Blog - Research - Countering Keto Misinformation

Al Roker vs. Jillian Michaels: Who’s right about the Keto diet?Published: Jan 22, 2019Author: Brett Arends for MarketWatch

Response from Charlie Foundation written by: Beth Zupec-Kania RDN,CD


Yet another article about ketogenic diets that is based on a distortion of information. The author quotes the summary of a review article published summer of 2018 by the European Society of Cardiology titled “Low carbohydrate diets are unsafe and should be avoided” (1). This statement is akin to saying, “cars are unsafe and should be avoided”.  Everyone would agree that some cars are unsafe and that driving under certain conditions are unsafe, but a blanket statement that all cars are unsafe is irrational.

But the bigger blunder here is that the quoted European article wasn’t even a study, it was a review of the published information from a US survey performed in the US called National Health and Nutrition Examination Survey 1999-2010 (NHANES). I dug up the survey and found out that “low-carbohydrate diets” aren’t even on the survey. The survey didn’t ask the participant to divulge the type of diet they were following, it only asked the participant to report what they ate in the previous 24 hours. The intent of the survey was to get an idea of what people eat. This type of survey lacks scientific rigor and is not intended for making statements about which diets are safe or unsafe.

As a nutritionist who has spent the past 27 years working exclusively with ketogenic and metabolic therapies, I would agree that these diets can be potentially dangerous. I’ve worked mostly with medically compromised children and adults who have chronic conditions. The suffering that these people have gone through before they have decided to trial a low-carbohydrate or ketogenic diet is far more debilitating than the adverse effects that they may encounter. Furthermore, the adverse effects are well known and can be largely prevented. An experienced ketogenic professional would be in-tune to this.

The Charlie Foundation is a non-profit organization that grew out of the remarkable recovery of a toddler named Charlie who suffered with daily seizures. After trying 7 anti-seizure medications and a brain surgery without any improvement his family turned to a medically supervised ketogenic diet. Within days his seizures stopped. Charlie was on the diet for 5 years then was gradually transitioned to a high-carb diet. He’s now 26 years old and has remained seizure and drug-free.

Getting back to Al Roker. If Al, like 60% of Americans, has struggled with obesity for years, then I would support his use of a low-carbohydrate therapy as long as he is doing it under medical guidance. There are 2 large studies that show benefits of using medically supervised diet for adults who are obese or have diabetes (3,4).

1) Low carbohydrate diets are safe and should be avoided. 2013

https://www.escardio.org/The-ESC/Press-Office/Press-releases/Low-carbohydrate-diets-are-unsafe-and-should-be-avoided

2) National health and nutrition examination survey: plan and operations, 1999-2010.

https://www.ncbi.nlm.nih.gov/pubmed/25078429

3) Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. 2017

https://www.nature.com/articles/s41387-017-0006-9

4) A Novel Intervention Including Individualized Nutritional Recommendations Reduces Hemoglobin A1c Level, Medication Use, and Weight in Type 2 Diabetes. 2017.

https://diabetes.jmir.org/2017/1/e5/


The Charlie Foundation’s response to the article in Big Think.
‘No one should be doing the ketogenic diet,’ says top U.S. cardiologist
Big Think – September 5, 2018
by STEPHEN JOHNSON

Response written by Beth Zupec-Kania RDN, CD

Dr. Kim Williams is quoted in this article that attacks ketogenic diet therapy. He based his opinion on a 2013 review of 17 studies which found low-carbohydrate diets to be associated with an increased chance of death, with particular increased risks to cardiovascular health. What he failed to understand is that this article is a review of low-carbohydrate, high-protein diets, not ketogenic diets, which are low-carbohydrate, high-fat, moderate protein.The difference is monumental. The article doesn’t even address ketosis or ketones. Dr. Williams has twisted the results of this study because he doesn’t know the difference. What he should have referenced are the articles that show an improvement in cardiovascular disease on ketogenic diets in the following studies.

Effects of low-carbohydrate and low-fat diets: a randomized trial.
https://www.ncbi.nlm.nih.gov/pubmed/25178568

A low-carbohydrate, ketogenic diet versus a low-fat diet to treat obesity and hyperlipidemia: a randomized, controlled trial.
https://www.ncbi.nlm.nih.gov/pubmed/15148063

My 88 year old mother’s cardiologist prescribed a statin because her LDL is elevated. Her cholesterol, HDL, and triglyceride levels are all in the normal range. It outraged me to learn that he didn’t explain the potential adverse effects of this drug and didn’t offer that she could modify her diet. Recent evidence has linked LDL in the elderly with longer life-spans (article). You can bet that I stepped in and refused to let my mother take this drug that has no statistical benefit of improving her lifespan or preventing her from having a heart attack, and would significantly increase her chances of developing diabetes.

Lack of an association or an inverse association between low-densitylipoprotein cholesterol and mortality in the elderly: a systematic review https://bmjopen.bmj.com/content/6/6/e010401

Statin induced diabetes and its clinical implications

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4156828/

For 25 years, the Charlie Foundation has been dedicated to providing education, resources and advocacy for medically supervised ketogenic therapies. A treatment discovered in the 1920s that was nearly abandoned for epilepsy, is now known to help improve and even cure epilepsy and has shown benefit in other conditions such as brain cancer, diabetes, autism and several genetic disorders. Ketogenic therapies have also grown into one of the largest areas of study for improving overall health. The Charlie Foundation remains committed to ensuring everyone who may benefit, especially those with epilepsy, are aware of and able to access dietary therapies.


Ketogenic fad diet could do more harm than good

By WRDW; Nick Viviani | Posted: Tue 10:32 AM, Sep 04, 2018

Responses written by Beth Zupec-Kania RDN, CD 

BZK- I’m writing in response to the poorly researched article by Nick Viviani. Clearly he has not looked into the growing body of evidence of the benefits of a medically supervised ketogenic diet for numerous disorders. His statements show a lack of debth in fact checking.

NV- New studies show the keto diet and other extreme high or low carb diets can actually be deadly to those trying to use them long term.
BZK- Which studies are you referring to? None were cited for this article.

NV- “Carbohydrates are the main source of energy that our brain uses. It’s the most efficient source of energy. If we use a protein or fat for fuel, it puts more stress on the body,” said Yurechko.
BZK- New research indicates that ketones produced by the ketoegnic diet are a “more efficient fuel for the brain”. The ketogenic diet can provide neurological protection and disease modifying effects for conditions such as epilepsy, Alzheimers and Parkinson’s diseases. – see attached article.

NV- Doctors say this diet was intended for children dealing with severe cases of Epilepsy, and even in those cases, there are still risks.
BZK- There are multiple studies proving the effectiveness and safety of ketogenic diet therapy under medical supervision for epilepsy including a recent consensus guidleine on use (which cites all of those studies) – see attached. The risks associated with epilepsy drugs and surgery can be significant, even life-threatening, therefore, its one-sided to target ketogenic diet therapy as dangerous.

NV- The diet is not recommended for people with uncontrolled Diabetes. Ketosis is a sign of not using enough insulin.
BZK- Ketosis can improve and even reverse diabetes. Recent studies show that a medically supervised ketogenic diet can be very beneficial for people with difficult to control diabetes – see final 2 articles.

Beth Zupec-Kania RDN, CD
Charlie Foundation www.charliefoundation.org
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2367001/
https://onlinelibrary.wiley.com/doi/pdf/10.1002/epi4.12225
https://www.nature.com/articles/s41387-017-0006-9
https://diabetes.jmir.org/2017/1/e5/


Dietary Fats and Cardiovascular Disease: A Presidential Advisory From the American Heart Association
Frank M. Sacks , Alice H. Lichtenstein , Jason H.Y. Wu , Lawrence J. Appel , Mark A. Creager , Penny M. Kris-Etherton , Michael Miller , Eric B. Rimm , Lawrence L. Rudel , Jennifer G. Robinson , Neil J. Stone , and Linda V. Van Horn and On behalf of the American Heart Association
Originally published15 Jun 2017Circulation. 2017;136:e1–e23

Response from The Charlie Foundation – Author: Beth Zupec-Kania RDN, CD

Dietary fat has endured a long history of controversy in its role in health. Saturated fat, found predominately in animal products (butter, cheese, cream, meat fats), and, in coconut oil, have been villainized as “bad” fats. Newer research is turning the tide on this old way of thinking.  A 2015 systematic review found no association between saturated fat consumption and risk of heart disease, stroke, diabetes, or death (1). An even more recent review of randomized controlled trials concluded that replacing saturated fats with mostly polyunsaturated fats is unlikely to reduce coronary heart disease. This 2017 review showed that inadequately controlled trials that were included in earlier meta-analyses explain the prior results (2). Despite these recent findings, the American Heart Association continues to tout the old data. It’s important, however, to understand that their reference to fat is in the context of a high-carbohydrate diet. Ketogenic and modified ketogenic diets have a completely different effect on metabolism. Emerging data from several sources reveal that low-carb, high-fat diets are effective in improving metabolic syndrome (3-5). Metabolic syndrome is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. Coconut oil is a safe fat to include in low-carb, high-fat diets. Its shorter chain length makes it easier to digest then long chain animal and vegetable oils. It also contains antibacterial properties which is helpful for the digestive tract. While coconut and palm oils found in processed snack foods are undoubtedly unhealthy, pure coconut oil has been used for decades in epilepsy. The MCT oil diet, originated at The Mayo Clinic consists of 60% MCT oil – a concentrated form of coconut oil. Not only has this oil been helpful in treating epilepsy, it has recently shown to be beneficial for brain health (6.7).

The Charlie Foundation encourages you to have regular cholesterol and lipid testing, including particle size, during ketogenic diet therapy. The particle size is important in understanding cardiovascular risk. Ketogenic diets often increase the large-sized LDL which is thought to be protective against heart disease. We also advise including monounsaturated fats such as extra virgin olive oil and avocado oil daily in the diet. These unique monounsaturated oils contain several vitamins plus the essential omega-3 and 6 fats.

Note- This commentary was written in response to this advisory from the AHA.

References

1. de Souza RJ et al. (2015). “Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies”. BMJ. 351 (h3978).

2.Hamley, S. (2017). “The effect of replacing saturated fat with mostly n-6 polyunsaturated fat on coronary heart disease: a meta-analysis of randomised controlled trials”. Nutrition Journal. 16 (1): 30. PMID28526025. doi:10.1186/s12937-017-0254-5.

3. Volek JS et al. (2009)“Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet.” Lipids. 44: 297–309.

4. Sharman MJ. (2002). A ketogenic diet favorably affects serum biomarkers for cardiovascular disease in normal-weight men. J Nutr 2002; 132: 1879–1885.

5. Volek JS, et al. (2005) “Modification of lipoproteins by very low-carbohydrate diets”. Journal of Nutrition; 135: 1339–1342.

6. Chang P. (2015) “Seizure control by decanoic acid through direct AMPA receptor inhibition.” BRAIN. doi:10.1093/brain/awv325.

7. Fernando W.M.A.D et al. (2015) “The role of dietary coconut for the prevention and treatment of Alzheimer’s disease: potential mechanisms of action.“ British Journal of Nutrition. doi:10.1017/S0007114515001452.

Author

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Comments

My father’s heart was autopsied by a coroner because he died an accidental death from a fall at age 62. My father had no heart disease when he died. When my father was in his late 40’s, he developed type 2 diabetes. His doctor and dietitian put him on a low glycemic diet which reversed his diabetes and he followed that diet for the last 15 years of his life. He never ate sugar again or high glycemic foods. He ate approximately 50% fat (mostly butter), 35% protein, and 15% carbohydrate. My father was a heavy smoker. He smoked 2 large packages of Players Plain unfiltered cigarettes a day until he was 59 years old. He then developed a small tumor in his lung which was operable. I am not promoting cigarette smoking as it can cause lung cancer. However my father’s condition of his heart when he died demonstrates that eliminating sugar and high glycemic foods from your diet for 15 years prior to death will prevent heart disease in a type 2 diabetic even if they are a heavy smoker. High glucose levels cause heart disease, not saturated fat.

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