Ketogenic and low-carb diet specialist Glasgow

Ketogenic & Low-Carb Diets

What are ketogenic and low-carb diets?

Ketogenic diets are high-fat, moderate-protein and low-carbohydrate diets that create a metabolic shift away from the oxidation of carbohydrates with a reciprocal increase in fat oxidation. In lay terms, that simply means that a greater proportion of energy is derived from burning fats as opposed to carbohydrate. Their aim is to achieve nutritional ketosis, defined as blood ketone levels of ≥0.5mM/dL.

Low-carbohydrate diets also restrict carbohydrate intake, but not as much as ketogenic diets. You may dip in and out of nutritional ketosis on a low-carb diet, but are unlikely to maintain it for extended periods.

Therapeutic uses for ketogenic and very low-carb diets

In addition, there is emerging evidence for the effectiveness of ketogenic diet therapy in:

  • Cancer

  • Polycystic ovary syndrome (PCOS)

  • Neurological disease and disorders

    • Alzheimer's

    • Parkinson’s

    • Multiple Sclerosis

    • GLUT1 deficiency syndrome

    • PDH deficiency

    • Brain cancer

    • Brain trauma

    • Autism

    • Headache

    • Sleep disorders

  • Acne

  • Mitochondrial disease (Figure 1).[1-3]

There is strong evidence for the effectiveness of ketogenic diets in the treatment of:

  • Epilepsy

  • Weight loss

  • Type 2 diabetes, metabolic syndrome and insulin resistance

  • Cardiovascular disease risk factors (Figure 1).[1]

Diagram of evidence base for ketogenic diets, Sonnda Catto, Nutritionist and ketogenic diet expert, Glasgow, Scotland

The case for ketogenic diet therapy in ME/CFS

While there have not yet been any published studies of the use of ketogenic diets in ME/CFS, the following scientific evidence suggests that they may be of therapeutic value:

  1. ME/CFS is characterised by chronic systemic inflammation, oxidative stress, impaired mitochondrial function and gut dysbiosis; ketogenic diets are proven to:

    • Reduce inflammation [4-7]

    • Reduce oxidative stress [5,8,9]

    • Improve mitochondrial function [2,5]

    • Stimulate mitochondrial biogenesis [2,5]

    • Boost energy production in brain tissue [10]

    • Favourably remodel the composition of the gut microbiome [11,12]

  2. Ketogenic diets are effective in the treatment of headache and sleep disorders, both common symptoms of ME/CFS [1]

  3. A number of small metabolomics studies have identified differences in plasma and serum metabolites of people with ME/CFS suggestive of impaired glycolysis (i.e. impaired use of glucose/carbohydrates), with corresponding compensatory increases in the metabolism of lipids and certain amino acids (protein) [13-17]

  4. Ketogenic diets are of benefit in other metabolic, mitochondrial and fatiguing neurological diseases.[1-3]

A collaborative pilot study by the University of Oxford and Oxford Brookes University (Dawes et al 2019, unpublished) provides tentative evidence that ME/CFS patients respond favourably to a ketogenic diet and is also suggestive of differences in energy metabolism relative to healthy controls. Further study is required to robustly assess the potential merits of ketogenic diet therapy in ME/CFS.

Sonnda’s Novel, Modified Ketogenic Diet

Combining her expertise in scientific research, nutrition, health behaviour change and the culinary arts, Sonnda has spent the last four years developing and refining a novel, modified ketogenic diet that overcomes the limitations of traditional ketogenic diets:

  • Micronutrient insufficiency

  • Fibre insufficiency

  • Lack of dietary diversity

  • Restrictiveness

  • Low palatability

  • Low adherence.

Originally designed to treat her own ME/CFS, Sonnda is currently seeking grant funding to study her novel, modified ketogenic diet in fulfilment of a doctoral degree (PhD).

Traditional Ketogenic Diets

The original ketogenic diet was introduced by Wilder in 1921 to treat epilepsy.[18] Deriving 90% of calories from fat, the diet allows very small intakes of protein and carbohydrate (6-8% and 2-4%, respectively [19,20]), making it severely restrictive, difficult to follow, unpalatable and with potential side effects, together resulting in relatively low adherence rates – 38% in a recent meta-analysis.[21]

Over the last 50 years, four relaxed variants of the ketogenic diet have been developed to try and address these limitations. Ranging from 60-70% calories from fat,[19,20] adherence rates are improved (56%-75% [3,21]), but micronutrient and fibre insufficiency remain.[22,23]

Is a ketogenic diet right for me?

If you suffer from any of the conditions listed above, then you may benefit from a well-formulated ketogenic diet, such as the one Sonnda has devised. If you wish to embark on a ketogenic diet, it is strongly recommend that you do so under specialist supervision.

Free Ketogenic and Low-Carb Recipes

Many of Sonnda’s delicious and nutritious recipes are suitable for those on a ketogenic or low-carb diet. Browse her selection of Free Recipes to get started now.

Success stories

Sonnda has shared her approach with weight loss and ME/CFS clients. Read their stories.

Book A Nutrition Consultation

If you’d like to work with Sonnda, please get in touch using the Contact Form, or simply phone or email.

References

  1. Paoli A, Rubini A, Volek JS, et al. Beyond weight loss: A review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. European Journal of Clinical Nutrition. 2013;67(8): 789–796. Available from: https://dx.doi.org/10.1038%2Fejcn.2013.116

  2. Branco AF, Ferreira A, Simões RF, et al. Ketogenic diets: From cancer to mitochondrial diseases and beyond. European Journal of Clinical Investigation. 2016;46(3): 285-298. Available from: https://doi.org/10.1111/eci.12591.

  3. Brenton JN, Banwell B, Bergqvist, AGC, et al. Pilot study of a ketogenic diet in relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(4): e565. Available from: https://doi.org/10.1212/NXI.0000000000000565.

  4. 32. Volek JS, Phinney SD, Forsythe CE, et al. Carbohydrate restriction has a more favorable impact on the metabolic syndrome than a low fat diet. Lipids. 2009;44(4):297-309. Available from: https://doi.org/10.1007/s11745-008-3274-2.

  5. 21. Boison D. New insights into the mechanisms of the ketogenic diet. Current Opinion in Neurology. 2017;30(2): 187-192. Available from: https://dx.doi.org/10.1097%2FWCO.0000000000000432.

  6. Dupuis N, Curatolo N, Benoist JF, et al. Ketogenic diet exhibits anti-inflammatory properties. Epilepsia. 2015;56(7):e95-e98. Available from: https://doi.org/10.1111/epi.13038.

  7. Youm YH, Nguyen KY, Grant RW, et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome–mediated inflammatory disease. Nat Med. 2015;21(3):263-269. Available from: https://dx.doi.org/10.1038%2Fnm.3804.

  8. Milder JB, Liang LP, Patel M. Acute oxidative stress and systemic Nrf2 activation by the ketogenic diet. Neurobiol Dis. 2010;40(1): 238-244. Available from: https://doi.org/10.1016/j.nbd.2010.05.030.

  9. Shimazu T, Hirschey MD, Newman J, et al. Suppression of oxidative stress by β-hydroxybutyrate, an endogenous histone deacetylase inhibitor. Science. 2013;339(6116), 211-214. Available from: https://doi.org/10.1126/science.1227166.

  10. Achanta LB, Rae CD. β-Hydroxybutyrate in the brain: One molecule, multiple mechanisms. Neurochem Res. 2017;42(1): 35-49. Available from: https://doi.org/10.1007/s11064-016-2099-2.

  11. Newell C, Bomhof MR, Reimer RA, Hittel DS, Rho JM, Shearer J. Ketogenic diet modifies the gut microbiota in a murine model of autism spectrum disorder. Mol Autism. 2016;7: 37. Available from: https://dx.doi.org/10.1186%2Fs13229-016-0099-3.

  12. Olson CA, Vuong HE, Yano JM, Liang QY, Nusbaum DJ, Hsiao EY. The gut microbiota mediates the anti-seizure effects of the ketogenic diet. Cell. 2018;173(7): 1728–1741. Available from: https://doi.org/10.1016/j.cell.2018.04.027.

  13. Armstrong CW, McGregor NR, Lewis DP, et al. Metabolic profiling reveals anomalous energy metabolism and oxidative stress pathways in chronic fatigue syndrome patients. Metabolomics. 2015;11(6): 1626-1639. Available from: https://doi.org/10.1007/s11306-015-0816-5.

  14. Fluge Ø, Mella O, Bruland O, et al. Metabolic profiling indicates impaired pyruvate dehydrogenase function in myalgic encephalopathy/chronic fatigue syndrome. JCI Insight. 2016;1(21): e89376. Available from: https://doi.org/10.1172/jci.insight.89376.

  15. Naviaux RK, Naviaux JC, Li K, et al. Metabolic features of chronic fatigue syndrome. Proceedings of the National Academy of Sciences of the United States of America. 2016;113(37): E5472-E5480. Available from: https://doi.org/10.1073/pnas.1607571113.

  16. Yamano E, Sugimoto M, Hirayama A, et al. Index markers of chronic fatigue syndrome with dysfunction of TCA and urea cycles. Sci Rep. 2016;6: 34990. Available from: https://dx.doi.org/10.1038%2Fsrep34990.

  17. Morten & McCullagh (unpublished).

  18. Wilder, RM. The effects of ketonemia on the course of epilepsy. Mayo Clin Bull. 1921;2: 307-308.

  19. Payne NE, Cross JH, Sander JW, et al. The ketogenic and related diets in adolescents and adults: A review. Epilepsia. 2011;52(11): 1941–1948. Available from: https://doi.org/10.1111/j.1528-1167.2011.03287.x.

  20. Giordano C, Maddalena M, Timofeeva E, et al 2014. Neuroactive peptides as putative mediators of antiepileptic ketogenic diets. Front Neurol. 2014;5: 63. Available from: https://doi.org/10.3389/fneur.2014.00063.

  21. Ye F, Li XJ, Jiang WL, et al. Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: A meta-analysis. Clin Neurol. 2015;11(1): 26–31. Available from: https://dx.doi.org/10.3988%2Fjcn.2015.11.1.26. 

  22. Kossoff EH, Zupec-Kania BA, Auvin S, et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018;3(2): 175-192. Available from: https://doi.org/10.1002/epi4.12225.

  23. Randall R. The ketogenic diet for epilepsy: Learn about the diet, the medical conditions it’s used to treat, and its mechanism of action. Today’s Dietitian. Available from: https://www.todaysdietitian.com/pdf/courses/RandallKetogenic.pdf [Accessed 30th April 2019].