
at 01:28 AM

That's all good but quite irrelevant to the issue which is how high-fat diets affect the blood lipid measurements.

0b73cdbd0cb68aeeda14dafeebb2f828

on March 28, 2013
at 11:24 AM

– Lumifer The conclusion above raises concerns about high fat diets and endothelial function. Correcting common 25(OH)D 50ng/ml + omega 3 + magnesium deficiencies restores endothelial function and prevents endothelial dysfunction.

0b73cdbd0cb68aeeda14dafeebb2f828

on March 28, 2013
at 11:14 AM

@ Kashkillz The study abstract concludes "Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions." I am simply suggesting Paleo reserves of anti-inflammatory Vitamin D3, omega 3, magnesium, potassium and melatonin would have been higher than is currently normal. Restoring natural anti-inflamamtory status would be a common sense strategy for anyone who wants their body functioning optimally as human DNA evolved.

7a6529ea25b655132fe58d793f95547a

(2040)

on March 28, 2013
at 01:57 AM

I think Ted's idea is relevant. To name a couple: copper and iodine deficiencies will cause higher than normal lipid profiles.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on March 28, 2013
at 12:41 AM

Also, worth pointing out this is a 10 year old paper, there are 60+ papers that reference this one, probably some more insight to be had in one of those.

336c383a3c4d28652d7ab888c79108a3

(614)

on March 27, 2013
at 11:05 PM

http://www.mynchen.demon.co.uk/Ketogenic_diet/Management/Calculating_the_ketogenic_diet.htm

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on March 27, 2013
at 09:23 PM

Dairy has never been known to induce dyslipidemia, right? ;)

800e726cb5dff569fd8edf604c3e2793

(1655)

on March 27, 2013
at 09:18 PM

I have a vague memory that kids' ketogenic diets were based mostly on very large amounts of heavy cream.

Medium avatar

(39831)

on March 27, 2013
at 08:06 PM

It's very unlikely that they used hydrogenated fats in these diets.

Ed7403e397077dd1acdbf25c7f6e56ce

(3452)

on March 27, 2013
at 07:46 PM

Can you source the fact that ketosis is inflammatory? I've been operating under the assumption of the opposite.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on March 27, 2013
at 07:33 PM

But you can't argue with the data...

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on March 27, 2013
at 07:33 PM

@Varelse, I agree, quality matters just as much as macronutrient ratio does. Considering this paper was published back in the early 2000s, back when Atkins had a resurgence, who knows what faux-food was used to achieve that macro ratio.

32f5749fa6cf7adbeb0b0b031ba82b46

(41747)

on March 27, 2013
at 07:28 PM

4:1 fat/protein:carbs is already 20% carbohydrate, ketosis at that level?

Medium avatar

(39831)

on March 27, 2013
at 07:22 PM

I don't think it's probable that soybean oil would have that effect.

72cf727474b8bf815fdc505e58cadfea

on March 27, 2013
at 06:58 PM

I read the full article and there's no additional information about their diet beyond macronutrient ratios (except for a note that ketosis was initially induced using "eggnog").

048dd52752c45129c1212bfffb37ca72

(3150)

on March 27, 2013
at 06:53 PM

This is interesting but I could not find a detailed list of what nutrients was the diet consisting of. It states that is a 'Standard Ketogenic Diet by Johns Hopkins' but giving a quick look at his clinical center webpage I could not find what it consists of. It says a ratio of 4:1 fats to carbs which could be formed of grains and it does not state if they used high quality omega-3, monounsaturated fats or good saturated fats instead of vegetable oils and grain-fed animals. Interesting, but with some weak points in my view.

61f9349ad28e3c42d1cec58ba4825a7d

(10490)

on March 27, 2013
at 06:46 PM

Yes, I would be interested to know what those fats were. There's a world of difference between a soybean oil-heavy diet and a beef tallow-heavy diet, for example.

72cf727474b8bf815fdc505e58cadfea

on March 27, 2013
at 06:40 PM

This is a very interesting study! I'm glad to see that they took detailed lipid measurements and not just standard LDL/HDL/TG. It's also interesting because these kids are eating trivial quantities of eeeevil carbs and not much protein either, so it's hard to claim this is about anything _other_ than fat intake. On the other hand, it's odd that they lump this all in under "high fat" rather than talking about what fats they're eating, when even the CW says that your choice of fat is a critical determinant of lipids.

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3 Answers

3
0b73cdbd0cb68aeeda14dafeebb2f828

on March 27, 2013
at 07:36 PM

I am always concerned reading modern research about the lack of awareness of the general deficiency status in modern humans with regard to Vitamin D3, Magnesium, potassium omega 3 and melatonin compared to the optimal levels typical of those living now as hunter gatherers in East Africa.

It seems to me a total disregard for the lack of anti-inflammatory reserves is tantamount to medical negligence. We would regard as idiots anyone managing a racing cars if no regard was paid to fundamentals like optimal tyre pressures or coolant levels.

We know Statins mimic the actions of Vitamin D and work in a way similar to magnesium, we know omega 3 reduces triglycerides and that melatonin has a role in metabolic syndrome and plays a major role as a natural anti inflammatory agent.

If we are about to embark on a long and difficult journey wouldn't it be common sense to start by making sure your tyre pressures and coolant levels met makers recommended settings?

If you are going to embark on a diet with the potential to raise inflammatory status isn't it common sense, before starting, to ensure the optimal natural levels of natural anti-inflammatory agents are equivalent to those human DNA evolved with?

800e726cb5dff569fd8edf604c3e2793

(1655)

on September 07, 2013
at 01:28 AM

That's all good but quite irrelevant to the issue which is how high-fat diets affect the blood lipid measurements.

7a6529ea25b655132fe58d793f95547a

(2040)

on March 28, 2013
at 01:57 AM

I think Ted's idea is relevant. To name a couple: copper and iodine deficiencies will cause higher than normal lipid profiles.

Ed7403e397077dd1acdbf25c7f6e56ce

(3452)

on March 27, 2013
at 07:46 PM

Can you source the fact that ketosis is inflammatory? I've been operating under the assumption of the opposite.

0b73cdbd0cb68aeeda14dafeebb2f828

on March 28, 2013
at 11:14 AM

@ Kashkillz The study abstract concludes "Further studies are necessary to determine if such a diet adversely affects endothelial vascular function and promotes inflammation and formation of atherosclerotic lesions." I am simply suggesting Paleo reserves of anti-inflammatory Vitamin D3, omega 3, magnesium, potassium and melatonin would have been higher than is currently normal. Restoring natural anti-inflamamtory status would be a common sense strategy for anyone who wants their body functioning optimally as human DNA evolved.

0b73cdbd0cb68aeeda14dafeebb2f828

on March 28, 2013
at 11:24 AM

– Lumifer The conclusion above raises concerns about high fat diets and endothelial function. Correcting common 25(OH)D 50ng/ml + omega 3 + magnesium deficiencies restores endothelial function and prevents endothelial dysfunction.

0
Ed7403e397077dd1acdbf25c7f6e56ce

on March 27, 2013
at 07:17 PM

I'm pretty sure it can be dangerous if done recklessly.

Dangerous or not, though, I'm quite positive that scheduled carbloading will greatly improve results.

336c383a3c4d28652d7ab888c79108a3

(614)

on March 27, 2013
at 11:05 PM

http://www.mynchen.demon.co.uk/Ketogenic_diet/Management/Calculating_the_ketogenic_diet.htm

0
72cf727474b8bf815fdc505e58cadfea

on March 27, 2013
at 07:03 PM

As I said in my comment above, I think this study has some strong points -- especially the use of detailed lipid testing and a long follow-up period. The authors note that these findings are probably not generalizable to adults on a ketogenic diet for weightloss:

  • Adults losing weight are eating a hypocaloric diet, which might have different effects from growing kids who want to meet or exceed their caloric needs.

  • Adults losing weight tend to improve their lipid profile as a result of losing excess fat, which would compensate for negative influences from the diet.

  • Adults losing weight tend to stay on a ketogenic diet for a relatively short time, in comparison to severely epileptic kids who will be on a ketogenic diet for years or longer.

However, they may well be applicable to people who are healthy and without excess fat, but intending to maintain ketosis indefinitely.

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