The Need For More Science
The body of scientific literature on ketogenic diets is surprisingly sparse when you consider the therapeutic applications of this diet have been in effect for nearly a century. A mere 1592 scientific papers are returned by PubMed (the US National Library of Medicine and National Institutes of Health online medical research database) with the search term “ketogenic diet”. It’s not that other diets are more thoroughly researched per se, but certainly other therapeutic strategies to mitigate disease, the most relevant example being anticonvulsant drugs for epilepsy (c.f. PubMed returns 135282 scientific papers with the search term “anticonvulsant drugs”) are monumentally better understood before being approved for use.
Frankly, research is just beginning to scratch the surface in terms of understanding how ketogenic diets work to reduce seizures in epilepsy or to provide the other documented benefits. Why is that important? Because the extensive list of documented side effects and adverse reactions indicate that the positive health effects of a ketogenic diet comes at a cost, one that may not be acceptable to many. Understanding how a ketogenic diet works to provide a benefit, also gives clues as to why it causes adverse reactions. And because the documented adverse reactions include serious illness and death, understanding why these might come about is a prerequisite for adopting this therapeutic strategy in a more widespread way. What insight we can glean from mechanistic studies will be the topic of several future articles.
Does the need for more science give ketogenic diets a green light or a red light? I certainly agree with the ketogenic diet community that more long-term and mechanistic studies are required. However, I disagree that, in the absence of the insight this research could provide, that everyone should just “try it for themselves”. We need to look at the information currently available for guidance. The studies do not ubiquitously show benefits; not everyone responds positively to a ketogenic diet; many unanswered questions regarding the effects (both positive and negative) of ketogenic diets remain; serious adverse reactions have occurred. As a community, we have a choice: proceed with great abandon, or have a more nuanced and accurate conversation of what we know versus what we don’t know. I support the latter and believe the capacity for harm needs to be just as much a part of the conversation as the therapeutic potential.