Early studies reported high success rates; in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).
Focus on exercise: The most compelling studies favor physical activity for mental acuity, says Gary W. Small, M.D., the director of the UCLA Longevity Center and a coauthor of The Alzheimer’s Prevention Program ($14, amazon.com). A study from the Annals of Internal Medicine found that people who were fitter at midlife had a 36 percent lower risk of developing dementia later in life than did their less-fit peers. “When people exercise, the areas that control memory, thinking, and attention increase in the brain,” says Small. “Regular exercisers also have less of the abnormal protein deposits in the brain that have been linked to Alzheimer’s.” That’s not to say that diet has no impact, says Small: “It’s just that the effects of exercise are more pronounced based on the evidence we have now.” Foods rich in omega-3 fatty acids (such as fish, nuts, and flaxseed) and antioxidant-rich fruits and vegetables (like strawberries and spinach) have been shown to improve brain health, while refined sugars and processed foods can have the opposite effect.
“As a rule of thumb, weight loss is generally 75 percent diet and 25 percent exercise. An analysis of more than 700 weight loss studies found that people see the biggest short-term results when they eat smart. On average, people who dieted without exercising for 15 weeks lost 23 pounds; the exercisers lost only six over about 21 weeks. It’s much easier to cut calories than to burn them off. For example, if you eat a fast-food steak quesadilla, which can pack 500-plus calories, you need to run more than four miles to ‘undo’ it!
“Everyone should strive to incorporate probiotics into their daily routine,” advises Roshini Raj MD associate professor of medicine at NYU Langone Health. Good gut wellness starts with your diet: Eat whole foods that offer a variety of fiber sources, such as fruits, veggies, and whole grains. These foods supply prebiotics—a type of fiber that feed the good bacteria, allowing them to thrive. A fiber-rich menu also nourishes the diversity of bacteria species in your gut, which helps protect you from diseases. Another dietary key to digestive health is fermented foods. These include yogurt and kombucha, which help keep your gut populated with beneficial bacteria.
The ketogenic diet has recently become very popular, and many food companies want to cash in by putting a “ketogenic” or “low carb” label on a new product. Be very cautious of special “keto” or “low-carb” products, such as pastas, chocolate bars, energy bars, protein powders, snack foods, cakes, cookies and other “low carb” or “ketogenic” treats. Read all labels carefully for natural low carb ingredients. The fewer ingredients the better.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.
In the mid-1990s, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC's Dateline programme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.
The fast is based on the diet of the prophet Daniel, whose exile in Babylon is detailed in the Old Testament. What he ate during that time dictates what fasters can eat today: fruits, vegetables, beans, nuts and grains (no leavened bread allowed — even the Bible-derived Ezekiel bread). The only beverage permitted is water, although followers can cook with plant-based drinks, such as soy or almond milk.
In its 2016 report “Healthy Eating Guidelines & Weight Loss Advice,” the Public Health Collaboration, a U.K. nonprofit, evaluated evidence on low-carbohydrate, high-fat diets. (The Keto diet falls under the LCHF umbrella.) Among 53 randomized clinical trials comparing LCHF diets to calorie-counting, low-fat diets, a majority of studies showed greater weight loss for the Keto-type diets, along with more beneficial health outcomes. The collaboration recommends weight-loss guidelines that include a low-carbohydrate, high-fat diet of real (rather than processed) foods as an acceptable, effective and safe approach.
A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild. However, many patients gave up with the diet, for various reasons, and the quality of evidence inferior to studies on children. Health issues include high levels of low-density lipoprotein, high total cholesterol, and weight loss.
^ Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, saccharin and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1). The eggnog may also be cooked to make a custard, or frozen to make ice cream.