Ketogenic Diets against Epilepsy

[notimportant1234]

I thought that the ketogenic diet was used for treating epilepsy (or managing - depending how much you care about wording) long before it became popular, shouldn't there be a lot of research on that?

[BrianSoddingBoru4]

I thought that the ketogenic diet was used for treating epilepsy (or managing - depending how much you care about wording) long before it became popular, shouldn't there be a lot of research on that?

There is a HUGE amount of research on it.

Boru

[LadyForCamus]

I thought that the ketogenic diet was used for treating epilepsy (or managing - depending how much you care about wording) long before it became popular, shouldn't there be a lot of research on that?

There is, lol.

[FlatAssembler]

An incomplete picture of the mechanism of action of a particular treatment is not any kind of argument or evidence against its demonstrable efficacy.

But... it... is. In science-based medicine (the form of medicine overwhelmingly practiced today) the scientific plausibility of a treatment being effective is the most important criterion, more important than studies.
Furthermore, there are, as far as I know, no high-quality studies about that. Almost none of them are blinded, and most of them even lack the control group. Experiments which are not blinded nor controlled mean very little. Such an experiment is what convinced McArthur Wheeler that lemon juice makes him invisible to the cameras.
And why don't we see that effect in animals? Grass-fed cows are mostly in the state of ketosis, since most of the energy in grass is in the form of fat, there are little usable carbohydrates or protein in most types of grass. Grain-fed cows, on the other hand, get most of their energy from starch. If there were any truth to that ketosis protecting against epilepsy, we would expect epilepsy to be much more common in grain-fed cows than in grass-fed cows. But that's not the case. Similarly, nearly all the carbohydrates that rabbits eat are in the form of cellulose, yet epilepsy is rather common in rabbits.

OK, maybe I am a bit biased against the claims of diets being able to cure diseases because I've been in that vegan/meat-eater debate for a long time. What do you think is the difference between those attempts to cure epilepsy with diet and attempts to cure type-2-diabetes with diet? There are low-quality studies which show a meat-based diet can cure type-2-diabetes, there are also low-quality studies, often cited by Neal Barnard, showing a low-fat (also excluding, for some reason, unsaturated fat) diet cures type-2-diabetes. The right thing to do is to reject both of those claims and be very skeptical of any similar claims, right?

[BrianSoddingBoru4]

An incomplete picture of the mechanism of action of a particular treatment is not any kind of argument or evidence against its demonstrable efficacy.

But... it... is. In science-based medicine (the form of medicine overwhelmingly practiced today) the scientific plausibility of a treatment being effective is the most important criterion, more important than studies.
Furthermore, there are, as far as I know, no high-quality studies about that. Almost none of them are blinded, and most of them even lack the control group. Experiments which are not blinded nor controlled mean very little. Such an experiment is what convinced McArthur Wheeler that lemon juice makes him invisible to the cameras.
And why don't we see that effect in animals? Grass-fed cows are mostly in the state of ketosis, since most of the energy in grass is in the form of fat, there are little usable carbohydrates or protein in most types of grass. Grain-fed cows, on the other hand, get most of their energy from starch. If there were any truth to that ketosis protecting against epilepsy, we would expect epilepsy to be much more common in grain-fed cows than in grass-fed cows. But that's not the case. Similarly, nearly all the carbohydrates that rabbits eat are in the form of cellulose, yet epilepsy is rather common in rabbits.

OK, maybe I am a bit biased against the claims of diets being able to cure diseases because I've been in that vegan/meat-eater debate for a long time. What do you think is the difference between those attempts to cure epilepsy with diet and attempts to cure type-2-diabetes with diet? There are low-quality studies which show a meat-based diet can cure type-2-diabetes, there are also low-quality studies, often cited by Neal Barnard, showing a low-fat (also excluding, for some reason, unsaturated fat) diet cures type-2-diabetes. The right thing to do is to reject both of those claims and be very skeptical of any similar claims, right?

Suppose we didn't know the mechanism whereby penicillin kills harmful bacteria (we do know that, but suppose we didn't).  Yet there are hundreds and hundreds of studies recounting tens of millions of instances in which penicillin cured infections and saved lives.

Should we stop using antibiotics simply because we don't know how they work?

Boru

[FlatAssembler]

Should we stop using antibiotics simply because we don't know how they work?

At least, with penicillin, you can easily do a double-blind controlled study showing it works. How do you do a double-blind controlled study whether some diet works against some disease? It's next to impossible.

[arewethereyet]

An incomplete picture of the mechanism of action of a particular treatment is not any kind of argument or evidence against its demonstrable efficacy.

But... it... is. In science-based medicine (the form of medicine overwhelmingly practiced today) the scientific plausibility of a treatment being effective is the most important criterion, more important than studies.
Furthermore, there are, as far as I know, no high-quality studies about that. Almost none of them are blinded, and most of them even lack the control group. Experiments which are not blinded nor controlled mean very little. Such an experiment is what convinced McArthur Wheeler that lemon juice makes him invisible to the cameras.
And why don't we see that effect in animals? Grass-fed cows are mostly in the state of ketosis, since most of the energy in grass is in the form of fat, there are little usable carbohydrates or protein in most types of grass. Grain-fed cows, on the other hand, get most of their energy from starch. If there were any truth to that ketosis protecting against epilepsy, we would expect epilepsy to be much more common in grain-fed cows than in grass-fed cows. But that's not the case. Similarly, nearly all the carbohydrates that rabbits eat are in the form of cellulose, yet epilepsy is rather common in rabbits.

OK, maybe I am a bit biased against the claims of diets being able to cure diseases because I've been in that vegan/meat-eater debate for a long time. What do you think is the difference between those attempts to cure epilepsy with diet and attempts to cure type-2-diabetes with diet? There are low-quality studies which show a meat-based diet can cure type-2-diabetes, there are also low-quality studies, often cited by Neal Barnard, showing a low-fat (also excluding, for some reason, unsaturated fat) diet cures type-2-diabetes. The right thing to do is to reject both of those claims and be very skeptical of any similar claims, right?

While a cure would be a wonderful thing, I think they are looking to control epilepsy...to reduce the number the epileptic events.

Saying that dietary changes are a cure is a stretch because they don't make the condition go away any more than dietary changes make diabetes go away.

[BrianSoddingBoru4]

Should we stop using antibiotics simply because we don't know how they work?

At least, with penicillin, you can easily do a double-blind controlled study showing it works. How do you do a double-blind controlled study whether some diet works against some disease? It's next to impossible.

But the diets HAVE been shown to work, that's the whole point.  People on the various diets show a significant reduction in the both the number and severity of seizures.  And there HAVE been double-blind studies of the ketogenic diets.

Here's one:  https://pubmed.ncbi.nlm.nih.gov/28537652/  

Here's another: https://pubmed.ncbi.nlm.nih.gov/18717710/

Oh, look!  https://lowcarbaction.org/study/efficacy...ver-study/

Plenty more out there, you just have to look.

Boru

[FlatAssembler]

At least, with penicillin, you can easily do a double-blind controlled study showing it works. How do you do a double-blind controlled study whether some diet works against some disease? It's next to impossible.

But the diets HAVE been shown to work, that's the whole point.  People on the various diets show a significant reduction in the both the number and severity of seizures.  And there HAVE been double-blind studies of the ketogenic diets.

Here's one:  https://pubmed.ncbi.nlm.nih.gov/28537652/  

Here's another: https://pubmed.ncbi.nlm.nih.gov/18717710/

Oh, look!  https://lowcarbaction.org/study/efficacy...ver-study/

Plenty more out there, you just have to look.

Boru

The first one you linked to and the third one you linked to talk about the same study, unrelated to epilepsy. The second one admits to have found no EEG-detectable differences between the keto diet and diet relatively high in glucose, and no statistically significant (p=0.07) reduction in subjectively-reported seizures.

[LadyForCamus]

At least, with penicillin, you can easily do a double-blind controlled study showing it works. How do you do a double-blind controlled study whether some diet works against some disease? It's next to impossible.

But the diets HAVE been shown to work, that's the whole point.  People on the various diets show a significant reduction in the both the number and severity of seizures.  And there HAVE been double-blind studies of the ketogenic diets.

Here's one:  https://pubmed.ncbi.nlm.nih.gov/28537652/  

Here's another: https://pubmed.ncbi.nlm.nih.gov/18717710/

Oh, look!  https://lowcarbaction.org/study/efficacy...ver-study/

Plenty more out there, you just have to look.

Boru

Clearly, he’d rather play obtuse than admit he was wrong.