If you're going to go nutty ketotic ...
... you might want to take thiamine.
Optic neuropathy in ketogenic diet
Optic neuropathy in ketogenic diet
SUMMARY A symmetrical, bilateral optic neuropathy is reported in 2 patients being treated with ketogenic diets for seizure control. Laboratory tests suggested a thiamine deficiency, and both patients recovered normal visual function after several weeks of treatment with thiamine. The risk of optic nerve dysfunction occurring during the treatment with a ketogenic diet can be minimised if routine vitamin B supplements are given and periodic evaluation of optic nerve function undertaken.
Comments
Both patients were prescribed vitamins - which they weren't given - because their prescribed diets were known to be deficient.
Not enough meat, dairy or offal is my guess.
So one thing not yet exhausted is ketosis. It's fresh meat, so to speak.
With LC, the superficial flaws completely obscure the fundamental flaws.
Wrt ketosis, why would Nature design a system that wastes the food/fuel which is a ketone body? Exhalation and urination, expelling fuel. This supposedly is an ideal and natural condition in everyday life for non-epilectics? Yeah, right.
In addition to what you say about ketosis, one thing I've been repeating is why the body seems to fight it so. You have to consistently eat a truly unnatural diet to remain consistently in ketosis.
Re your other comment on ketosis, it's odd to me how it has been given new life. The populace, unfortunately, has a short memory, because there can be no doubt about why Atkins thought (or presented as his "science") his diet worked. I found the lack of discussion of ketosis in the New Atkins (Westman, Volek & Phinney) rather interesting, and in light of this new fangled take, I think at least Volek & Phinney have some 'splainin' to do.
In Japan obesity is considered taboo. It is literally a CRIME to be fat in Japan although no one is ever charged or prosecuted.
There is immense social pressure for Japanese to remain thin. Japanese people eat small meals and rarely snack.
Japanese women have a "correct" weight of 43kg. Even being a few kg overweight results in ridicule. A female Japanese friend of mine was called "Sumo" because she was considered grossly overweight at 55kg!
What about sumo wrestlers you ask? They cut back their food intake and try lose weight as quickly as possible after they retire. Most ex-sumo are normal weight.
Obviously the kids weren't enough raw liver and sheeps eyeballs and their butter wasn't from pature fed cows. /sarc
In these cultures, meat is eaten in rather small quantities, compared to the American diet. Vegetables are plentiful on plates, even in smaller-sized portions. And rice in Japan - every meal and many, many snacks are simply rice-based. In Italy, pasta and bread are staples , enjoyed with vegetables (which are carbs).
Tabus about being fat aside (offhand, I can't think of modern, civilized cultures in which fat women are considered sexy), the diets themselves are different. There are opportunities to eat more and more, just as there are those opportunities here - but you don't have gigantic portions (except maybe in restaurants in hotels that serve tourists).
My husband and I order fried calamari here in the States when it's on the menu. Not an appetizer in Italy the way it is here. Also, not portion-sized to serve four people as it is here. He and I split a portion. Really, with salad, that's a good-enough calorie hit to add salad and a mixed drink and you've got dinner! Make exactly the same dish with tempura batter on the calamari and it's the same scenario.
The young are still quite slender. The severely obese are rarer here than in North America or Europe, but you do see them. I'd say the population looks like the US around 1950 or so. Greater affluence and an aging population are part of it.
Oh, and about Okinawa. Okinawa now ranks next to last in longevity of all prefectures in Japan. So much for the healthy Okinawan diet -- which nobody eats any more!
The Health Ministry's "Healthy Life" ranking (computed by average age while not in long-term care or bedridden) puts Okinawan women at #4 and Okinawan men at #14. So Okinawa's not too shabby! Sorry I defamed her! They're still not eating the Okinawan diet, though.
http://stats-japan.com/t/kiji/11421 for women.
Recently came across a paper discussing ketones as substrate for de novo lipogenesis in the brain. Might explain a lot why babies might need ketones in addition to glucose to build their brains.
'Rice intake and PRS were inversely associated with weight gain, and PRS was inversely associated with hypertension, but positively associated with fasting blood glucose elevation. No association between rice intake and PRS with the metabolic syndrome was found.'
PRS=Percentage of rice in staple food
It's a bunch of artificially made-up foods and extracted oils.
The diet was KNOWN to be deficient - that's why the supplements were prescribed.
It's not used today - a "modified Atkins' is used, it's more liberal and more sustainable.
it has happened before that drugs have introduced an element of malnutrition into ketogenic treatment of epilepsy. Valproate causes selenium deficiency independent of diet, this is a matter of record, but has resulted in a spurious connection between ketogenic dieting and selenium deficiency.
Vitamin deficiencies caused by drugs are commonplace and underdiagnosed. Anything that affects the gut can hinder absorption of those vitamins that depend on stomach acid, microflora, or metabolism in the gut lining.
Also, why was optic neuritis the only symptom of thiamine deficiency? Is this normal?
The supplements that corrected the problem were multivitamin, not just thiamine.
I linked to various papers on thiamine and diet here some time ago: http://hopefulgeranium.blogspot.co.nz/2012/08/the-role-of-vitamin-fortification-in.html
The sparing action of protein and fat on thiamine is mentioned here:
http://www.jbc.org/content/206/2/725.full.pdf
"In individuals with sub-clinical thiamine deficiency, a large dose of glucose (either as sweet food, etc. or glucose infusion), can precipitate the onset of overt encephalopathy"
http://en.wikipedia.org/wiki/Wernicke%E2%80%93Korsakoff_syndrome
Some people are also born sensitive to thiamine deficiency and transketolase insufficiency, this is thought to be the basis of Wernicke-Korsakoff syndrome.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.1984.tb01181.x/abstract;jsessionid=30B25BF6AF8031E8587F842548EA890A.d01t02
That something similar might be present in some cases of epilepsy doesn't seem out of the question.
The problem is that researchers think of the "mediterranean diet" as a choice while it was actually a necessity.
In the past mediterranenan populations like italians ate a "meditteranean diet" with little meat, lot of beans, bread, season veggies and low calorie because they dind't have money to afford anything else.
Now that things are different and you can buy whatever you want, italians are eating exactly like americans. Not only, but it can be seen that the real traditional italian diet is anything but light or low calories.
Typical traditional foods in italy nowadays are: lasagna, panzerotti (fried dough filled with mozzarella), pizza, cotoletta (breaded fried meat) carbonara (eggs and bacon)) sgagliozze (fried cornmeal) barbequed pork ribs, fried liver with onions, fried sardines, pasta al forno (pasta, mozzarella, fried meatballs, sauce, parmesan, fried eggplants, mozzarella in cazzorra (fried bread with mozzarella cheese inside) and so on
The only reason why Italy was considered an healthy country consuming a mediterranean diet it's because people were too poor to eat those traditional dishes everyday, so they would resort to bread, beans, veggies. But now that people can afford it, the real traditional dishes can be seen for what they really are: high-carb, high-fat, mostly fried, high-calories. People don't eat many veggies in Italy, they don't eat beans anymore, the diet is definitely high in calories.
This proves once again that we're fatter because we can afford more calories, food ic cheaper and more caloric dense. There's no other reason. If certain population have a low-calorie diet and are thin it's because of necessity, because they can't afford more caloric-dense food. The only exception are health-conscious people who follow a nutritional regime and exercise and such. But spontaneous nutrition is low-calorie and low-fat when people live as poorer farmers and high-everything including calories when people can afford all the food they want.
Thiamin, riboflavin, and alpha-tocopherol content of exotic meats and loss due to gamma radiation.
Lakritz L, Fox JB, Thayer DW.
Source
U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, Wyndmoor, Pennsylvania 19038, USA.
Abstract
Changes in thiamin, riboflavin, and alpha-tocopherol concentrations due to gamma irradiation were followed in alligator, caiman, bison, and ostrich (exotic) meats. The proximate composition showed that the exotic meats generally had lower fat content than domestic animal meats and that the thiamin content of the reptiles was lower. The changes in the vitamins due to irradiation were similar to those previously observed for domestic species. The results indicate that the loss of vitamins in these species is negligible insofar as the American diet is concerned, and that the concept of "chemiclearance" is applicable to exotic meats.
3 oz of braised beef liver has 9.2mg thiamine.
Typical analysis of canned ham per 100 g: 65-72 g water, 18 g protein, 5-12 g fat, 0.5-0.8 MJ, 1100-1250 mg sodium, 1.2-2.7 mg iron, 0.2 mg copper, 2 mg zinc, 0.5 mg thiamin, 0.2-0.25 mg riboflavin, 4 mg niacin, 0.2 mg vitamin B6, and may have residual ascorbic acid 10-60 ma.
Lean meat other than pork seems to be a poor source of thiamine; fish is the worst possible source, especially raw fish; nuts and milk are a good source.
I mean, this is a harmful side effect of a KETOGENIC (raise hands in the sign of the cross) diet, isn't it?
As opposed to the effect of ANY diet deficient in thiamine (or maybe one or more other vitamin in the supplement).
And therefore telling us nothing worthwhile about nutty ketosis that doesn't also apply to diets of all macronutrient ratios.
Abstract: Seventy-two epileptic patients receiving phenytoin (PHT) alone or in combination with phenobarbital for more than 4 years were divided into four groups, the first taking two placebo tablets per day; the second folate (5 mg/day) and placebo; the third placebo and thiamine (50 mg/day); and the fourth both vitamins. The clinical trial lasted 6 months. At baseline assessment, 31% of the patients had subnormal blood thiamine levels and 30% had low folate. The vitamin deficiencies were independent phenomena. It was found that thiamine improved neuropsychological functions in both verbal and non-verbal IQ testing. In particular, higher scores were recorded on the block design, digit symbol, similarities and digit span subtests. Folate treatment was ineffective. These results indicate that, in epileptics chronically treated with PHT, thiamine improves neuropsychological functions, such as visuo-spatial analysis, visuo-motor speed and verbal abstracting ability.
Can J Neurol Sci. 1982 Feb;9(1):37-9.
Cerebrospinal fluid and blood thiamine concentrations in phenytoin-treated epileptics.
Botez MI, Joyal C, Maag U, Bachevalier J.
Abstract
Thiamine and folate levels in blood and cerebrospinal fluid (CSF) were determined by microbiological assays in 23 control subjects and 11 phenytoin-treated epileptics. There was no significant difference between the two groups for serum and CSF folate levels. There was, however, a statistically significant difference between the groups for both whole blood thiamine and CSF thiamine levels. Epileptic patients being treated with phenytoin had lower values than control subjects.i
Now, biotin is also required by transketolase and all the other thiamine-requiring enzymes. Deficiency of biotin is rare - except when taking these drugs - but would mimic thiamine deficiency by lessening its activity.
Epilepsy drugs will mess you up, which is why most parents of kids who did ketosis formerly say they would still recommend ketosis, despite side effects, if it lowers the need for drugs. Even parents whose kids didn't benefit tended to be in favour of others trying it.
There's no surprise that they no longer hold the same place they once did for longevity; their diet has undergone substantial changes.
Let this be a lesson for anyone who relies on the prescriber to identify a drug-induced malady. You have more chance of the pharmacist spotting it - always discuss treatment with the pharmacist as well as the doctor.
http://www.ncbi.nlm.nih.gov/pubmed/22688375
'In conclusione, il nostro osservatorio ha permesso alcune importanti deduzioni:
a. un italiano su due ha problemi di peso;
b. la maggior parte degli obesi sono sedentari;
c. l’obesità è un fenomeno prevalentemente maschile;
d. gli uomini, sebbene più obesi, sono i più soddisfatti del proprio peso; in conseguenza sono meno portati a modificare i propri comportamenti;
e. l’obesità è una priorità dei nostri giorni, anche da un punto di vista culturale e di comportamenti;
f. l’obesità è un fenomeno che aumenta con l’età;
g. non vi sono rilevanti differenze del fenomeno obesità in termini di area geografica; si rileva solamente una leggera maggiore concentrazione di obesi nel Sud e nelle Isole;
h. il consumo eccessivo di alcol può essere considerato una delle concause dell’obesità;
i. è importante valorizzare i pasti come momento di convivialità e recuperare anche a tavola il piacere di intrattenersi a conversare;
j. è sconsigliabile mangiare meccanicamente senza distogliere lo sguardo dalla TV;
k. gli indici di aderenza e scostamento alle raccomandazioni si sono dimostrati validi indicatori.'
Italian eating behavior, 2011:
One in two Italians has a problem with weight. The obesity problem is predominantly a male problem, but men are actually pretty satisfied with their weight. And the obese person is likely one who is sedentary. Advice? Stop watching TV while you eat! Eat at the table and have conversations and enjoy your meal. You are more likely to gain weight as you age. And, oh, yes, don't drink so much alcohol!
Do you know if there's been anything like the "social contagion" modeling done on closely-monitored groups of Italians, like Christakis & Fowler did for Framingham, Massachusetts?
http://www.fas.harvard.edu/home/content/obesity-rate-will-reach-least-42-say-models-social-contagion
(ignoring the predictions, just concentrating on whether the math works out the same between a flu virus for example, and obesity)
or click here
other information on this type of model click here or copy & paste this into your URL location bar:
https://www.google.ca/search?client=ubuntu&channel=fs&q=social+contagion+model+obesity&ie=utf-8&oe=utf-8&redir_esc=&ei=cr2pULKeO7O1yQHR5oHABQ
PS - i re-evaluated my own spinach consumption - I really was eating way too much & I've reduced it hugely in favour of smaller amounts of a wider variety. Red cabbage is a new favourite.
Fair enough on the artificial foods, but as far as extracted oils go it seems pretty hard to do a ketogenic diet without them. Pretty much all low carbers love their added fats.
My local supermarket sells delicious gluten-free gourmet sausages in half a dozen varieties. They average 78% fat, 20% protein and 2% carbohydrate - then ideal ratio for a ketogenic diet.
The other alternative is to use coconut cream as an ingredient. It makes fantastic shakes and "icecream".
So you make a great recommendation. The nutty ketotic should eat some liver from time to time.
@blogblog, That protein would apparently be too high for Jimmy and Attia.
BTW, I think most of these kids might run into problems of one sort or another without supplements as much due to calorie restriction as the limitations on foods.
True ketogenic diets are mostly no picnic for those following them, but I imagine when it works for the epileptic its well worth it.
also that would require buying more than a pound of sausage everyday, which is a lot of food, hassle (cooking and everything) and money
for some reason I can't picture someone eating sausage and spinach everyday as healthy and I'm pretty sure he/she would get tired of such diet in a matter of weeks.
Italy is the one of the countries with the LOWEST rates of obesity. Korea and Japan and China, rice-eaters all, also have extremely low-rates, comparatively speaking.
What is surprising is how many more overweight/obese children there are - although the chart for adults confines the data to 'obese' and the chart for kids expands to include 'overweight/obese.' Greece, Italy and the United States seem to be in a race to see who can fatten up their children faster! Surprising because families share food and their food culture.
The way italian eats (they love caloric dense, fried, fat and starchy foods) if food was as cheap in Italy as it is in america, italians would be more obese than americans are.
if Jimmy Moore can be nutty ketotic and well nourished, is there any reason the epileptic kids couldn't eat as well?
Maybe not, according to this review: http://pediatrics.aappublications.org/content/119/3/535.full
A modified Atkins diet also is emerging as a possible alternative dietary treatment for seizures.28,29 With restriction of carbohydrates (10–20 g per day), the Atkins diet can induce ketosis and does not restrict protein, fluid, or calories and does not require an admission or a fast. In a follow-up study, 65% of patients on the Atkins diet had a >50% reduction in seizures and 6 (35%) had a >90% reduction.29 Additional studies of the modified Atkins diet are underway including adult patients with epilepsy.
A third diet is the low glycemic index diet,30 in which fruits, breads, and starches are discouraged. This diet has even fewer carbohydrate restrictions than the modified Atkins diet.
Low-glycemic-index treatment: A liberalized ketogenic diet for treatment of intractable epilepsy
Heidi H. Pfeifer, RD, LDN and Elizabeth A. Thiele, MD, PhD
http://www.neurology.org/content/65/11/1810.full
The ketogenic diet is often effective for intractable epilepsy, but many patients have trouble complying with the strict regimen. The authors tested an alternative diet regimen, a low-glycemic-index treatment, with more liberal total carbohydrate intake but restricted to foods that produce relatively little increase in blood glucose (glycemic index < 50). Ten of 20 patients treated with this regimen experienced a greater than 90% reduction in seizure frequency.
Yet Pfeifer and Thiele are getting good results - good enough for 4 of 11 patients to have complete freedom from seizures - with a more liberal low carb diet based on low-GI carbs, that is, by minimizing glucose rather than by increasing ketones.
This should make us question which other benefits usually attributed to ketosis could be achieved with the same approach.
Full text here: http://www.direct-ms.org/sites/default/files/KetogenicDietModifiedEpilepsy.pdf
It's unfortunate that actual foods and carbs intakes aren't specified in the paper.
How is it different from the ketogenic diet?
The LGIT allows for an increased intake of carbohydrates, with a typical goal of 40-60 grams per day. Food quantities are not weighed out to the gram, but are based on portion sizes. Because it is based on portion instead of exact measurement, patients are able to live a more flexible lifestyle that includes eating at restaurants. Foods that are the basis for the ketogenic diet and are high in fat, such as heavy cream and high fat meats (bacon, sausage, hot dogs and eggs) are also included in the LGIT. However, on the LGIT the percentage of calories from fat is approximately 60%, compared with up to 90% on the ketogenic diet.
Because Rose had tried several medications without success, and because her seizures were still impacting her quality of life, her family decided to speak with her doctors about other treatment options. Initially, a dietary therapy called the ketogenic diet was recommended, but for this teenager and her busy family, it didn't seem like a good fit. Both parents work full time, and Rose and her siblings have active schedules, so the planning and weighing of foods involved in the ketogenic diet felt too restrictive for them.
They chose instead to try a new dietary therapy, called the low glycemic index treatment (LGIT). The LGIT allows a more generous intake of carbohydrates than the ketogenic diet but is restricted to foods that are low in glycemic index, meaning foods that have a relatively low impact on blood glucose levels. For example, Rose cannot eat pasta, most breads, some tropical fruits, or candy because these foods raise blood glucose levels too high. Instead, she eats meats, cheeses, and most vegetables because these foods have a relatively low glycemic index. She doesn't have to weigh her foods but instead must pay attention to portion size, balancing her intake of carbohydrates throughout the day with adequate amounts of fats and proteins.
http://www2.massgeneral.org/childhoodepilepsy/medical/treatment.htm
The low glycemic index treatment (LGIT) is another dietary therapy currently being studied to treat epilepsy. Like the modified Atkins diet, the LGIT also attempts to reproduce the positive effects of the ketogenic diet. However, it allows for a broader range of food types and, again, does not require the weighing of foods.
Carbohydrate intake on the LGIT is less restricted than on the ketogenic diet. The LGIT allows for approximately four times as many grams of carbohydrates, provided that they come from foods with a low glycemic index. The glycemic index is a measure of a particular food's effect on the body's blood-sugar level. Foods that contain simple sugars, such as sucrose (table sugar), have a high glycemic index because they rapidly raise blood sugar after consumption. Conversely, many grains and legumes have a low glycemic index because they affect blood-sugar levels more slowly than high glycemic index foods. Counting carbohydrates and rough portion control is usually sufficient for the treatment to have a seizure-reducing effect.
As with other epilepsy treatments, it is not known how the LGIT works, but preliminary study results suggest that it may be as effective as the ketogenic diet, reducing seizures by half in 70 percent of patients. Because it is more easily tolerated than other dietary therapies, physicians and patients may be more likely to consider the LGIT a treatment option.
Still, I find the abstracts linked here and elsewhere highly educational and thought provoking, at the very least :)
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