Hopkins: Ketogenic Diets Safe

Johns Hopkins has been doing research and clinical trials on ketogenic diets for seizure disorders in children for years. The diet they use is much more carb-restricted than we find in PP, and probably higher in fat content. The article in Diabetes in Control describes it this way:

The ketogenic diet, consisting of high-fat foods and very few carbohydrates, is believed to trigger biochemical changes that eliminate seizure-causing short circuits in the brain’s signaling system. Used as first-line therapy for infantile spasms and in children whose seizures cannot be controlled with drugs, the diet is highly effective but complicated and sometimes difficult to maintain. It can temporarily raise cholesterol, impair growth and, in rare cases, lead to kidney stones, among other side effects.

The Hopkins Children’s Hospital used the diet for 16 months to 8 years to reduce or eliminate the seizures. The study being referenced is a follow-up to see if any lasting health problems from the diet are revealed.

There don’t seem to be any long-term effects:

Only two of the 101 patients reported kidney stones after stopping the diet, the same rate found in the general population not treated with the ketogenic diet, the researchers say.

None of the 25 patients who had liver and kidney function tests had abnormal results. Among the 26 patients who had their cholesterol tested, the average level was 157 milligrams per deciliter of blood (less than 200 is considered normal), with three of the 26 having abnormal levels. Most patients’ cholesterol levels go up while on the diet, but are believed to return to normal thereafter. The Hopkins study now confirms that this is the case.

In 2008, Johns Hopkins Children’s Hospital described the results on cholesterol this way:

While most children developed high cholesterol after starting the diet, in half of them, cholesterol gradually improved returning to normal or near-normal levels, with or without modifications to their diet to reduce fat intake.

Interestingly, efforts to reduce saturated fat saw no greater decrease in cholesterol levels. In other words, doing nothing and reducing saturated fat had the same effect over time. That might be good news for low carbers that are worried about an increase in cholesterol in the early years of the new way of eating.

Since 2005, Hopkins has noted that a modified Atkins low carb diet plan has nearly the same benefits as their more restrictive ketogenic diet for children with seizure disorders. In effect, any diet that puts the patient into ketosis restricts the seizure activity.

Jan’s Pumpkin Pecan Coconut Low Carb Cookies

These are a great, soft cookie with under 2 grams of carbs per 2″ cookie. The cookie is moist, chewy, and the sweetness can be controlled easily if you so desire. The flavors blend well, and neither the pumpkin, coconut, apple filling or pecans overpower the other flavors. The recipe makes about 24 cookies 1 1/2″ to 2″ in diameter. Jan created these cookies by experimentation, and they are fabulous!

Cookie Ingredients:
3/4 Cup Almond Meal
1/4 Cup Flax Seed Meal
1/4 Cup Unsweetened Shredded Coconut
1/4 Cup Pecans, chopped
3 tsp Sweetner
1/2 Package Single Serving Apple Drink Mix (pictured)
1 Grade AA Large Egg
1/2 Cup unsweetened Pumpkin filling
1/4 Cup Butter
1 1/2 tsp Dark Molasses
1/4 Cup Shortening

Topping
1 tsp Brown Sugar
1/4 Cup unsweetened Shredded Coconut
1/4 Package Single Serving Apple Drink Mix (Pictured)

Heat oven to 325°F. Mix topping ingredients together and set aside. In a 2 quart mixing bowl, mix dry cookie ingredients well. Add egg, pumpkin filling, butter (allow to soften to room temperature first) and shortening and mix well. Form 1″ balls with cookie mix, and press down onto greased cookie sheet, flattening them to form 1 1/2″ to 2″ diameter. Sprinkle topping over cookies and bake for 12 – 15 minutes. Store cookies in refrigerator.

Total effective carb count (ECC) is 36 grams per batch of cookies.

Bloated Government

In the UK, the government sponsors the “National Child Measurement Programme”, an attempt to combat childhood obesity by assessing the height and weight of children. The program does the measurements in the schools, and then sends letters home to parents.

Lucy, a five year old, was measured and the letter warned she “may have an increased risk of heart disease, diabetes, high blood pressure and cancer as her body mass index (BMI) was outside recommended guidelines”.

The Daily Mail Onlline recounts the reaction of the parents. As the mother said:

I couldn’t believe what I was reading, Lucy is five-years-old and not fat in the slightest. She shouldn’t even be thinking about her weight at her age.

‘I want her to be running around playing and having fun, not worrying about what she looks like.

It would be easy to say mum is a bit sensitive about her daughter’s weight, and in denial about how she is setting her daughter up for medical problems by her poor parenting.

The problem with formulas to determine optimum weight for an individual is that they are often just plain wrong. A number doesn’t make you healthy. And in Lucy’s case, the number is obviously wrong, as anyone with any sense can see. But perhaps that’s more than we can ask from a government program. Here’s a picture of Lucy:

She looks like the picture of health, to me. Sounds like the bloated, overweight, tub-of-lard actor in this issue is not the kids in Britain, but the fat-ass government.

No Link Between Fat and CHD

A new “meta analysis” of existing studies purports to find no link between fat intake and coronary heart disease (CHD):

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

The problem with this study is that it is a meta analysis, which as Dr. Eades explains:

For those who don’t know, meta-analyses are compilation studies in which researchers comb the medical literature for papers on a particular subject and then combine all the data from the individual studies together into one large study. This combining is often done to bring together a collection of studies, none of which contain data that has reached statistical significance, to see if the aggregate of all the data in the studies reaches statistical significance. I think these types of meta-analyses are highly suspect, because they can lead to conclusions not warranted by the actual data.

Those same concerns apply to this study, of course. But one thing this study does is help counter the other meta analysis studies that purport to show a link between dietary fat intake and heart disease.

Meanwhile, we find another study that says butter ain’t so bad:

Now a new study from Lund University in Sweden shows that butter leads to considerably less elevation of blood fats after a meal compared with olive oil and a new type of canola and flaxseed oil. The difference was clear above all in men, whereas in women it was more marginal.

Seems that about 20 percent of the fat in butter consists of short and medium-length fatty acids which are metabolized for energy and don’t contribute to blood lipid levels.

Good news for me. Butter is one of my favorite foods.

Low Carb and BP

Dana Carpendar at Hold the Toast blog recaps the results of an interesting study in the Archives of Internal Medicine:

47% of the low carb group had their blood pressure medication discontinued in the course of the study, as compared to 21% of the low fat group. Dr. William Yancy, who ran the study, said the difference in the two groups might have been even greater had subjects remained on their blood pressure medication, but they instead took people off medications as their readings normalized.

The study started the low carb group at the true low carb level promulgated by the Atkins diet, 20 grams per day. Far too often, studies comparing low carb diets to low fat diets use 100 or more grams per day of carbohydrate. The study lasted nearly a year, long enough for true differences in the diets to be seen. For the low fat diet group, the study added a common diet drug, orlistat, a drug that sequesters fat so it can be eliminated before being absorbed by the body.

Weight loss for the two groups is statistically insignificant, even though some low carbers have pointed to the results proudly. The small sample size and small difference in the number of pounds lost between the two groups just doesn’t lend itself to proclaiming any victory for the low carb diet. But the study does show the low carb diet is the equal of a low fat diet in nearly every respect. The study’s Abstract points this out.

No matter what you read, the main benefit of a low carb diet in this study was that it matched the low fat diet in nearly all areas, and was superior in controlling high blood pressure:

Conclusion: In a sample of medical outpatients, an LCKD [low carb ketogenic diet] led to similar improvements as O + LFD [orlistat plus low fat diet] for weight, serum lipid, and glycemic parameters and was more effective for lowering blood pressure.

It would be interesting to see how the participants felt about their low carb or low fat diet. My experience has been that the low carb diet is much easier to maintain, as I rarely struggle with hunger even while losing weight.

And, I love bacon.

Can You Eat Too Much Protein?

Dr. James Carlson is a board certified family physician with multiple degrees … biochemistry and molecular cellular biology from Cornell University, an MBA from Regis University, and a Juris Doctorate from Concord University. And that’s in addition to his medical education at the NY College of Osteopathic Medicine. Dr. Carlson is one of those smart guys I like, one that, like Dr. Eades, has actually had a medical practice with real patients and real mysteries to solve.

His blog post today covers a subject that many low carb dieters wonder about: for some reason, they stop losing weight, even though they have not increased their carb intake. In forums, these people are often told they are “cheating”, perhaps without knowing it. But I’m always struck with how much this kind of “advice” resembles the justifications for the failed low-fat diet: if you can’t stay on the diet, its your fault.

Dr. Carlson does a good job of describing a situation where protein can be made into glucose:

Ok, so back to protein. Yes, one can definitely over consume protein, allowing the glucogenic amino acids to be converted to glucose, this can cause a sugar rise, subsequent release of insulin and that is what is causing your weight loss stall or possibly weight gain.

There’s a lot more there about a topic most low carbers have heard, gluconeogenesis, and one they probably haven’t, glyceroneogenesis. Follow the link to read it all.

So why would a careful low carber, who has been losing steadily and eating all the right things, suddenly stop losing? Nothing has changed, right? Wrong.

No, the dieter isn’t necessarily cheating. The dieter has lost 20 or 30 pounds. I have lost 30 pounds, about 13% of my pre-diet body weight. And when I started the diet, I calculated my protein requirement based in large part upon … my weight. That’s what has changed.

So, for the low carb dieter who has lost weight, its back to the tables and charts to re-calculate what their protein requirement is; for most people, it will be less than before. While weight lifters may have more lean body mass, most of us will have less calculated lean body mass. I don’t think we are actually losing muscle. And while I’m not absolutely certain on this point, I think the charts and measurements we use have a built-in variation that gets more and more accurate as we reduce our body fat percentage.