THE KETOGENIC DIET, which involves a radical reduction in carbohydrates in favor of fats, has been gaining popularity recently. IS THERE REALLY A JUSTIFICATION FOR HURRAOPTIMISM AROUND THIS CONTROVERSIAL NUTRITIONAL MODEL? WHAT ARE THE MAIN ASSUMPTIONS OF THE KETOGENIC DIET AND WHY CAN IT BE DANGEROUS TO HEALTH IN THE LONG TERM?
THE KETOGENIC DIET WAS FIRST USED IN 1921 TO TREAT EPILEPSY (WILDER, 1921). FOR MANY YEARS, THIS NUTRITION HAS BEEN USED IN THE MEDICAL WORLD AS A THERAPEUTIC DIET FOR CHILDREN'S EPILEPSY AND WAS WIDELY USED UNTIL THE INTRODUCTION OF ANTI-EPILEPSY DRUGS. THE RENAISSANCE OF THE KETOGENIC DIET AS A RAPID WEIGHT LOSS FORMULA IS A RELATIVELY NEW CONCEPT WHICH, ALTHOUGH EFFECTIVE, CAN BE VERY DANGEROUS IN THE LONG TERM. LIMITING YOUR CONSUMPTION OF CARBOHYDRATES AND REPLACING THEM WITH FOOD RICH IN FAT HELPS TO REDUCE THE FEELING OF HUNGER AND THEREFORE PROMOTES BODY WEIGHT LOSS. THE WEIGHT LOSS PROCESS IS ALSO STRENGTHENED BY THE PROCESS OF KETOSIS, WHICH OCCURS WHEN GLUCOSE RESERVES ARE NOT ENOUGH TO FULLY BURN FAT AND THE BODY STARTS PRODUCING KETONE BODIES. WHEN CONSIDERING THE KETOGENIC DIET THROUGH THE PRISM OF BODY WEIGHT LOSS, HOWEVER, YOU SHOULD REMEMBER THAT THIS METHOD OF NUTRITION HAS A DIURETIC EFFECT, SO EARLY BODY WEIGHT LOSS IS CAUSED BY LOSS OF WATER AND ONLY LATER OF FAT TISSUE.
KETOGENIC DIET IS ONE OF THE LOW-CARBONATE DIETS MOST OFTEN ASSOCIATED WITH THE ATKINS, KWAŚNIEWSKI, DUKAN DIET, OLEOKETO DIET, DR BUDWIG AND SOME OTHERS. THE MAIN PURPOSE OF THE KETOGENIC DIET IS TO KEEP CARBOHYDRATE CONSUMPTION AT A LEVEL LOWER THAN 10% OF DAILY KILOCALORIES. IT IS WORTH REMEMBERING THAT THE DIET MODEL COMMONLY RECOGNIZED IN THE MEDICAL ENVIRONMENT AS OPTIMAL PROVIDES FOR A CARBOHYDRATE CONSUMPTION AT A LEVEL OF APPROXIMATELY 50-65% OF ENERGY SUPPLIED. DRASTIC RESTRICTION OF CARBOHYDRATES CAUSES A REDUCED SUPPLY OF MANY VITAMINS AND MINERALS, SUCH AS: B VITAMINS, ZINC, MAGNESIUM, AS WELL AS FIBER, THE DEFICIT OF WHICH IS A RISK FACTOR IN SOME METABOLIC DISEASES, SUCH AS. COLOR INTESTINE CANCER.
THE SHORT-TERM EFFECTS OF THE KETOGENIC DIET ARE QUITE WELL DESCRIBED. THEY MOST COMMONLY INCLUDE NAUSEA, VOMITING, HEADACHE AND DIZZINESS, FATIGUE, INSOMNIA AND CONSTIPATION. THESE SYMPTOMS WILL GO AWAY WITHIN A FEW DAYS TO A FEW WEEKS. LONG-TERM HEALTH CONSEQUENCES RISK LIVER FATTY, HYPOPROTEINEMIA, KIDNEY STONES AND MANY VITAMIN AND MINERALS DEFICIENCIES (MA et al. 2019; OH et al. 2020; BROOM et al. 2019).
THERE IS LITTLE RESEARCH ON THE EFFECT OF KETOGENIC DIET ON CALIGNAN CANCERS, AND MOST OF THEM ARE CONDUCTED ON ANIMAL MODELS. (HOPKINS ET AL. 2018; POFF ET AL. 2013; POFF ET AL. 2015). MOST STUDIES HAVE NOT CONFIRMED THE PROTECTIVE EFFECT OF THE KETOGENIC DIET ON INHIBITION OF TUMORS' GROWTH (CHU-SHORE ET AL. 2010). ALTHOUGH THE RESULTS OF SOME STUDIES APPEAR TO BE PROMISING, MANY PAY ATTENTION TO SERIOUS SIDE EFFECTS (VIDALI et al. 2017).
THERE ARE CURRENTLY NO RELIABLE RANDOMIZED STUDIES ON APPROPRIATELY LARGE GROUPS OF PATIENTS, THEREFORE, RECOMMENDING A KETOGENIC DIET BASED ON A FEW INDIVIDUAL OBSERVATIONS IS A GREAT ABUSE. THE LITERATURE DESCRIBES THE CASES OF TWO PEDIATRIC PATIENTS WITH MALIGNANT AGESTRYTOMA IN ADVANCED STAGES IN WHOM THE USE OF THE KETOGENIC DIET BROUGHT A POSITIVE THERAPEUTIC RESPONSE (NEBELING ET AL. 1995). ANOTHER STUDY DESCRIBES THE BENEFITS OF COMBINING A KETOGENIC DIET WITH CONVENTIONAL TREATMENT IN A GROUP OF WOMEN WITH TRIPLE NEGATIVE BREAST CANCER (IYIKESICI ET AL. 2017). HOWEVER, THESE ARE NOT NUMBERS BASED ON WHICH CONCLUSIONS CAN BE DRAWN REGARDING THE RECOMMENDATION OF THIS FEEDING METHOD.
SOME OF THE RESEARCH CANNOT BE CONDUCTED WITH CONCLUSIONS DUE TO THE LOW LEVEL OF COMPLIANCE WITH THE KETOGENIC DIET RECOMMENDATIONS AMONG THE PARTICIPANTS. THIS IS ASSOCIATED WITH POOR TOLERANCE OF THE DIET AND THE NEED TO STOP IT DUE TO INCREASING NAUSEA, CONSTIPATION, FATIGUE OR CANCER PROGRESSION (ZAHARA et al. 2017).
SUPPORTERS OF THE KETOGENIC DIET BELIEVE THAT SIDE EFFECTS SUCH AS MICRONUTRIENT DEFICIENCIES, LOSS OF APPETITE, NAUSEA, HEADACHE AND DIZZINESS, CONSTIPATION, FATIGUE, HYPERLIPIDEMIA, WORRIED VISION AND BODY WEIGHT LOSS CAN BE AVOIDED OR REDUCED WHEN THE DIET STARTS SLOWLY AND APPROPRIATELY SUPPLEMENTED WITH VITAMINS AND MINERALS (KLEMENT ET AL. 2016; KOSSOFF ET AL. 2009). IN MY OPINION IT IS THIS A VERY DANGEROUS RECOMMENDATION, BECAUSE WHEN TREATING CANCER DISEASE, IT IS KEY TO PROPER NUTRITION AND STRENGTHEN THE BODY AND AVOID UNWANTED SIDE EFFECTS. THIS HELPS PREVENT THE VERY DANGEROUS PHENOMENON OF MALNORITION AND WASTEMENT, WHICH NOT ONLY WORSES THE RESPONSE TO THE TREATMENT, BUT VERY OFTEN ALSO WORSE THE PATIENT'S PROGNOSIS.
ONLY SOME CLINICAL STUDIES CONFIRM THE EFFECTIVENESS OF THE KETOGENIC DIET AS A COMPLEMENTARY ANTI-CANCER THERAPY. IN ORDER TO EXPLAIN THE MECHANISMS BEHIND THE KETOGENIC DIET AND ITS APPLICATION IN CLINICAL PRACTICE, WELL-DESIGNED RANDOMIZED STUDIES CONDUCTED ON A LARGE GROUP OF PATIENTS ARE NEEDED.
LITERATURE:
C.J. Chu-Shore, E.A. Thiele. Tumor growth in patients with tuberous sclerosis complex on the ketogenic diet. Brain & Development, 32 (2010), pp. 318-322.
B. D. Hopkins, C. Pauli, X. Du, D. G. Wang, X. Li, D. Wu, et al. Suppression of insulin feedback enhances the efficacy of PI3K inhibitors Nature, 560 (2018), pp. 499-503.
MS Iyikesici, A. K. Slocum, A. Slocum, F. B. Berkarda, M. Kalamian, T. N. Seyfried. Efficacy of metabolically supported chemotherapy combined with ketogenic diet, hyperthermia, and hyperbaric oxygen therapy for stage IV triple-negative breast cancer Cureus, 9 (2017), p. e1445.
R. J. Klement, R. A. Sweeney. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Research Notes, 9 (2016), p. 143.
EH Kossoff, BA Zupec-Kania, PEAmark, KR Ballaban-Gil, AGChristina Bergqvist, R. Blackford, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia, 50 (2009), pp. 304-317.
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LC Nebeling, F. Miraldi, S. B. Hurin, E. Lerner. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. Journal of the American College of Nutrition, 14 (1995), pp. 202-208.
A. M. Poff, C. Ari, T. N. Seyfried, D. P. D.'Agostino. The ketogenic diet and hyperbaric oxygen therapy prolong survival in mice with systemic metastatic cancer. PLoS One, 8 (2013), p. e65522.
A. M. Poff, N. Ward, T. N. Seyfried, P. Arnold, D. P. D'Agostino. Non-toxic metabolic management of metastatic cancer in VM mice: novel combination of ketogenic diet, ketone supplementation, and hyperbaric oxygen therapy. PLoS One, 10 (2015), p. e0127407.
S. Vidali, S. Aminzadeh-Gohari, RG Feichtinger, R. Vatrinet, A. Koller, F.Locker, et al. The ketogenic diet is not feasible as a therapy in a CD-1 nu/nu mouse model of renal cell carcinoma with features of Stauffer's syndrome. Oncotarget, 8 (2017), pp. 57201-57215.
R. M. Wilder. The effects of ketonemia on the course of epilepsy. Mayo Clinic Proceedings, 2 (1921), pp. 307-308.
Dr. Emilia Kałędkiewicz
