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When does a ketogenic diet become a drug?

MedExpress Team

Medexpress

Published June 9, 2023 08:22

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Created for therapeutic purposes, the ketogenic diet is finding more and more applications in the treatment of many diseases, not just neurological ones. Whether it is just a supportive treatment or a real cure is explained by Katarzyna Drąg - clinical dietitian at the Children's Clinical Hospital UCK WUM.

The popularity of the keto diet continues to grow . How is it different from other diets and what is it about putting the body into a state of ketosis that is its goal?

Katarzyna Drąg: The ketogenic diet, also known as the ketogenic diet or colloquially keto diet, is a diet characterized by low carbohydrate (about 5-10% of energy) and high fat intake (about 70-90% of energy). In comparison, a standard diet provides 45-65% of energy from carbohydrates and 20-35% from fats. The proportion of protein in both cases is similar and should be within the recommended standard for the age.

Such a modification of the composition of the diet means that the amount of glucose (i.e. the main source of energy for cells) that the body obtains from food is insufficient to meet its energy needs, and in order to continue to function it is forced to produce energy from other compounds alternative to glucose. These are ketone bodies (a.k.a. ketones), produced in the liver, through the metabolism of fats. After a few days or weeks of such feeding, cells begin to treat ketones as the primary energy substrate, and the body enters a state of ketosis.

You can find out whether a person is in a state of ketosis by measuring the concentration of beta-hydroxybutyrate in the blood, a ketone body that makes up about 80% of all ketones. It is assumed that optimal values should be in the range of 0.5-3 mmol/L. Higher results are obtained primarily for therapeutic purposes. In people who are not on a diet, ketones in the blood are virtually non-existent (<0.22 mmol/l).

The ketogenic diet is not an entirely new, revolutionary idea for burning fat. It originated in the early 20th century as a way to treat epilepsy.Is this moment considered the beginning of its use as a therapeutic diet?

The first half of the 20th century is believed to have been groundbreaking in terms of the emergence of the ketogenic diet. It was then that the results of the first clinical trials were published, documenting its positive effects in the treatment of epilepsy. This does not mean, however, that ketosis had not been used to treat it before. It was, and had been in ancient times. Scientists, unaware of the mechanisms responsible for the control of epileptic seizures, recommended periodic fasts to patients, and noticing an improvement afterwards, in the absence of other therapeutic methods, continued to use them for many more centuries. Information on this subject can be found, among others, in the works of Hippocrates, BC. Starvation, like the ketogenic diet, leads to the production of ketones from accumulated adipose tissue, but in practice it is not possible to maintain for a long time, as it can lead to death. Thus, the ketogenic diet began to be regarded as its better alternative, since it could be used for a long time. Over the years, its positive effects also began to be used in the treatment of other diseases, although it is now mainly associated as one of the weight-loss diets.

The creators of the diet recognized that burning fat requires eating fat. In light of current recommendations, it is recognized that vegetables and fruits should predominate in a healthy diet. In this context...

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