Talk:Ketogenic diet

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Frequently asked questions

Isn't this the trendy keto diet that's in the news?

No. The typical minimum fat content for most kids on this diet is more than the maximum fat content for adults who are on the very most extreme keto diets for weight loss and other goals. Most adults on a "keto" diet plan for 60% to 80% of calories from fat (and then they cheat). Most kids on this diet get 90% of their calories from fat (80% of their food by weight), and cheating has potentially deadly consequences. The sample menu shown at Ketogenic diet#Classic contains about 150 grams of fat, 25 grams of protein, and 10 grams of carbohydrates (including fiber). The very low-carbohydrate ketogenic diet typically recommends up to 50 grams of total carbohydrates per day, with 50 to 100 grams of protein.

Why doesn't this article talk about weight-loss or bodybuilding diets? Bodybuilders call their diets "ketogenic".

Any diet that metabolizes any fat at all is "ketogenic", because ketones are the natural, unavoidable metabolic byproduct of eating fat. Even everyday, normal diets are "ketogenic" at some level. This article is not about weight loss or body building, which produce higher levels of ketones than typical diets, but far lower levels than this medically supervised treatment for epilepsy. The average diet for epilepsy usually produces 150% of the ketones that even an extreme diet for weight loss or bodybuilding does. If you are interested in those diets, please read Low-carbohydrate diet.

Why doesn't this article talk about Inuit dietary practices? They ate a lot of fat during part of the year.

This article is not about the Inuit diet. This article is only about the medical diet for treating epilepsy. The diet for epilepsy eats far more fat than even the highest estimates for the Inuit diet. The Inuit diet is estimated to have included high levels of fat, amounting to 25% to 35% of the food by weight. A typical diet to treat epilepsy is 80% fat by weight, which is more than double the amount in the Inuit diet.

Lots of diets have been called "ketogenic" since 2015. Why did you pick this name for an epilepsy treatment?

The process for writing articles on Wikipedia is:

Pick a subject – in this case, an extremely strict dietary treatment for epilepsy.
Look at high-quality reliable sources about your subject to identify possible names for the subject – in this case, "ketogenic diet" is the most widely used name for this treatment for epilepsy, and has been for the last century.
Determine whether the common name used by sources is already used for another article – it wasn't, so we used it. Note that this article was named in 2004, a full decade before the "keto" diet trend started.

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Article history

Ketogenic diet is a featured article; it (or a previous version of it) has been identified as one of the best articles produced by the Wikipedia community. Even so, if you can update or improve it, please do so.

This article appeared on Wikipedia's Main Page as Today's featured article on January 17, 2010.

Article milestones
Date	Process	Result
July 9, 2008	Good article nominee	Listed
November 12, 2009	Peer review	Reviewed
December 16, 2009	Featured article candidate	Promoted

Current status: Featured article

First umbrella review published

The first umbrella review of 68 randomized clinical trials on the effects of the ketogenic diet has been published. The results of high-quality evidence were a reduction in seizure frequency, triglycerides and a significant increase in low-density lipoprotein cholesterol. Moderate-quality evidence included a decrease in weight and an increase in total cholesterol. If the review is to be cited it would be worth citing the high-quality results. There is no long-term clinical data because the trials were between 8weeks and 9 months. But these findings suggest that the ketogenic diet is not heart healthy long-term, as they raise LDL-c and total cholesterol which will increase the risk of cardiovascular disease and events. Here is a link to the paper [1], in full [2]. High-quality evidence supports a reduction in seizure frequency but this is already stated on the article. If anyone wants to add this umbrella review to the article please add it. I wouldn't say there is anything new here that we did not know already but this is the biggest review to date that has looked at 68 trials. Psychologist Guy (talk) 11:05, 22 June 2023 (UTC)[reply]

It looks like the research included is mostly about adults, and mostly not about epilepsy. WhatamIdoing (talk) 01:01, 2 March 2024 (UTC)[reply]

Not fad diet

Ketogenic diet is not a fad diet. So the link to Fad diet in the "See also" section should be removed. CometVolcano (talk) 07:20, 13 January 2024 (UTC)[reply]

It is outside of epilepsy treatment. See also sections are for tangential topics, they are not categorizations. Bon courage (talk) 07:38, 13 January 2024 (UTC)[reply]

I've removed it. While diets that are (somewhat) ketogenic can be fad diets, those are covered in other articles, not this one. It is rather odd for someone to get to the bottom of a medical therapy article and be given a link to "fad diet" as though that was relevant to this topic. -- Colin°^Talk 22:37, 13 January 2024 (UTC)[reply]

harms or dietary intolerance in young children

This edit by User:FULBERT added the text "while harms or dietary intolerance in young children were rarely reported in the literature." The relevant text I can find in the source (Pharmacologic and Dietary Treatments for Epilepsies in Children Aged 1–36 Months) is "Dietary harms were not well-reported." There is a section in the source called "Harms of Dietary Treatments" It discusses four trials that report various harms along with their other findings. It isn't clear what led them to conclude "Harms of diets were rarely reported, so we drew no conclusions about harms or dietary intolerance." Possibly the wide range of occurrence reported, type of side-effect or lack of specifics of side effects mean they were unable to draw conclusions. But I think the text added to our article suggests harm or intolerance is rarely reported because it rarely occurs, rather than that details of harm or intolerance are rarely adequately collected during studies. Often there is just a non-specific rate of drop-out without going into details of why. The review is critical of current studies in this population group ("the lack of reporting on treatment outcomes beyond seizure frequency"). I would be surprised if the infant population was significantly better at tolerating this diet compared to slightly older children.

My conclusion is this is a review critical of the lack of knowledge in this field (epilepsy treatment of very young children) and a comment that they so lack information in one aspect (harm caused by diet) they can't draw any conclusions is probably not encyclopaedically relevant to this article. We certainly shouldn't give the impression that side-effects or harm is rare in infants, because it doesn't say that. If you agree, I'll remove the sentence. Perhaps there is something else we can draw from this source? -- Colin°^Talk 08:29, 1 March 2024 (UTC)[reply]

I am finding that sentence confusing, and now that I've read your comment, I'm even more confused about what was meant. WhatamIdoing (talk) 01:01, 2 March 2024 (UTC)[reply]

Revert of addition of immunomodulatory effect

bon courage reverted my addition of what I thought was a pretty interesting finding, published by folks from the NIAID. He said in his revert the edit needed a Med RS. -:) Oh well , I am not sure what more of a medical resource it would need, if he had cared to look it up ( or my credentials -:). It is a medical resource. This entire page doesnt have anything about immune modulation (yet) and this new finding is cutting edge, might explain why ketogenic diet works in epilepsy. I will restor emy edit as I think this was a frivolous revert of a well sourced good faith edit. Wuerzele (talk) 21:26, 11 April 2024 (UTC)[reply]

You added this paper [3], a 2-week primary study. It doesn't pass WP:MEDRS. No dispute that you added this in good faith but this is not well sourced content. It doesn't belong on Wikipedia. Psychologist Guy (talk) 21:41, 11 April 2024 (UTC)[reply]

“No dispute that you added this in good faith but this is not well sourced content”

I agree. It seems too early. Let’s wait for better sources (MEDRS-compliant-reviews). --Dustfreeworld (talk) 05:12, 12 April 2024 (UTC)[reply]

... if he had cared to look it up ( or my credentials -:). It is a medical resource ... I think this was a frivolous revert ← this combination of cluelessness about the basics of our medical sourcing guidelines, assumption of bad faith, and "don't you know who I am!?" argumentation is pretty alarming in an editor with a non-trivial contribution history. Bon courage (talk) 03:44, 12 April 2024 (UTC)[reply]

The ketogenic diet FAQ is wrong according to published papers and this article should be expanded to include weight loss uses

Summary: Like it or not, not only the common usage of the term "ketogenic diet", but also the use of that term in scientific literature has evolved to mean a diet which produces measurably elevated levels of blood ketones.

There is also a significant amount of emerging research that shows ketogenic diets for weight loss are not a "fad diet" but rather have proven scientific evidence showing that they work also for treatment of fatty liver disease (as one example). The use of a keto diet for weight loss should be merged into this page as the accepted medical definition of a ketogenic diet is one that produces elevated levels of blood ketones in non-diabetics. Even if those diets are not as extreme as the ones for treatment of epilepsy, words and phrases change meaning over time and this definition has been used by many peer reviewed articles and should be accepted.

I'm not going to provide an exhaustive list of sources showing this is the accepted scientific definition, but a few for example are listed below, e.g.

Bueno NB, de Melo IS, de Oliveira SL, da Rocha Ataide T. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr. 2013 Oct;110(7):1178-87.

Paoli A, Rubini A, Volek JS, Grimaldi KA. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013 Aug;67(8):789.

Masood W, Annamaraju P, Khan Suheb MZ, et al. Ketogenic Diet. [Updated 2023 Jun 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499830/

A quick google search will find the plethora of other papers that does not consider the definition to be a diet used only for epilepsy treatment or 90% fat content. 2001:558:6045:10D:EC97:D297:9502:B579 (talk) 04:30, 29 April 2024 (UTC)[reply]

This is not correct. Medical organizations do not recommend the keto diet for weight loss, nor do any health guidelines. The StatPearls source you cited admits that there is no long-term health outcome data on keto and weight loss. The evidence is only short term, much more clinical data is needed if you are going to make those claims. The same source says that a ketogenic diet increases the risk of heart disease and kidney stones. Due to the increased CVD risk, cardiology organizations do not recommend keto. As for your claims about keto improving liver disease, there is not any good clinical evidence for this. Your source does list some papers but there are no good systematic reviews on this because again the evidence is limited and not conclusive. Harvard Health says that keto could be worse for the liver [4]. Psychologist Guy (talk) 08:29, 29 April 2024 (UTC)[reply]