Hi Fatima. As you said, most of studies that evaluated low carbohydrate diets showed improvements in epilepsy, weight loss, glycemic control and lipid profile. Moreover there is no evidence that causes any kidney problem. It is important to emphasize that there is no best diet, just another tool can be used.

Here some links of systematic reviews and longitudinals studies.

Article Efficacy and Safety of Low-Carbohydrate Diets: A Systematic Review

Article Comparative Effects of Low-Carbohydrate High-Protein Versus ...

Article Beyond weight loss: A review of the therapeutic uses of very...

Article Weight Loss With a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

Article Renal Function Following Three Distinct Weight Loss Dietary ...

Article A Randomized Trial of a Low-Carbohydrate Diet for Obesity

The long-term health implications of keto diets are not well known due to limited literature. However, long-term side effects may include hepatic steatosis, hypoproteinemia, kidney stones, and vitamin and mineral deficiencies.

Dear Fatima Gül Rifai

I hope these articles will help your question of long-term effects of keto diets:

Article Effect of a Very Low-Protein Diet on Outcomes: Long-term Fol...

Article An 8-Week, Low Carbohydrate, High Fat, Ketogenic Diet Enhanc...

Article An 8-Week Ketogenic Low Carbohydrate, High Fat Diet Enhanced...

I sincerely hope these studies may help

Regards

By my experience ketogenic diet is unbalance and must ne supplemented with multivitaminic, Calcium, Iron and Potassium salt to prevent renal injuries. Furthermore in case that diet to lose weight must be do to brief term(6-12 m) and after the other food must be gradually reintroduced.

Dear colleague Ketogenic diets were first used in 1920 to treat epilepsy. In those years oral antiepileptics did not exist, so they kept the patients (children and adults) for years with this type of diet. Today, for refractory epilepsies, this type of diet is still used (see https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/diet-therapy.html). However, this diet, like any deficiency diet, has long-term side effects, not short-term ones. Today neurologists do not keep in ketosis any epileptic patient, refractory to medication, for more than a year. It also happens if you use this diet to lose weight. It must be supplemented with vitamins and minerals. After finishing the diet there must be a change of dietary habit to avoid regaining weight. a greeting

Please go through the following RG links.

Article Long Term Effects of Ketogenic Diet in Obese Subjects with H...

Article Long-term effects of a ketogenic diet in obese patients

Article Low-carbohydrate diets: What are the long-term health implications?

Article Long-term ketogenic diet causes glucose intolerance and redu...

@ Fatima Gül Rifai Curious, what kind of journey have your thoughts on this topic had over the course of almost a year? Would you recommend any particular articles at this point?

My own theme has been to focus on the degree of resulting ketogenic status (nutritional ketosis as measured by blood or breath ketones) achievable via any range of inputs, rather than focusing just on the dietary inputs. This would include any less desirable side effects.

I understand that roughly 95% of patients respond very well across all relevant metabolic markers, with roughly 10% having the sole warning flag of LDL elevation, but without increased clinical cardiovascular risk. I understand that results are pending to confirm this LDL has normal serum clearance rates (high production but high removal), meaning it is not subject to any prolonged backup of excess time where it is at risk for oxidation.

I have been in clinical practice for 20 years and adjust the ketogenic diet for my clients based on extensive blood chemistries. Understanding functional pathology is key to making this diet work well. Alot of people forget the oral health dilemma when it comes to healthy eating. Keto has been fantastic while we sort out oral infections because grain feeds infection and patients cannot eat grain or high levels of carbohydrates. This is how we prep patients before dentistry to lower insulin/glucose before treatment so they recover safely. I have been eating ketogenic predominantly since 2000. No issues and I do my pathology assessments to check on my organs.

Check this paper https://link.springer.com/article/10.1007/s00415-019-09658-6

Important Question. Thanks!

Don't target keto food intake as a goal.

Rather, target keto status as a proxy for health, measure keto status, and then target diet/behavior in all directions to facilitate keto status.

Specifically, use blood strips (or maybe newer breath tech) to confirm a state of nutritional ketosis. This would be > 0.3 on the blood BHB readouts. If someone is achieving that, then that means their insulin to glucagon ratio is low enough that fat burning pathways are not blocked, autophagy is stronger, and chronic inflammation is lower.

Only after spending perhaps a month learning from blood or breath testing which dietary/behavioral impacts have which specific quantified impacts should one shift to focus on applying that person-specific learning to focus on diet and lifestyle.

For example, how many additional swim laps during a fasted state does it take, more or less, to drain glycogen levels low enough (hepatic plus hopefully muscle as well -- depending on degree of exertion) to cancel out the insulin effect of an additional snickers mini bar?

Measuring blood/breath ketones until one tires of such enables patients to learn actual verified answers to practical questions like that.

Some general tips:

+ Insulin is the real enemy. It blocks fat burning, autophagy, proper mitochrondrial ecology, and increases inflammation.

+ Ketones (blood or breath) are only produced if insulin is low, so are a good proxy.

+ Dietary carbs are irrelevant outside their insulinagenic impact: white bread carbs should never be lumped with raw sweet potato carbs or celery carbs. Fiber matters and also polyphenols (deep colors like in blackberries) that inhibit hepatic amylase.

+ View a "keto diet" as one alternative to the real harm of the recent western diet that spikes insulin in conjunction with inflammatory fats. That's the combination which has killed a 1918 pandemic worth of people every year. Fat doesn't cause problems unless insulin is high or the fat is transfat (now generally banned) or high in omega-6 (palm oils, vegetable oils, etc).

Keto diet depends primarily on knowledge of food (permitted and forbidden) from foods It is a diet that contains a low amount of carbohydrates and high fat, and provides many health benefits. You can try a regular low-carb diet for the first few weeks. This will get your body to burn more fat before cutting out carbohydrates completely.  The keto diet can alter the balance of water and minerals in your body, so additional salt can be added to your meals or take mineral supplements. As for the minerals, try to take a day Minerals include sodium, potassium and magnesium per day to reduce side effects.

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