Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet

Csaba Tóth, Zsófia Clemens

Diabetic patients are, generally, recommended to follow a diet that is low in fat and high in carbohydrates.  Clinical studies, conversely, showed metabolic benefits conferred by carbohydrate-restricted diets including the ketogenic diet and the paleolithic diet in type 2 diabetes.  Much less data on the use of low carbohydrate diets in type 1 diabetes (T1DM) are available.  Two studies by Nielsen et al. showed that a low carbohydrate diet lowers the need for insulin as well as the number of hypoglycemic episodes in T1DM .  It was also suggested that a low carbohydrate diet is sustainable on the long-term

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Pre-operative Very Low Calorie Ketogenic Diet (VLCKD) vs. Very Low Calorie Diet (VLCD): Surgical Impact

Alice Albanese, L. Prevedello, M. Markovich, L. Busetto, R. Vettor, M. Foletto

Pre-operative diet may play an important role as far as patients’ fitness for surgery, post-operative outcomes, and successful weight loss.  Our aim was to compare surgical outcome and weight loss in two groups of patients who were offered two different pre-operative kinds of diet: very low calorie diet (VLCD) and very low calorie ketogenic diet (VLCKD).

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Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients

Rainer J. Klement; Reinhart A. Sweeney

Single arm with 6 participants:  Our data lend support to the hypothesis that KDs administered as supportive measures during standard therapy are safe and might be helpful in preservation of muscle mass. There was consensus that the KD was satiating and weight loss occurred in all patients, although this was only significant in two patients. Our data indicate that weight loss was mainly due to fat mass loss with concurrent preservation of muscle mass. Overall quality of life remained fairly stable, and all subjects reported feeling good on the diet. Tumor regression occurred as expected in five patients with early stage disease

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Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease

Alessandro Pinto; Alessio Bonucci; Elisa Maggi; Mariangela Corsi; Rita Businaro

Review:  The few studies conducted on humans available so far are based on a pre/post design but without a reference control group and without randomization.  Of particular interest were the RCTs that correlated the introduction of KD to an improvement of verbal receptive vocabulary and of reaction time in children affected by epilepsy, as well as an improvement in attention and memory in patients affected by multiple sclerosis.  The results demonstrated causal evidence and stressed the need to increase the number of studies to demonstrate that 4:1 KD induces a cognitive improvement in neurological diseases

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Modified ketogenic diet in lymphoma: A case series in the Veteran Affairs Pittsburgh Healthcare System

Jocelyn Tan-Shalaby; Roby Antony Thomas; Jennifer Carrick; Andrew D. Liman; Vida Almario Passero; Arisha Patel; Jenna Shields

Single arm prospective with 3 participants:  Ketogenic diets in human lymphomas appears well tolerated and can improve symptoms, quality of life, and limit tumor growth. Ketogenic diets may reverse the weight loss seen in terminal cancer patients with cachexia

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Modified Atkins diet in advanced malignancies – final results of a safety and feasibility trial within the Veterans Affairs Pittsburgh Healthcare System

Jocelyn L. Tan-Shalaby; Jennifer Carrick; Krystal Edinger; Dana Genovese; Andrew D. Liman; Vida A. Passero; Rashmikant B. Shah

Single arm prospective with with 17 participants:  Dysfunctional mitochondrial processes limit malignant cells ability to use energy from fatty acids and ketones. Animal studies using ketogenic diets for cancer show encouraging results. We tested the diet’s safety and feasibility in cancer patients across a broad variety of solid tumors.

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Isocaloric fructose restriction and metabolic improvement in children with obesity and metabolic syndrome

Robert H. Lustig; Kathleen Mulligan; Susan M. Noworolsk;i Viva W. Tai; Michael J. Wen; Ayca Erkin‐Cakmak; Alejandro Gugliucci; Jean‐Marc Schwarz

Single arm prospective with 27 participants from 2 specific, at risk, ethnic groups:  This study argues that the health detriments of sugar, and fructose specifically, are independent of its caloric value or effects on weight. Further studies will be required to determine whether sugar restriction alone can impact metabolic syndrome in adults and whether such effects are short‐lived or long‐term.

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Management of Glioblastoma Multiforme in a Patient Treated With Ketogenic Metabolic Therapy and Modified Standard of Care: A 24-Month Follow-Up

Ahmed M. A. Elsakka; Mohamed Abdel Bary; Eman Abdelzaher; Mostafa Elnaggar; Miriam Kalamian; Purna Mukherjee; Thomas N. Seyfried

Case Report:  A press-pulse therapeutic strategy was implemented to target glucose and glutamine availability in a 38-year-old GBM patient using a modified SOC and KMT. As less than 20% of younger adults generally survive beyond 24 months with GBM, it is possible that the response observed in this case resulted in part from KMT and the modified SOC. The patient is now 40 years old and remains in excellent health with no noticeable neurological issues (Karnofsky Score, 100%) after 24 months of treatment.

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Efficacy of Metabolically Supported Chemotherapy Combined with Ketogenic Diet, Hyperthermia, and Hyperbaric Oxygen Therapy for Stage IV Triple-Negative Breast Cancer

Mehmet Salih İyikesici; Abdul Kadir Slocum; Ayshe Slocum; Ferhan Bulent Berkarda; Miriam Kalamian; Thomas N. Seyfried

Case Report:  We have described a complete response to MSCT, KD, HT, and HBOT in a 29-year-old woman with stage IV (T4N3M1) TNBC that had metastasized to the lymph nodes, liver, and abdomen. Despite the advanced stage of this disease, the therapeutic strategy of combining MSCT, KD, HT, and HBOT achieved a clinical and radiological complete response in this patient within four months.  The treatment regimen was continued for an additional two months when pCR was further documented in tissue following her mastectomy.

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Patient with Recurrent Glioblastoma Responding Favorably to Ketogenic Diet Combined with Intranasal Delivery of Perillyl Alcohol: A Case Report and Literature Review

Juliana Guimarães Santos; Wanise Maria Souza Da Cruz; Axel H. Schönthal; Marcela D'alincourt Salazar; Cristina Asvolinsque Pantaleão Fontes; Thereza Quirico-Santos; Clovis Orlando da Fonseca

Case Report:  After 3 months of a Ketogenic Diet combined with intra-nasal POH therapy led to a marked reduction of the lesion and significant clinical improvement. Tumor growth was halted during the 3-month treatment phase.

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β-Hydroxybutyrate Deactivates Neutrophil NLRP3 Inflammasome to Relieve Gout Flares

Emily L. Goldberg; Jennifer L. Asher; Ryan D. Molony; Albert C. Shaw; Caroline J. Zeiss; Chao Wang; Ludmilla A. Morozova-Roche; Raimund I. Herzog; Akiko Iwasaki; Vishwa Deep Dixit

Rat study:  Aging and lipotoxicity are two major risk factors for gout that are linked by the activation of the NLRP3 inflammasome. Neutrophil-mediated production of interleukin-1β (IL-1β) drives gouty flares that cause joint destruction, intense pain, and fever…… Collectively, our studies show that BHB, a known alternate metabolic fuel, is also an anti-inflammatory molecule that may serve as a treatment for gout.

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Fasting Lipoprotein and Postprandial Triacylglycerol Responses to a Lowcarbohydrate Diet Supplemented With n-3 Fatty Acids

Jeff S. Volek, PhD, RD; Ana L. Gómez , MS; William J. Kraemer , PhD

Single arm prospective with 10 Participants:  A hypocaloric low-carbohydrate diet rich in MUFA and supplemented with n-3 fatty acids significantly reduced postabsorptive and postprandial TG in men that were not hypertriglyceridemic as a group before the diet.  This may be viewed as a clinically significant positive adaptation in terms of cardiovascular risk status.

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Effect of 6-month Adherence to a Very Low Carbohydrate Diet Program

Eric C Westman, MD, MHS; William S Yancy, MD; Joel S Edman, DSc; Keith F Tomlin; Christine E Perkins, MSW

Single arm prospective with 51 participants:  In these subjects, the mean body weight decreased 10.3% +/- 5.9% from baseline to 6 months. The mean percentage of body weight that was fat decreased 2.9% +/- 3.2% from baseline to 6 months. Serum total cholesterol level decreased 11 +/- 26 mg/dL, low-density lipoprotein cholesterol level decreased 10 +/- 25 mg/dL, triglyceride level decreased 56 +/- 45 mg/dL, high-density lipoprotein (HDL) cholesterol level increased 10 +/- 8 mg/dL, and the cholesterol/HDL cholesterol ratio decreased 0.9 +/- 0.6 units. A very low carbohydrate diet program led to sustained weight loss during a 6-month period.

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Body Composition and Hormonal Responses to a Carbohydrate-restricted Diet

Jeff S. Volek; Matthew J. Sharman; Dawn M. Love; Neva G. Avery; Ana L. G[oacute]mez; Timothy P. Scheett; William J. Kraemer

Single arm propective with 12 participants:  Authors conclude that a carbohydrate-restricted diet resulted in a significant reduction in fat mass and a concomitant increase in lean body mass in normal-weight men, which may be partially mediated by the reduction in circulating insulin concentrations.

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An Isoenergetic Very Low Carbohydrate Diet Improves Serum HDL Cholesterol and Triacylglycerol Concentrations, the Total Cholesterol to HDL Cholesterol Ratio and Postprandial Pipemic Responses Compared With a Low Fat Diet in Normal Weight, Normolipidemic Women

Jeff S. Volek; Matthew J. Sharman; Ana L. Gómez; Timothy P. Scheett; William J. Kraemer

Ramdomized crossover with 10 participants:  In normal weight, normolipidemic women, a short-term very low carbohydrate diet modestly increased LDL-C, yet there were favorable effects on cardiovascular disease risk status by virtue of a relatively larger increase in HDL-C and a decrease in fasting and postprandial triaclyglycerols.

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Effects of a Lowcarbohydrate Diet on Weight Loss and Cardiovascular Risk Factor in Overweight Adolescents

Stephen B. Sondike, MD; Nancy Copperman, MS, RD; Marc S. Jacobson, MD

RCT with 30 participants:  To compare the effects of a low-carbohydrate (LC) diet with those of a low-fat (LF) diet on weight loss and serum lipids in overweight adolescents. The LC group lost more weight (mean, 9.9 +/- 9.3 kg vs 4.1 +/- 4.9 kg) and had improvement in non-HDL cholesterol levels. There were no adverse effects on the lipid profiles of participants in either group. The LC diet appears to be an effective method for short-term weight loss in overweight adolescents and does not harm the lipid profile.

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A Low-carbohydrate as Compared With a Lowfat Diet in Severe Obesity

Frederick F. Samaha, MD; Nayyar Iqbal, MD; Prakash Seshadri, MD; Kathryn L. Chicano, CRNP; Denise A. Daily, RD; Joyce McGrory, CRNP; Terrence Williams, BS; Monica Williams, BS; Edward J. Gracely, PhD; and Linda Stern, MD

RCT with 132 participants:  Severely obese subjects with a high prevalence of diabetes or the metabolic syndrome lost more weight during six months on a carbohydrate-restricted diet than on a calorie- and fatrestricted diet, with a relative improvement in insulin sensitivity and triglyceride levels, even after adjustment for the amount of weight lost.

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Effect of a High Saturated Fat and No-starch Diet on Serum Lipid Subfractions in Patients With Documented Atherosclerotic Cardiovascular Disease

James H. Hays, MD; Angela DiSabatino, RN, MS; Robert T. Gorman, PhD; Simi Vincent, PhD, MD; Michael E. Stillabower, MD

Prospective single arm:  To determine whether a diet of high saturated fat and avoidance of starch (HSF-SA) results in weight loss without adverse effects on serum lipids in obese nondiabetic patients.  HSF-SA diet results in weight loss after 6 weeks without adverse effects on serum lipid levels verified by nuclear magnetic resonance, and further weight loss with a lipidneutral effect may persist for up to 52 weeks.

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A Randomized Trial of a Low-Carbohydrate Diet for Obesity

Gary D. Foster, PhD; Holly R. Wyatt, MD; James O. Hill, PhD; Brian G. McGuckin, EdM; Carrie Brill, BS; B. Selma Mohammed, MD, PhD; Philippe O. Szapary, MD; Daniel J. Rader, MD; Joel S. Edman, DSc; Samuel Klein, MD

RCT with 63 participants:  The low-carbohydrate diet produced a greater weight loss (4%) than did the conventional diet for the first six months, but the differences were not significant at one year.  The lowcarbohydrate diet was associated with a greater improvement in some risk factors for coronary heart disease.

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A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women

Bonnie J. Brehm; Randy J. Seeley; Stephen R. Daniels; David A. D’Alessio

RCT with 53 participants:  Based on these data, a very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.

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Effect of Low- Carbohydrate, Unlimited Calorie Diet on the Treatment of Childhood Obesity: A Prospective Controlled Study

James R. BailesJr.; Misty T. Strow; Joseph Werthammer; Richard A. McGinnis; Yoram Elitsur

Non-ramdomized Prospective Controlled Study:  Obese children following a high protein, low CHO diet (<30g/day) lost an average of 5.21 ± 3.44 kg and decreased their BMI by 2.42 ± 1.3 points, compared to the children in the Low Cal Diet (calorie restricted) who gained an average of 2.36 ± 2.54 kg and 1.00 point on the BMI value.  A high protein, low carbohydrate, unlimited calorie diet was superior to a restricted calorie protocol for weight loss in obese school age children; moreover, compliance was better.

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A Low-Carbohydrate, Ketogenic Diet versus a Low-Fat Diet To Treat Obesity and Hyperlipidemia: A Randomized, Controlled Trial

William S. Yancy Jr., MD, MHS; Maren K. Olsen, PhD; John R. Guyton, MD; Ronna P. Bakst, RD; Eric C. Westman, MD, MHS

RCT with 120 participants:  Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than with the low-fat diet.

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Comparison of Energyrestricted Very Lowcarbohydrate and Low-fat Diets on Weight Loss and Body Composition in Overweight Men and Women

JS Volek; MJ Sharman; AL Gómez; DA Judelson; MR Rubin; G Watson; B Sokmen; R Silvestre; DN French; WJ Kraemer

RCT with 28 particpants:  This study shows a clear benefit of a VLCK over LF diet for short-term body weight and fat loss, especially in men. A preferential loss of fat in the trunk region with a VLCK diet is novel and potentially clinically significant but requires further validation.

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