Category: health

Ketogenic diets can improve behaviour in autistic children

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

Ryan W Y Lee 1, Michael J Corley 2, Alina Pang 3, Gaye Arakaki 4, Lisa Abbott 5, Michael Nishimoto 6, Rob Miyamoto 7, Erica Lee 8, Susan Yamamoto 9, Alika K Maunakea 10, Annette Lum-Jones 11, Miki Wong 12

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.

BMJ: GP patient group appointments disappoint

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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.

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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.

Rotavirus immunisation shown to reduce the onset of type one diabetes

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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.

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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%.

Having type one diabetes ages your brain faster

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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

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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.

The ketogenic diet shows promise to improve cardiovascular disease in varied mechanisms

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Review


The Ketogenic Diet and Cardiovascular Diseases


Damian Dy ´nka , Katarzyna Kowalcze , Anna Charuta and Agnieszka Paziewska *
Institute of Health Sciences, Faculty of Medical and Health Sciences, Siedlce University of Natural Sciences and Humanities, 08-110 Siedlce, Poland; damian.dynka24@gmail.com (D.D.); katarzyna.kowalcze@uph.edu.pl (K.K.); anna.charuta@uph.edu.pl (A.C.)

  • Correspondence: agnieszka.paziewska@uph.edu.pl

  • Abstract: The most common and increasing causes of death worldwide are cardiovascular diseases
    (CVD). Taking into account the fact that diet is a key factor, it is worth exploring this aspect of CVD
    prevention and therapy. The aim of this article is to assess the potential of the ketogenic diet in the
    prevention and treatment of CVD. The article is a comprehensive, meticulous analysis of the literature in this area, taking into account the most recent studies currently available.
  • The ketogenic diet has been shown to have a multifaceted effect on the prevention and treatment of CVD. Among other aspects, it has a beneficial effect on the blood lipid profile, even compared to other diets. It shows strong anti-inflammatory and cardioprotective potential, which is due, among other factors, to the anti-inflammatory properties of the state of ketosis, the elimination of simple sugars, the restriction of total carbohydrates and the supply of omega-3 fatty acids.
  • In addition, ketone bodies provide “rescue fuel” for the diseased heart by affecting its metabolism. They also have a beneficial effect on the function of the vascular endothelium, including improving its function and inhibiting premature ageing.
  • The ketogenic diet has a beneficial effect on blood pressure and other CVD risk factors through, among other aspects, weight loss.
  • The evidence cited is often superior to that for standard diets, making it likely that the ketogenic diet shows advantages over other dietary models in the prevention and treatment of cardiovascular diseases. There is a legitimate need for further research in this area.
  • Published in 2023 Nutrients MDPI

Musculoskeletal problems and arthritis have large effects on UK health

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Adapted from The State of Musculoskeletal Health Report 2023 by Versus Arthritis

Over ten million people in the UK have arthritis.

Health inequalities are defined as “unfair and avoidable differences in health across the population, and between different groups in society”.

One health inequality is deprivation. For example hip and knee osteoarthritis is commoner in the most deprived compared to the least deprived. Some ethnic groups are also affected considerably more than others. As a reference point, White British people have a 16.8% prevalence of a long term musculoskeletal problem (MSK). UK Chinese people have a 7.4% prevalence and UK Pakistani people have a 20.8% prevalence.

People with a MSK problem are 20% less likely to be in work compared with those who don’t have such a condition. In 2021 23.3 million working days were lost due to these conditions making it the third most common reason for working days lost.

I in 3 current UK employees have a long term health condition. 1 in 10 have a MSK condition. I in 3 of these employees with a long term MSK condition have not discussed it with their employer.

Of people who have no long term health condition 82.1% are in employment but this drops to 62.4% of those with a MSK condition. Of those with no long term health condition 15.2% are economically inactive. This rises to 34.9% of those with MSK conditions.

MSK conditions account for the third largest area of NHS spending at £4.7 billion in 2013-14 and are estimated to have cost £6.3 billion in 2022-23. The cost due to just Osteoarthritis and Rheumatoid arthritis will be £3.43 billion by 2030.

For many people, joint replacement surgery is the most effective treatment for their MSK condition. But many operations were not carried out over the Covid period. The conditions have not got better, the waiting lists have just got a lot longer. Approximately half of the operations done in 2019 were carried out in 2020 and the figures were still lagging in 2021.

Rheumatoid Arthritis affects 27,000 new patients each year. 30% of those with the Rh A develop osteoporosis. One in ten will develop interstitial lung disease over their lifetime. 60% of people with Rh A are physically inactive. One third of them have a mental health problem such as anxiety or depression. About a third of diagnosed people will stop work within five years of diagnosis.

Risk factors for getting the condition include age. It comes on most commonly between the ages of 40 and 70. It is 2 to 3 times more common in women compared to men. Being overweight increases the risk. There are hereditary factors involved. The gut microbiome is thought to play a part. Smoking increases the risk, worsens the disease and weakens treatment response.

My comment: As a GP I had hoped that new therapies and operations would revolutionise the outlook for musculoskeletal conditions and indeed there has been a lot of positive change. There is still some way to go. There isn’t much you can do about your heredity or gut microbiome but you can be a non smoker, keep slim and keep active. Meanwhile I wonder if anyone is researching how people of Chinese extraction have much fewer MSK conditions than any other group.

These are the factors that are important for metabolic health

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I was asked recently what I thought the definitions of good metabolic health and bad metabolic health should be. These were my criteria.

Metabolic health consists of two groups of factors: what you have and what you don’t have.

Metabolic health exists on a spectrum and your place on this spectrum may change over time. Perfection in anything is rarely obtainable and if obtained may not be sustainable. In general as we age we lose metabolic health for instance. Conversely exercise improves metabolic health at almost any age.

If you have good metabolic health you have:

Adequate or good muscle mass.

Normal to low fat mass for your life stage and gender.

A blood pressure of less than 140/90 and ideally lower than 130/80.

Fasting blood sugar less than 6.0 mmol/l.

HbA1c of 5.6 or lower.

Normal kidney function, liver function, haematology, low inflammation markers,  and low insulin.

Low triglycerides and high /normal HDL.

Be able to move quickly and without undue effort while walking and running appropriate to your life stage.

Be able to get up from a chair or the ground without using your arms depending on your life stage.

Have good grip strength.

Have good coordination, balance, memory, problem solving abilities, and sensory function.

You sleep well.

You are in a good mood most of the time.

If you don’t have metabolic health, remember the spectrum issue. You can always aim to improve some of these parameters.

Signs that your metabolic health needs some work are:

You have low muscle mass.

You have excess fat mass.

Your blood pressure is consistently over 140/90.

You require medication for blood pressure.

Fasting blood sugar over 6.1 mmol/l

HbA1c over 5.6.

Less than normal kidney function, liver function, haematology, raised inflammation markers other than transiently due to acute illness, and raised insulin.

High triglycerides. Low HDL.

Can’t move at a reasonable pace for the circumstances eg you can’t keep up with your classmates or friends during walks, dancing,  games or exercise classes.

You can’t get up from the floor without using your arms if you are under the age of 40 (and have no disabilities) or from seated in a chair otherwise.

Your grip strength is poor.

You have poor coordination, balance, memory, problem solving abilities, and sensory function that is not correctable with aids.

Yours sleep is habitually poor and you are tired most days.

Your mood is low most days.