The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research. A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, ...First Do No Harm, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.
"One of the primary places where you are going to see metabolic changes on any kind of diet is in your gastrointestinal tract -- and that can include a change in bowel habits often experienced as constipation," says Sondike, who is also credited with conducting the first published, randomized clinical trial on low-carb diets. The reason, Sondike tells WebMD, is that most folks get whatever fiber they consume from high-carb foods such as bread and pasta. Cut those foods out, and your fiber intake can drop dramatically, while the risk of constipation rises.
About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether. Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.
That said, it’s a good idea to work with a doctor or registered dietitian before you start eating keto—and continue to check in with them while you adapt to your new diet, recommends David Nico, PhD, author of Diet Diagnosis. Planning ahead can help you steer clear of nutritional deficiencies that can strike when you cut most carbs out of your diet. And doing so might also help minimize your keto flu symptoms.
In addition to keeping you adequately hydrated -- which can also help alleviate constipation -- drinking lots of water can also help offset still another low-carb diet problem: bad breath. The ketones produced during the diet can lead to what is sometimes described as a fruity odor although it is often described as having an almost "chemical" odor similar to acetone or nail polish remover.
A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital and followed-up by a report published in 2001. As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.
You probably hear the most about low-carb eating for weight loss, but for some people, the approach could also help optimize their health, says Schmidt. “Research shows that women who are obese or have metabolic problems [may] do better hormonally on lower carbs,” says Schmidt, pointing out that other outcomes of the diet can include better sleep, mental clarity, and increased satiety. (1)
The medical community is taking note of the high public interest in keto. An article in the Jan. 16, 2018, Journal of the American Medical Association summarized several areas of promise: Many people feel less hungry on the high-fat keto diet and so may naturally reduce their overall calorie intake. Beyond weight loss, there was good news for diabetes management, with improved insulin sensitivity and blood-sugar control for people following a ketogenic diet in an early, still-ongoing study. However, an editorial appearing online July 15, 2019, in JAMA Internal Medicine concluded that “enthusiasm outpaces evidence” when it comes to a keto diet for obesity and diabetes.