Ketogenic diets can improve behaviour in autistic children

Apr 24, 2024Apr 10, 2024 kaitiscotlandLeave a comment

A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder

Ryan W Y Lee¹, Michael J Corley², Alina Pang³, Gaye Arakaki⁴, Lisa Abbott⁵, Michael Nishimoto⁶, Rob Miyamoto⁷, Erica Lee⁸, Susan Yamamoto⁹, Alika K Maunakea¹⁰, Annette Lum-Jones¹¹, Miki Wong¹²

DOI: 10.1016/j.physbeh.2018.02.006

Abstract

Purpose: The ketogenic diet is a low-carbohydrate, moderate protein, high-fat diet that has emerged as a potential treatment for autism spectrum disorder.

Autism spectrum disorder is a neurodevelopmental disorder of social communication, and restricted, repetitive behaviors and interests in need of novel therapies.

An open-label clinical trial was done in Honolulu, Hawaii to test a modified ketogenic diet for improvement of core clinical impairments in children with ASD.

Intervention: A modified ketogenic gluten-free diet regimen with supplemental MCT was completed in 15 children ages 2 to 17 years for 3 months. Clinical (ADOS-2, CARS-2) and biochemical measures were performed at baseline and 3-months on the ketogenic diet.

Main outcome: Children administered a modified ketogenic gluten-free diet with supplemental MCT significantly improved core autism features assessed from the ADOS-2 after 3 months on diet (P = 0.006). No significant difference was observed in restricted and repetitive behavior score (P = 0.125) after 3 months on the diet protocol. Substantial improvement (> 30% decrease ADOS-2 total score) was observed in six participants, moderate improvement (> 3 units) in two participants, and minor/no improvement in seven participants. Ten participants assessed at a six-month time point sustained improvement in total ADOS-2 and social affect subdomain scores comparing baseline and 6 months (P = 0.019; P = 0.023), but no significant improvement in restricted and repetitive behavior scores were noted (P = 0.197). Significant improvements in CARS-2 items after 3 months of the modified ketogenic protocol were observed in imitation, body use, and fear or nervousness (P = 0.031, P = 0.008, P = 0.039). The percent change on ADOS-2 score from baseline to 3 months was associated with baseline high-density lipoprotein levels (ρ = −0.67, P = 0.007) and albumin levels (ρ = −0.60, P = 0.019). Moreover, the percent change from baseline to 3 months in ADOS-2 scores was significantly associated with percent change in high-density lipoprotein levels (ρ = 0.54, P = 0.049) and albumin levels (ρ = 0.67, P = 0.010).

Conclusions: A modified gluten-free ketogenic diet with supplemental MCT is a potentially beneficial treatment option to improve the core features of autism spectrum disorder and warrants further investigation.

My comment: Looking after a child with autism is very challenging. As the ketogenic diet shows promise and has a good track record for health outcomes over many years it may be worth a trial for parents or for those children living in institutional settings. If a child is also on insulin for type one diabetes careful reduction and adjustment of insulin doses will be required usually with professional help.

PHC: Providing a free course to help you eat well

Apr 18, 2024Apr 4, 2024 kaitiscotland1 Comment

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PHC have just released the new Real Food Healthy Lifestyle course.

It is an online course led by Liz LePlan, the PHC Ambassador Co-ordinator.

It comprises eight recorded sessions and takes people through the low carbohydrate approach. You can find it here. https://phcuk.org/support/

There is also a new Facebook group to support our work in Scotland and to try and reach out to more like-minded souls and help people who want to improve their health. We would really like you to join the group and share your own success stories and tips. Please also invite your friends and any healthcare practitioners that you know.

https://www.facebook.com/groups/lowcarbrealfoodphcscotland

If you would like to watch a replay of the main event that the PHC runs each year, the Annual Conference then it is now available on YouTube.

This year the conference coincided with the 75 year anniversary of the NHS and had the theme ‘Fixing the NHS – one person at a time’.

You will also find replays of the Scottish Conference here too. https://www.youtube.com/c/PHCukorg

The next Scottish Conference which will be in the Autumn of 2024, likely in Edinburgh.

BMJ: GP patient group appointments disappoint

Apr 12, 2024Apr 4, 2024 kaitiscotland3 Comments

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Adapted from BMJ 23 March 2024

A study published in BMJ Open reported on the analysis of 29 patient trials who were placed in group appointments in their General Practice. The participants had the same conditions as other group members.

These appointments have been seen as a way to make patient education and care more efficient. Given the constraints that Primary Care faces regarding health care professionals, this is perfectly reasonable. Group therapy, at least in theory, also allows patients to learn from each other and to support each other.

Unfortunately the outcomes were not any better for the group appointment attendees, except for lower diastolic blood pressure. There were no other statistically relevant changes. In addition, there was no difference in the use of medical services.

IDDT: What patients want from a doctor consultation and how to get it.

Apr 6, 2024Mar 15, 2024 kaitiscotlandLeave a comment

From Open Verse

Adapted from IDDT Newsletter March 2024

What can patients do to help ensure a good consultation with their GP or specialist doctor?

This was the aim of a diabetes support group. They brainstormed what they wanted to achieve and then discussed the way to get this.

The first step is preparation for your appointment.

What is the point of the consultation? Is it a first meeting, a review of progress, a follow up from a previous meeting? Think, What do I want to get out of this consultation?

Have a clear understanding of your problem if possible. Rehearse what you intend to say.

If you have a complex or worrying problem you may wish take a partner or friend with you to listen so that important information is not forgotten.

Prepare a list of questions you have for the doctor. Give it to them. This way they can figure out best how to answer comprehensively on what they can answer and tell you what they can’t answer.

During the consultation

Try to sit so you can face the doctor either side on or in front of them.

Keep it simple if you can and let the doctor know you have questions to ask, and when is it a good time to ask them.

Maintain eye contact with the doctor, encourage a two way conversation and demonstrate a desire to build a working relationship with the doctor.

Briefly summarise your symptoms.

Ask clarifying questions if you have any uncertainty such as, Why do you advise me to take these medications? Ask if there are alternative treatments.

Answer questions honestly eg if you haven’t been taking your medication as prescribed.

Be positive.

What patients want in a consultation.

Patients want to feel welcomed into the consultation. They want a doctor who shows interest, care and respect for them. A sense of humour may be appropriate.

They want to have eye contact and not just have a doctor who looks at a computer.

They want to be treated in an intelligent adult to adult way. They want the doctor to listen and to have a two way exchange.

They need the doctor to have their notes and be familiar with them.

The patient’s carer also needs to be involved in the conversation.

They need TIME to allow a relevant discussion. Often more than one issue is involved. Test results need to be explained and some patients will want specific information other than “normal” or ” a bit low”. They want options to be discussed and involved in implementing a course of action.

Patients dislike being contradicted over their experience and treatment history. They want their doctor to be frank when the doctor doesn’t know something. They welcome referral or a doctor speaking to someone with more expertise when necessary.

Some patients are very keen to have copies of letters and summaries of the discussion and action plans.

My comment: This patient group has a good structure of the ideal consultation and is similar to the sort of thing that doctors also want. In my experience there are often impediments achieving this. Such things are lack of scheduled time, interruptions, lack of continuity of doctor-patient relationships, difficulty getting notes and getting computers to work. It also helps if patients are focussed on one or at most two main issues and don’t bring a shopping list of everything that bothers them. It is helpful to involve the team of health care professionals so that things that concern eg a podiatrist or a pharmacist can be dealt with separately to the GP or consultant.

PURE study describes a healthy diet

Mar 30, 2024Mar 12, 2024 kaitiscotland2 Comments

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PURE Study and Full-Fat Dairy

The world’s largest observational study, the Prospective Urban Rural Epidemiology (PURE) Study, released its most recent paper with one of the key findings being that whole-fat dairy should be included as one of six foods that comprising a healthy diet.

Multiple papers have been published from the PURE data. This one is focused on developing a globally applicable healthy diet score, called the PURE Score.

The researchers analyzed data not only from PURE but also from five independent studies encompassing a total of more than 244,000 individuals from 80 countries.

The PURE scoring system defined a healthy diet as one relatively high in fruits, vegetables, nuts, beans, fish, and whole-fat dairy. A higher score was attributed to diets composed of more of these nutrient-dense foods.

A higher intake of these foods correlated with improved health and a reduced risk of illness, the study found.

This research has the same limitations of all epidemiological studies in that it shows correlation, not a cause-and-effect relationship. However, PURE’s contrary finding on full-fat dairy is meaningful in that it contradicts the conventional wisdom.

Dariush Mozaffarian, the influential former Dean of the Friedman School of Nutrition Science & Policy at Tufts University, cited this paper and acknowledged that full-fat dairy can indeed be part of a healthy diet. U.S. health recommendations have favored low-fat dairy for decades, but the PURE finding imply that high-fat dairy is the better option for health.

My comment: The debate about what a healthy diet is continues. I’m still on an Atkin’s style diet and still on about 35 -85g of carb a day. I’m more willing than I used to be to enjoy my favourites such as mushroom risotto, seafood risotto and paella. I easily meet the legumes, nuts, fish and dairy intakes but don’t tend to eat the fruit and vegetable amounts suggested unless I’m on holiday where they have big self serve buffets. I know that eating more vegetables in particular is good for fibre, vitamins, and antioxidants, and are generally low in calories, but I just don’t find them as appetising as meat, fish, eggs, cheese and nuts. I probably eat one of each a day on average.

Rotavirus immunisation shown to reduce the onset of type one diabetes

Mar 25, 2024Dec 22, 2023 kaitiscotland3 Comments

Finland has been vaccinating children from rotavirus since 2009.

This has led to a 10 fold fall in the number of children getting a rotavirus infection by the age of 5.

There has also been a fall (they don’t say how much of a fall) in children being diagnosed with type one diabetes.

This supports the belief that rotavirus is a trigger for inducing islet cell autoimmunity.

Diabetes Care doi:10.2337/dc23-1203

Step counts: Aim for at least 2,600 a day and 8,000 if you can.

Mar 19, 2024Dec 21, 2023 kaitiscotland2 Comments

Adapted from BMJ Oct 14 2023

Advice about step counts are easy to understand and can be measured with smart watches or keeping your phone in your pocket.

A meta-analysis has concluded that even 2,600 steps will improve cardiovascular and total mortality.

Increasing this further increases the benefits till gains flatten out at 8,000 steps a day. Walking faster was better than walking slower.

A UK Biobank study showed that increasing physical activity protected against neuropathy and nephropathy in people with type two diabetes. Unfortunately retinopathy was not affected.

They found that walking for an hour and a half each week lowered neuropathy and nephropathy by between 20-30%.

One in 20 type two diabetics get into remission

Mar 13, 2024Dec 15, 2023 kaitiscotlandLeave a comment

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Adapted from BMJ Dec 4 2021

A Scottish study showed that one in 20 people diagnosed with type two diabetes gained remission long term. This was defined as having a HbA1c of below 48 mmol/mol.

In comparison with those who did not gain remission, they tended to be older, to have a lower HbA1c at diagnosis, not to have taken glucose lowering medications, and to have lost weight since diagnosis. They were also more likely to have had bariatric surgery.

A review of weight loss diets in diabetics reported in Diabetolgia, reported gloomy results for all of the diets that they reviewed. Meaningful weight loss did not occur often.

These included low carbohydrate diets, high protein, Mediterranean and vegetarian. The best results were for low calorie liquid shakes when these replaced normal food. But even then the weight loss was only a few kilograms.

Most people with type two diabetes need to lose weight to improve their cardiovascular risk, especially if they don’t want to rely on lifelong medication.

Having type one diabetes ages your brain faster

Mar 7, 2024Dec 14, 2023 kaitiscotland1 Comment

Adapted from BMJ July 16 2023

A North American study has demonstrated that the brains of type one diabetics of middle age or older showed structural changes in brain volume and white matter compared to similar aged and demographically similar control subjects without diabetes. MRI studies were used.

The differences are the equivalent of 4 to 9 years difference in brain aging.

The study was published in Diabetes Care.

Protein from meat is more favourably absorbed than protein from plants

Mar 1, 2024Dec 14, 2023 kaitiscotland5 Comments

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Adapted from Nutrients Volume 15 June 25 2023. Effects of consuming once equivalent portions of animal v plant based protein foods, as defined by the Dietary Guidelines for Americans on Essential amino acid bioavailability in young and older adults: Two cross over randomised controlled trials. Gavin Connolly et al. Department of Nutritional Science. Purdue University, West Lafayette, Indiana.

The 2020-25 Dietary Guidelines for Americans recommend that protein foods are consumed as part of a healthy dietary pattern. This includes animal based protein such as red meat, poultry, fish and eggs and plant based. These include soy products, beans, peas, lentils, nuts and seeds.

One ounce of protein equivalents are one whole egg, one ounce of meat, 0.25 cups of beans, or 0.5 ounces of nuts.

Protein foods differ up to three fold in metabolizable energy and macronutrient contents. For example, one ounce of pork contains 7g of total protein and one oz of almonds contains 3g of total protein. Protein quality can be defined as the ability of a dietary protein to provide adequate amounts and proportions of essential amino acids (EAA). These can then be used by the body to make proteins and maintaining and growing body tissues.

Animal proteins contain all the EAA whereas plant proteins, apart from soy lack one or more of them. This is why vegans and vegetarians are urged to eat a wide variety of plants.

Research has previously found that in young adults, animal protein sources resulted in better whole body net protein balance (anabolic response) compared to plant based foods. Up till the study presented in this paper the protein balance had not been assessed in older adults.

The study group of the young adults ranged in age from 22-39. The study of the older adults ranged from 55-75 years. BMI was 22-35, stable weight, not pursuing moderate to vigorous exercise more than 3 hours a week, not ill, non smokers, not diabetic, not pregnant or lactating, and willing to not exercise for 48 hours before the testing days.

Each participant completed four 300 minute trials. These were randomised, investigator blinded and of cross over design. The trial meals were two oz equivalent meals of 1. unprocessed pork loin, 2. scrambled whole eggs. 3.black beans and 4. raw sliced almonds. Blood samples were taken at various timed intervals on 8 occasions after the meals.

Of the young adults 30 completed the study. There were equal numbers of men and women. Average age was 26, average BMI 26.4. Ethnicity was mixed.

Of the older adults 25 completed the study. 15 women and 10 men. Average age was 64.2, BMI 26.1 and again there were mixed ethnicities.

The results showed that the pork and whole egg meals resulted in greater essential amino acid bioavailability compared to the beans and almonds. This was true for both the young and older adults. This was a similar result to a previous study where pork, whole eggs, beef sirloin, tofu, kidney beans, peanut butter and mixed nuts were compared.

There were no differences in the protein bioavailability between the younger and older groups.

My comment: Apart from the very sensible advice given to vegans and vegetarians about consuming a wide variety of plants, this study would demonstrate that eating enough plant protein, aiming for a bit more than you may expect from plant protein estimates, would be potentially helpful in maintaining healthy body composition.