Keto Clarity: Your Definitive Guide to the Benefits of a Low-Carb, High-Fat Diet (45 page)

The only type of research that can lead to a solid conclusion about what we should do to be healthy is experimental research. You probably remember this from high school biology or chemistry class. You had well-defined substances, maybe chemicals in a test tube, with various controls. It’s possible you were asked to repeat the experiment several times to make sure your results were similar. That’s because to really know something or to conclude that one thing is caused by another, it is imperative to experiment and then do it again and again to make sure the same result is obtained each time. This is the most relevant research there is when it comes to practical applications. When this kind of study is conducted, it’s referred to as a
controlled clinical trial
.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Unfortunately, it is very expensive and time-consuming to conduct controlled clinical trials about diet and health with human subjects, and the researchers in charge of designing these studies have been heavily predisposed to study low-fat diets instead of high-fat diets. As a result, compared to low-fat diets or drugs, there is relatively little information about low-carb, high-fat diets.

Controlled studies, which compare one approach to another, fit into one of four categories: a
parallel group,
in which participants are randomly assigned to a specific group; a
crossover,
in which participants are given an intervention in a random sequence over time; a
cluster,
in which preexisting groups are selected at random for some kind of intervention; or a
factorial,
in which participants are assigned at random to a group for a combination of interventions. So this kind of research really is the best way to determine whether an approach really leads to the desired endpoint or outcome. Ideally, a technique known as
randomization
is used to arbitrarily assign people to one treatment or another. In many circles, the gold standard of human clinical research studies is the randomized, controlled clinical trial.

An n=1 case study
can
be a controlled study if an individual tries different diets and keeps everything else the same. In research language this is known as a “multiple-period, within-subject, crossover study.” A case series is a research publication that tells the experience of several case studies, with or without the “crossover” on several different diets.

There is no standard definition of what constitutes a small or large study, but in general, a study with fewer than fifty participants is considered a small study while a large study has hundreds of participants. A large study tends to offer up more relevant and applicable results, and the more diverse the participants, the more likely the results will be relevant to you. For example, if the study looked at 8,000 men and you are a woman—well, you get the picture, right?

This leads us to the final rub—there is no one exactly, 100 percent just like you. So even though there’s a lot of great research that has been done to this point, none of it may ever be relevant to you! The only way to know for sure if something will work for you is to try it and see. That’s why we are huge advocates of self-experimentation and doing what works for you to become optimally healthy. You are your own best health advocate, and you know the most about your own body. Take control of your own health and never fall victim to false interpretations of any research study.

DOCTOR’S NOTE FROM DR. ERIC WESTMAN: Generally speaking, if a study comes from a clinical practice, it is not as highly regarded as a study that had special staff taking measurements, double-checking procedures, and thoroughly documenting events and outcomes.

Now that you know how to discern the difference between strong, solid experimental studies and weak observational studies that often get a lot more attention than they deserve, let’s take a look at the science supporting ketogenic diets. Don’t worry if you’re not a scientist or don’t understand all the complex jargon of research papers—we’ll explain it all in plain English for you. However, if you do want to dig a little deeper into the research, the citations for all these studies are listed in the back of the book.

Epilepsy

In the case of epilepsy, a state of nutritional ketosis is effective in the treatment of seizures while avoiding the side effects of antiepileptic medications designed to accomplish the same results. Interestingly, valproic acid is a medication used in the treatment of epilepsy and several mood disorders that is an inhibitor of histone deacetylase, as is the ketone beta-hydroxybutyrate. Histone deacetylase inhibitors are currently being investigated for their anticancer and antiaging properties. This may suggest an actual mechanism for the antiseizure properties of beta-hydroxybutyrate.

– Dr. Keith Runyan

We begin with the oldest use of the ketogenic diet. The Bible describes fasting, which as we’ve noted causes the body to produce ketones, as a treatment for “fits.” Other ancient Western medical practitioners advised their patients with recurring seizures not to eat carbohydrates (sugars and starches), which they found worked as well as not eating any food at all. Today, we understand that both “not eating” and “not eating carbohydrates” are the same thing behind the scenes—both make the body use fat for fuel. Of course, eating moderate protein and a lot of fat is the healthy way to sustain fat-burning over a long period of time.

The low-carb, high-fat, ketogenic diet was rediscovered in the early 1900s as a treatment for epilepsy. In many instances, seizures resolve completely when the patient begins eating this way. Endocrinologist H. Rawle Geyelin used this approach with several epileptic patients and presented his promising findings at the 1921 meeting of the American Medical Association. He ultimately developed the low-carb, high-fat, ketogenic nutritional approach to treating epilepsy that would become the go-to means for controlling epileptic seizures until the early 1940s. When prescription medications for epilepsy were developed, reliance on this natural dietary approach began to wane.

More than ninety years of experience and a number of clinical trials show the benefit of the ketogenic diet for children with drug-resistant epilepsy. About one fourth of these children completely stop having seizures and another third have a substantial reduction in the number of seizures. More recently, some adults with epilepsy have benefitted as well.

– Dr. Mary Newport

The Ketogenic Diet (capitalized here to distinguish it as an official medical treatment for epilepsy) became less and less popular as new medications were developed to treat seizures, but there were a few medical centers that continued using this approach because it worked so well. Then in 1997, the Ketogenic Diet received a tremendous boost in popularity with
. . . First Do No Harm,
a made-for-TV movie starring Meryl Streep that was written and directed by Jim Abrahams, cofounder of the advocacy group The Charlie Foundation for Ketogenic Therapies. It details the story of a mom whose son has epilepsy and her frustration with the medical profession refusing to tell her about the Ketogenic Diet as an alternative therapy. The film spawned even more research about the uses of a ketogenic diet to treat epilepsy.

The studies that have been conducted on this nutritional therapy now include several clinical series and randomized, controlled trials that clearly demonstrate that it works for some—but not all—people with epilepsy. There are treatment centers around the world that offer the Ketogenic Diet as a therapy for patients with epilepsy.

The efficacy of ketosis in reducing the frequency of seizures in patients with epilepsy has been in the medical literature since 1928.

– Dr. David Perlmutter

Interestingly, there has been very little conversation between researchers investigating the effects of low-carb, ketogenic diet on weight and general health and researchers investigating the Ketogenic Diet as a treatment for epilepsy. But effective strategies for increasing ketone production may come from the traditional teachings of the Ketogenic Diet, which calls for a fat to protein and carbohydrate ratio of four to one. First, the protein requirement is determined: 1 gram of protein per kilogram of body weight. Then, add in 10 to 15 grams of carbohydrate. The rest of the diet is comprised of fat. So if a child weighs 44 pounds (20 kilograms), the daily protein intake would be 20 grams and carbohydrate intake would be 10 grams, for a total of 30 grams that are not fat. Then, since the ratio of fat to protein and carbohydrate is 4, multiply 4 by 30 to get 120 grams of fat per day.

So, from the historical use of the ketogenic diet, it was discovered that ketone levels could be optimized by keeping carbs and protein low. The effectiveness of this nutritional treatment for epilepsy has resulted in researchers and clinicians trying a ketogenic diet to treat other medical conditions in people who are not responding well to traditional drug therapies.

Diabetes Mellitus (Type 2 Diabetes)

Type 2 diabetes is a state of profound carbohydrate intolerance, and carbohydrate restriction reduces the demand on the pancreas to secrete excessive insulin in the face of insulin resistance while improving glycemic control and facilitating weight loss.

– Dr. Keith Runyan

Fears about using a low-carb, high-fat diet to treat diabetes don’t make any sense at all when you consider that for thousands and thousands of years, the human diet didn’t include much sugar or starch. In fact, in the late 1800s and early 1900s, a low-carb, high-fat diet was actually the primary treatment for diabetes! Insulin was discovered in 1921, but before that, a diet of 70 percent fat, 22 percent protein, and 8 percent carbohydrate was advocated by people like Frederick M. Allen and Eliot P. Joslin—top luminaries in the world of medicine—to treat diabetes.