Cauliflower rice. If you haven’t already eaten some, you’ve probably seen it proliferating in grocery stores and on social media. According to this Consumer Reports article, cauliflower is the new kale, with sales rising 71 percent last year. For a growing number of carb conscious eaters, chopped or “riced” cauliflower has become a popular substitute for well… rice. Of all the cauliflower-embracing diets in vogue these days, the ketogenic or “Keto” diet is certainly top of the heap right now.
This high fat, moderate protein, and low carb diet has attained celebrity fad status lately but, as you probably know, it has actually been around for nearly 100 years. The ketogenic diet has long been used in an effort to reduce seizures in children with difficult-to-treat epilepsy.
The anticonvulsant effect is thought to be due to the release of ketone bodies brought about by the diet’s high fat, very low carbohydrate make up. These ketone bodies, beta-hydroxybutyrate (βHB), acetoacetate and acetone, are said to put the body in a state of “ketosis,” an effect similarly attained through fasting.
Largely considered complementary and alternative medicine (CAM), the ketogenic diet has nonetheless been the subject of an increasing amount of research. In fact, we are less than a month into the new year and no less than ten research papers on the subject show up for 2019 in a quick PubMed search. These are timely considering the growth in popularity of the ketogenic diet and the concomitant increase in patients (and their parents) wanting to try it out.
What follows is a smattering of some of the newer research:
- A good history of the ketogenic diet for the treatment of epilepsy in children is offered in this review by Madzhidova et. al.. It was published in the January 2019 issue of the Swiss journal Pharmacy. The authors discuss the various age-related implementations of the diet and conclude that the majority of published studies do show some reduction in seizure occurrence. However, though generally considered safe, the ketogenic diet does pose some risk and requires careful management.
- Also out this month (Jan 2019) in the Polish journal Nutrients, is a review of the diet’s potential neuroprotective benefits for the treatment/prevention of degenerative diseases like Parkinson’s and Alzheimer’s. The author (Wlodarek) ultimately concludes that while some single studies have shown a reduction in symptoms in these patients, the research is largely still too scant. Further, the use of the diet in the elderly does increase their risk for malnutrition.
- Just out in the journal Trials is a study protocol that is taking a look at one specific ketone body, beta-hydroxybutyrate, and its use as a dietary supplement for the prevention of migraines. This randomized, placebo-controlled, double-blind, single-center trial (MigraKet) is being conducted in Basel, Switzerland and so far has nearly 100 migraineurs enrolled. The study is estimated to be completed in July 2019.
This is just a glimpse at the new research and it is likely that there will be a lot more as the year progresses. As a neurologist you are in a unique position because so much of the research on the ketogenic diet has to do with its neuroprotective effect. This, plus the current keto kraze we are in means you are likely to get asked about this diet by your patients and colleagues. If you haven’t already, it may be time to bone up. While you’re at it, try one of the many keto cauliflower rice recipes floating around social media, you might find yourself recommending it to your patients.