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Berberine health benefits as a supplement

Once we have decided to leave all fad diets and quick fixes behind, and follow a sustainable low-carbohydrate and healthy fat lifestyle, we often expect to see our bodies heal completely within months. Unfortunately, this is not how it works, I think that we are lucky that our bodies can heal quicker than the time it took for our bodies to become unhealthy. But also, fortunately, there are natural products available that may aid in such processes for example Berberine.

Berberine is a plant-derived traditional medicine used in China for more than 3000 years [1]. The search for natural products is continuously on the increase due to drugs that have some limitations because of adverse effects [2]. Berberine is considered one of the most promising natural products for the treatment of metabolic diseases [2]. Metabolic diseases include diabetes, obesity, non-alcoholic fatty liver disease (NAFLD), hyperlipidemia, and gout [2].

Berberine in diabetes:

Studies have illustrated that Berberine may aid in the following which may help to improve diabetes [2]:

Berberine in weight-loss and insulin resistance:

As low-carbohydrate dietitians, we aim to lower circulating blood glucose levels, which in turn lowers circulating insulin hormone. Lowering insulin, a fat-storing hormone, may aid with weight loss. As described above Berberine aids in lower blood glucose and consequently also lowers insulin and thus may aid in weight loss. Yes, a lifestyle change is still required, but some individuals have such high insulin levels that it takes years to recover. A natural supplement like Berberine may aid to speed up the initial process to a stage where one only requires healthy food to become and stay healthy.

Berberine and inflammation:

Berberine has anti-inflammatory effects by downregulating inflammatory markers [2]. Studies illustrated reduced inflammation in the liver and visceral fat tissue [2]. 

Berberine and Non-alcoholic fatty liver disease (NAFLD):

Berberine improves fat accumulation in the liver as well as retention of fat within the liver [2]. Berberine is also associated with the inhibition of inflammation of the liver and aid in regulating gut bacteria which can be associated with improved gut health [2].

Berberine and cholesterol levels:

Berberine remarkably reduces serum Triglycerides (TG) which is known to be the very unhealthy cholesterol also associated with metabolic diseases. Berberine also lowers total cholesterol (TC), and low-density lipoprotein-cholesterol (LDL-C) concentrations and increases serum high-density lipoprotein-cholesterol (HDL-C; good cholesterol) concentrations [2].

Berberine and gout:

Multiple studies demonstrated that Berberine could substantially reduce fasting serum uric acid (UA) levels [2]. This reduction is beneficial for the treatment of hyperuricemia or gout. The uric acid lowering effect of Berberine may be ascribed to several mechanisms. Berberine could dilate blood vessels, regulate blood flow, and improve renal function, which leads to the increased excretion of UA [2].

An increasing number of studies illustrate that Berberine has a good therapeutic effect on five metabolic diseases, namely, T2DM, obesity, NAFLD, gout, and hyperlipidemia [2]. However, natural medicine should be used in combination with improved lifestyle changes to achieve optimal and sustainable results.

References

  1. Gaba S, Saini A, Singh G, Monga V. An insight into the medicinal attributes of berberine derivatives: A review. Bioorganic & Medicinal Chemistry. 2021: 38; 116143.
  2. Xu X, Yi H, Wu J, Kuang T, Zhang J, Li Q, Du H, Xu T, Jiang G, Fan G. Therapeutic effect of berberine on metabolic diseases: Both pharmacological data and clinical evidence. Biomedicine & Pharmacotherapy 133. 2021; 110984.

Cow’s milk protein allergy (CMPA) and the lactating mother by Elzette Struwig RD(SA)

An allergy is an immune-mediated response.

A food allergy occurs when the immune system identifies a food protein as hazardous, which causes the immune system to become activated. This is to protect the body from this protein. Symptoms that range from asthma, eczema, rashes, rhinitis, or even anaphylaxis can then occur. Regarding food allergies, IgE-mediated Cow’s milk protein allergy (CMPA) is the most common allergy in infants during the first year of life [1].

Cow’s milk protein allergy (CMPA) can often manifest in a breastfed or formula-fed infant through delayed reactions, such as vomiting, diarrhea, colic, and intestinal constipation [2]. The diagnosis of CMPA is based on the improvement of symptoms on the exclusion of cow’s milk protein (CMP) from the diet or IgE blood tests, which can be very traumatizing for the infant [2]. The treatment option is the exclusion of the allergen from the diet. In a breastfeeding mother, the milk protein is transferred from the mother’s bloodstream, due to intake from her diet, to the breastmilk. A breastfeeding mother may and ideally should continue breastfeeding her infant with CMPA. A mother who makes this decision, for the benefit of her child, should then exclude CMP from her diet. Cow’s milk elimination (in a child who is no longer being breastfed) without adequate replacement feed may impair the normal growth and development of the child [2]. Please keep in mind that this allergy is not related to lactose (the sugar found in dairy products), but whey and casein, the protein found in dairy products. In this case, lactose-free products would make no difference. Unfortunately, whey (the CMPA seen more often), is found in an even greater variety of food products than lactose. For example, whey is often used as a seasoning in food sources such as chips, sauces, and baked goods.

A lactating mother of an infant with CMPA should exclude all the allergens from her own diet. This can be done by proper label reading. Or better yet, to avoid products contained in packages and wrapping and rather stick to natural options such as fruit, vegetables, meat, fish, eggs, and foods high in fatty acids such as nuts, seeds, avocado, and oils. 

Once the infant’s symptoms start to improve, it is a confirmation that the CMPA was the cause for the little one’s discomfort. It is recommended to reintroduce an allergen with the supervision of a dietitian. The reintroduction of an allergen is called a food challenge and it is to determine whether the infant has outgrown the allergy. Ideally, a mother should first start using cow’s milk protein products again, before providing it directly to her infant.

The mother and infant need to maintain a well-balanced dietary intake while excluding cow’s milk protein from the diet. A dietitian can help to establish these requirements and assist with the reintroduction of the allergen.

References

  1. Perezabad L, López-Abente J, Alonso-Lebrero E, Seoane E, Pion M, Correa-Rocha R. The establishment of cow’s milk protein allergy in infants is related with a deficit of regulatory T cells (Treg) and vitamin D. Pediatric Research. 2017: 5 (81); 722.
  2. Faria D, Cortez A, Speridião P, Morais M. Knowledge and practice of pediatricians and nutritionists regarding the treatment of cow’s milk protein allergy in infants. Rev. Nutr. 2018;31(6):535-546.

Carbohydrate restriction and ketogenic diets in patients suffering from Type 2 Diabetes Mellitus (T2DM) by Elzette Struwig RD(SA)

According to the United States center for Disease Control and Prevention, 85% of the diabetic patients are overweight and 55% are obese [1]. Due to the number of overweight/obese individuals increasing, the World Health Organization estimates that approximately 366 million people will have diabetes by the year 2030 [1]. This is of great concern, and can also be an indication that current practices, including dietary practices to prevent Type 2 Diabetes Mellitus (T2DM) are not effective enough to lower these figures. It is my opinion that current practices are focused on the management of T2DM and not as much the prevention thereof. Practices to prevent lifestyle diseases such as T2DM may include healthy eating, exercise, proper stress management, etc. 

As mentioned previously overweight/obesity is associated with T2DM, thus the management of weight can help to prevent T2DM. Weight loss these days could be done quite easily due to the abundance of weight loss clinics and programs available. The challenges are to maintain a healthy weight, and when losing and maintaining weight, to do so in a healthy manner. Currently, a lot of individuals are following some sort of low-carbohydrate diet to shed some kilograms. 

Being a dietitian myself who focusses on low-carbohydrate and ketogenic diets and follow such a lifestyle myself. I have seen that, if done correctly, this type of lifestyle may provide health benefits and is quite sustainable for most of our patients. There is also a vast majority of social media groups (not always following the correct medical guidelines) in which individuals find this type of lifestyle sustainable. I believe that sustainability is one of the most important aspects when choosing a specific dietary lifestyle, as, without it, it is just another quick fix. 

But why can a low-carbohydrate or ketogenic diet be considered for the prevention of T2DM? Several studies have shown the benefits of ketogenic diets for patients with type two diabetes may include, weight loss, reducing HbA1c, reversing nephrology, cardiac benefits, improvement of lipid profile and even have a potential effect on reversing diabetic neuropathy and retinopathy [1]. Saslow et al. conducted a 12-month study in 2017 in which adults with elevated HbA1c and body weight assigned to a very low-carbohydrate ketogenic diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow a moderate-carbohydrate, calorie-restricted, low-fat diet (2). The study also found that the ratio of triglycerides to HDL, which predicts coronary disease, decreased in the low-carbohydrate group compared to the moderate-carbohydrate group, suggesting that the very low-carbohydrate ketogenic diets may have certain benefits on lipid profiles (2). 

As I have experienced the increased energy levels, better sleep, reduction in visceral fat, stabilizing blood pressure levels, so have many of our patients also experienced the benefits of a low-carbohydrate lifestyle. It is important to consider all aspects when choosing a dietary lifestyle, as weight is not the only indication of health. Make sure that the calories you consume count to contribute to your health, possibly prevent diseases such as T2DM and not contribute to them. 

References

  1. Azar ST, Beydoun HM, Albadri MR. Benefits of Ketogenic Diet for Management of Type Two Diabetes: A Review. Obesity & Eating Disorders. 2016: 2; 22. 
  2. Saslow LR, Daubenmier JJ, Moskowitz JT, Kim S, Murphy EJ, Phinney SD, Ploutz-Snyder R, et al. Twelve-month outcomes of a randomized trial of a moderate-carbohydrate versus very low-carbohydrate diet in overweight adults with type 2 diabetes mellitus or prediabetes. Nutrition and Diabetes. 2017: 7; 304.

Breastfeeding, diet and your child's future

Personally, I found breastfeeding very hard, with many moments where I wanted to give up. Our little one suffered from colic and severe reflux, and despite all the benefits associated with breastfeeding, I felt that this may be the cause of all these symptoms. Of course, it was not, and breastfeeding was still the best possible option, I just needed to remind myself of that on a regular basis. 

Breastfeeding benefits

Breastfeeding provides protection against respiratory and gastrointestinal infections and is associated with a reduced risk of inflammatory diseases such as asthma, atopy, diabetes, obesity, and inflammatory bowel disease [1]. Prolonged and exclusively breastfed infants have improved cognitive development [1]. A mother’s breastmilk also provides immunity to her infant and develops the infant's intestinal mucosa, microbiota, and their own immunologic defenses [1]. Breastfeeding provides so many benefits, and when possible, it is important to try and breastfeed for as long as possible. 

A mother’s diet and lactation

Can a mother’s nutritional status and or diet, affect the quality of her breastmilk? Unfortunately, the nutritional stores of a lactating woman may be more or less depleted as a result of the pregnancy and the loss of blood during childbirth [2]. The nutrients present in breastmilk comes from the mother’s diet or her nutrient reserves [2]. The alteration of nutrients in food to nutrients in breastmilk is not complete [2]. Thus for a breastfeeding mother to have a good nutritional status she has to increase her nutrient intake [2]. Luckily, the nutritional content of breastmilk remains quite similar, there are only a few nutrients that become deficient in breastmilk if it is deficient in a mother’s diet. A mother whose diet is deficient in thiamine and vitamins A and D will also produce breastmilk deficient in these nutrients [2]. Studies have also shown that the levels of polyunsaturated fatty acids especially Docosahexaenoic acid (DHA) in a mother’s diet influences the levels in her breastmilk [3]. Keep in mind that this fatty acid is essential for neurological development, and if not consumed within the diet, supplementation is recommended. 

In conclusion, we are all aware that breastfeeding is the gold standard for infant feeding and nutrition. However, we as mothers can get very concerned about our own diets and how it will affect the breastmilk provided to our infants. It is always best to speak to your medical professional but to maintain and sustain a well-balanced and nutrient-dense diet can provide benefits to the mother as well as her baby. Don't give up mommies at the end it is really worth it!

References

  1. Le Doare K, Holder B, Bassett A, Pannaraj PS. Mother’s Milk: A Purposeful Contribution to the Development of the Infant Microbiota and Immunity. Frontiers in Immunology. 2018: 8; 361.
  2. Segura SA, Ansótegui JA, Díaz-Gómez NM. The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements? Anales de Pediatría (English Edition). 2016: 84 (6); 347.
  3. Bzikowska A, Czerwonogrodzka-Senczyna A, Wesołowska A, Weker H. Nutrition during breastfeeding - impact on human milk composition. Europe PMC. 2017. 

A mind-set for sustainable weight loss.

A new year, new resolutions and new challenges. As January kicks off we are always full of hope and expectations for the year ahead, especially when it comes to our weight and our aspirations to follow a healthier diet plan and as a bonus lose some weight. It is a great trait to be optimistic, but let’s be realistic, by the time work and school starts, all our good ambitions have collapsed. Maybe I can help with a few tips on how to maintain these dietary goals we set for ourselves and by this time next year it is not just a dream, but a dream come true. 

As a registered dietitian, I often see the common mistakes that are made when setting health and weight loss goals for one’s self. I would like to give you some insight on what the ideal mindset is to set you up for success and not a failure. The first question I ask a patient on their first consultation is (in a very polite manner of course) ‘why are you here today?’ Which basically means, what is your goal and what drives this goal? Is your goal to see yourself in a specific bikini that did not fit you for the past 5 years, or do you see yourself running around with grandchildren without excess weight? Whatever the goal might be, it is important to visualize that and keep that in mind as the bullseye, to keep you going strong during challenging times. As the well-known saying goes, ‘keep your eyes on the prize’. The drive behind the goal is just as important as the goal itself, unfortunately, in most of the cases, we tend to be people-pleasers and set goals to impress others, rather than focus on our own health and happiness. The first challenge is to discover what your goal is and what drives you? 

Once you are able to visualize yourself reaching your goal and have the drive to do so, your weight loss goal should be reachable and realistic. We all know that goals should be SMART (specific, measurable, achievable, relevant and time-limited), we have heard it a million times. But in basic terms, make sure your weight loss goal is achievable. Be realistic, if you have three kids between the ages of 1 and 10 years, for example, it might be more challenging (or take a while longer) to reach your goals, compared to your neighbour who has no kids and is a housewife and can spend hours in the gym. A very important question to ask, is, ‘how long did it take you to gain the weight you want to lose?’. With that in mind, you should be prepared to lose your excess weight over more or less the same period of time. Determine whether your goal is achievable? 

It is obvious to one’s self when you start losing weight, but some people do not believe the progress if they don’t see it in the number on the scale. That should not be your guideline! There is a lot of factors that can influence the number on the scale one of which is the loss of fat mass and gain of muscle mass. This often causes people to lose motivation and give up, therefore don’t get onto the scale on a daily basis or even a weekly basis for that matter. Measure your results by the centimeters you have lost, to finally fit into that dress you never were able to. You will feel on top of the world and even more inspired to keep it up. How are you tracking your progress? 

Once you have set a realistic goal to work towards to, in my opinion, the fourth thing that we do wrong is the lack of a proper plan. Yes, we want to lose fat mass, but how will we do it and how will we maintain it. A quick fad diet to aid in losing the extra weight picked up over December might help, but this can result in the weight (or more) being gained back as fast as it was lost. When I talk about a plan, I mean a proper eating and exercise plan that is sustainable and feasible. I would recommend, that if needed, the advice of an expert in the field such as a dietitian, nutritionist, life coach, personal trainer etc. they can help to determine your individual needs, because, keep in mind, all humans are different and live different lifestyles and will therefore, require a plan that fits in with their specific lifestyles and not the other way around. Do you have a structured plan? 

Life happens but having a plan is important to keep you on track to follow your well-planned low-carbohydrate, high-fat meal plan. Therefore, plan in advance. If you know you are going to have a busy week, why not do all the grocery shopping over the weekend and better yet prepare food for Monday, therefore, Monday you can prepare food for Tuesday, and so on and so forth, this will allow you to always be a day in advance. Just think about it, working in advance allows you to come home to a ready homecooked meal. Plan, plan, plan? 

Now that you have your plan stuck to the fridge, you are ready for this life-changing experience. Be prepared and aware, that some days may be more challenging than others. If a day comes crashing down on your perfectly calculated plan, please don’t abandon your dreams, just carry on where you left off. Remember we are aiming for a lifestyle change and not a quick fix. One slip up does not mean that the entire plan should go to waste. It is all part of the journey. Ensure to have a contingency plan in place for days where you planned to make an oven roasted lemon butter chicken with Al Dente mixed veggies, but one of the kids got sick, the car broke etc. etc. Remember a quick salad with a tin of tuna is just as suitable and nowadays that roasted chicken and ready-made veggies, at your local grocery store is a lifesaver. If you skipped meals or had something that does not fit in with your plan, it is not the end of the world, just carry on as planned. Do you have a contingency plan? 

With various fad diets popping up all over the internet, I can understand that it can become challenging to find your feet when it comes to what is healthy and what not. We all want to see results within a day or two, but we know, deep down that, it is not the solution. Believe in yourself and commit to something that can change your life for the good. Great things can happen if you believe in yourself and give yourself the credit you deserve. 

The Keto-Fad | Fact or Fiction?

From corsets to camisoles, diet fads have been used through the ages. In 1820, Lord Byron commercialized the vinegar and water diet, which involves drinking water mixed with apple cider vinegar. One of today’s latest diet trends is the ketogenic diet (KD). In actual fact, the KD was already developed in the 1920s and was used worldwide for the non-pharmacological management of drug-resistant epilepsy1. In modern times, however, the applications of the KD, as well as other low-carbohydrate and high-fat (LCHF) diets are evolving. These applications may vary from weight-loss, Type 2 Diabetes Mellitus (T2DM), Polycystic Ovary Syndrome (PCOS), Inflammatory Disorders (ID) to cancer (as combination therapy) and so much more. Many individuals who follow an LCHF or KD states that they experience long-term benefits and tempts to make this a lifestyle and not a ‘quick fix’. Many of the ‘diets’ or lifestyles that are applied in the modern world were developed centuries ago. Another example is Banting, this low-carbohydrate diet was already described by William Banting in the 1800s, while in 2018 plenty of South Africans are Banting. 

As a registered dietitian, who has seen the benefits of the KD in individuals with drug-resistant epilepsy and cancer, I do believe there is surely benefits for certain individuals when following some form of an LCHF lifestyle. When I talk about benefits, my very first epilepsy patient was a 2-year-old female who was suffering from GLUT-1 Deficiency Syndrome (GLUT-1 DS) and had 10 seizures on average per day and is now completely seizure free for the past 3 years. But what is the difference in applying a classical KD (in which 90% of the total energy comes from fat) or just following an LCHF lifestyle? Thinking about it, an LCHF diet or lifestyle consists of a lot of foods that are readily available in nature, which therefore means that the diet does not (or is not supposed to) consist of unnatural foods. While on the other hand a classical KD, which is applied for medical purposes, is very strict, all foods should be weighed, and there is only just enough protein provided within the diet to ensure growth, while almost all of the remaining energy intake comes from fat. A strict KD then causes an individual’s body to use fat, in the form of ketones as the primary energy source (known as ketosis) and no longer carbohydrates in the form of glucose, hence the name, ketogenic. An LCHF lifestyle can cause ketosis as well, but usually not to such a severe extent. Keep in mind, that the human’s brain is 60% fat and the brain’s capabilities may improve when fat is supplied as the energy source, for example in individuals suffering from Parkinson’s Disease, Alzheimer’s and even Attention Deficit Disorder (ADD) etc. 

A narrative review written by Professor Tim Noakes and Johann Windt, which was published in 2016, aims to provide clinicians with a broad overview of the effects of LCHF diets on body weight, glycaemic control, and cardiovascular risk factors while addressing some common concerns and misconceptions. The conclusion as made from this study states that although LCHF diets may not be suitable for everyone, available evidence shows this eating plan to be a safe and efficacious dietary option to be considered. The Dietary Guidelines for Americans (DGA) recommend a total carbohydrate intake of 45-65% of total energy per day. Any carbohydrate intake less than 45% of the total energy, is considered to be a reduced carbohydrate diet/lifestyle. But why do individuals follow LCHF or Keto-diets? One of the main understandings is due to the leptin and ghrelin hormone balances. Leptin hormone contributes to the feeling of satiety while ghrelin contributes to the feeling of hunger. Leptin levels may be improved by an increased intake of omega-3 fatty acids, which is often something that naturally occurs in an LCHF lifestyle or KD. Therefore, some individuals suffer from fewer cravings, making it easier to control their calorie intake when wanting to shed some weight. With all the diet trends, I have experienced that individuals will often try something for a short period of time, but it is important to plan for the long hall and find something that is appropriate for the entire family. 

There is concrete evidence that supports the application of ketogenic diets in individuals with drug-resistant epilepsy. However, in practice, the applications of LCHF and KD remains patient specific. Beneficial responses to any diet are entirely reliant on the degree of patients’ adherence, thus an LCHF diet is only appropriate for those patients motivated to comply and completely grasp the aspects thereof. 

Bibliography

1. Kossof, EH, Zupec-Kania, BA, Amark, PE, Ballaban-Gil, KR, Bergqvist, AGC, et al. Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group. Epilepsia: 1-14, 2008.

2. Noakes, TD, Windt, J. Evidence that supports the prescription of low-carbohydrate high-fat diets: a narrative review. British Journal of Sports Medicine: 51; 133-139, 2016.

Can a ketogenic diet really aid those suffering from epilepsy?

A diet that can help to prevent seizures and improve quality of life, sounds to good to be true. But, the ketogenic diet (KD) offers a lot of potential, not only for weight loss aspects but also for medical conditions such as epilepsy, cancer, chronic inflammatory disorders etc. The KD is a high fat, adequate protein and low carbohydrate diet. The hallmark of the KD is the production of ketone bodies by the liver which becomes the brain’s primary source of energy. The KD has been applied in individuals with refractory or also known as drug-resistant epilepsy since the 1920s. The diet was discovered by the observation of decreased seizure frequency during episodes of fasting. In 1921, Dr. Wilder at Mayo clinic suggested the KD for the long-term management of epilepsy. In terms of this suggestion, it was stated that the benefits of fasting could be recreated through the implementation of a KD. Additionally, the KD could be sustained for a much longer period as it compensates for the clear disadvantages associated with a prolonged period of fasting. 

The use of the diet was restricted to very young children and strictly impaired individuals as it was considered a last resort therapy, due to its severe dietary restrictions, unpalatability and limited access to ketogenic diet centres. Nevertheless, currently, the KD is a well-established nonpharmacologic treatment for childhood refractory epilepsy. Today, there are established KD clinics worldwide with dietitians trained and experienced in the KD. But the question remains: when should someone be referred to such a clinic or dietitian, to initiate the KD? It is recommended to implement the KD after two trials of anti-seizure medication has failed to alleviate the frequency and/or the severity of seizures [1]. 

Initial anti-seizure drug (as standalone therapy) control seizures in approximately half of patients with newly diagnosed epilepsy [2]. The remaining half of the patients, normally those suffering from drug-resistant/refractory/intractable epilepsy, may benefit from the KD. Systemic reviews of KD therapies in children with refractory epilepsy suggest that 33 - 56% of children achieve ≥50% seizure reduction and approximately 16% achieve seizure freedom [3]. Keep in mind that the KD is the treatment of choice for GLUT1 deficiency syndrome and pyruvate dehydrogenase deficiency (PDHD), which are two distinct disorders of brain energy metabolism [4]. Some KD therapies, for example, the classical KD, may be too restrictive for adults suffering from refractory epilepsy and for those refusing pharmacological treatment, and is associated with decreased compliance. However, with the development of less restrictive diets such as the Modified Atkins Diet (MAD), Medium-Chain Triglyceride (MCT) Diet, and the Low Glycaemic Index Treatment (LGIT), the diet is associated with increased compliance in adults [5]. Therefore, the KD can be used safely in the adult and adolescent population, with a response rate similar to those seen in children [6]. 

Traditionally, the long chain triglyceride (LCT) diet was used, but recently, it has appeared that the medium chain triglyceride (MCT) diet is more effective and palatable [4]. This is primarily as a result of the unique metabolism of MCT oils and the higher ketone yield per gram as MCT oils bypass normal absorptive pathways and as such are metabolized faster [4]. The increased ketogenic potential results in the patients having lower dietary fat demands, thereby allowing for a greater intake of protein and carbohydrates which are associated with increased compliance [4]. 

The KD is characterized by ratios between total fats and the sum of the carbohydrates and proteins. The ratio is calculated based on the total grams of fat to the total grams of protein and carbohydrates combined. Up until recently, the 4:1 ratio or also known as the classical KD (CKD) has been the most commonly used therapeutic ratio. The modified Atkins or modified ketogenic diet (MAD/MKD) has a ratio of 2:1. These diets are less restrictive, compared to the CKD and are most likely to be used in infants, adolescents, and adults. 

The LGIT relates to a ratio of approximately 1:1 compared to the CKD, with emphasis on the consumption of low glycaemic index (GI) foods (GI of <50), as well as a low glycaemic load. The LGIT is not normally recommended in those suffering from refractory epilepsy, as the diet does allow for a greater intake of carbohydrates, however, the LGIT is a healthier option for those wanting to follow a KD for weight loss. Reason being, the LGIT still allows for an intake of fruits, vegetables and high-fibre foods. Therefore, the LGIT is rarely associated with vitamin or mineral deficiencies, constipation, nausea or other side effects that may be associated with a strict CKD. 

The KD and variants thereof has shown promising results in those (from infancy to adulthood) suffering from refractory epilepsy and should be recommended by medical professionals after two trials of anti-seizure medication has proven to be unsuccessful. The KD should be monitored by an experienced medical professional in order to encourage the benefits and prevent the side effects. In practice I have life changing results when the KD is applied in individuals with epilepsy. From children who can live and grow up without the challenges associated with frequent seizures and even adults who can finally get a driver’s licence because their seizures are properly controlled. The KD is considered to be both a medical therapy, requiring medical supervision, as well as a dietary option for healthy individuals. 

Bibliography

1. Sharma S, Jain P. The ketogenic diet and other dietary treatments for refractory epilepsy in children. Ann Indian Acad Neurol. 2014; 17(3): 253–258.

2. Kossoff EH, Henry BJ, Cervenka MC. Transitioning pediatric patients receiving ketogenic diets for epilepsy into adulthood. Seizure. 2013: 22; 487-489.

3. Schoeler NE, Cross JH. Ketogenic dietary therapies in adults with epilepsy: a practical guide. Pract. Neurol. 2016: 16; 208-214.

4. Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AGC, Blackford R, Bchhalter JR. Optimal clinical management of children receiving the ketogenic diet: Recommendations of the International Ketogenic Diet Study Group. Epilespia. 2008: 1-14.

5. Cervenka MC, Henry BJ, Felton EA, Pattona K, Kossoff EH. Establishing an Adult Epilepsy Diet Center: Experience, efficacy and challenges. Epilepsy and Behavior. 2016: 58; 61-68.

6. Nei M, Ngo L, Sirven JI, Sperling MR. Ketogenic diet in adolescents and adults with epilepsy. Seizure. 2014: 23; 439-442.

Are we sugarcoating our kid's lunchboxes

A new year, new resolutions and new challenges. As January kicks off we are always full of hope and expectations for the year ahead, especially when it comes to our weight and our aspirations to follow a healthier diet plan and as a bonus lose some weight. It is a great trait to be optimistic, but let’s be realistic, by the time work and school starts, all our good ambitions have collapsed. Maybe I can help with a few tips on how to maintain these dietary goals we set for ourselves and by this time next year it is not just a dream, but a dream come true. 

As a registered dietitian, I often see the common mistakes that are made when setting health and weight loss goals for one’s self. I would like to give you some insight on what the ideal mindset is to set you up for success and not a failure. The first question I ask a patient on their first consultation is (in a very polite manner of course) ‘why are you here today?’ Which basically means, what is your goal and what drives this goal? Is your goal to see yourself in a specific bikini that did not fit you for the past 5 years, or do you see yourself running around with grandchildren without excess weight? Whatever the goal might be, it is important to visualize that and keep that in mind as the bullseye, to keep you going strong during challenging times. As the well-known saying goes, ‘keep your eyes on the prize’. The drive behind the goal is just as important as the goal itself, unfortunately, in most of the cases, we tend to be people-pleasers and set goals to impress others, rather than focus on our own health and happiness. The first challenge is to discover what your goal is and what drives you? 

Once you are able to visualize yourself reaching your goal and have the drive to do so, your weight loss goal should be reachable and realistic. We all know that goals should be SMART (specific, measurable, achievable, relevant and time-limited), we have heard it a million times. But in basic terms, make sure your weight loss goal is achievable. Be realistic, if you have three kids between the ages of 1 and 10 years, for example, it might be more challenging (or take a while longer) to reach your goals, compared to your neighbour who has no kids and is a housewife and can spend hours in the gym. A very important question to ask, is, ‘how long did it take you to gain the weight you want to lose?’. With that in mind, you should be prepared to lose your excess weight over more or less the same period of time. Determine whether your goal is achievable? 

It is obvious to one’s self when you start losing weight, but some people do not believe the progress if they don’t see it in the number on the scale. That should not be your guideline! There is a lot of factors that can influence the number on the scale one of which is the loss of fat mass and gain of muscle mass. This often causes people to lose motivation and give up, therefore don’t get onto the scale on a daily basis or even a weekly basis for that matter. Measure your results by the centimeters you have lost, to finally fit into that dress you never were able to. You will feel on top of the world and even more inspired to keep it up. How are you tracking your progress? 

Once you have set a realistic goal to work towards to, in my opinion, the fourth thing that we do wrong is the lack of a proper plan. Yes, we want to lose fat mass, but how will we do it and how will we maintain it. A quick fad diet to aid in losing the extra weight picked up over December might help, but this can result in the weight (or more) being gained back as fast as it was lost. When I talk about a plan, I mean a proper eating and exercise plan that is sustainable and feasible. I would recommend, that if needed, the advice of an expert in the field such as a dietitian, nutritionist, life coach, personal trainer etc. they can help to determine your individual needs, because, keep in mind, all humans are different and live different lifestyles and will therefore, require a plan that fits in with their specific lifestyles and not the other way around. Do you have a structured plan? 

Life happens but having a plan is important to keep you on track to follow your well-planned low-carbohydrate, high-fat meal plan. Therefore, plan in advance. If you know you are going to have a busy week, why not do all the grocery shopping over the weekend and better yet prepare food for Monday, therefore, Monday you can prepare food for Tuesday, and so on and so forth, this will allow you to always be a day in advance. Just think about it, working in advance allows you to come home to a ready homecooked meal. Plan, plan, plan? 

Now that you have your plan stuck to the fridge, you are ready for this life-changing experience. Be prepared and aware, that some days may be more challenging than others. If a day comes crashing down on your perfectly calculated plan, please don’t abandon your dreams, just carry on where you left off. Remember we are aiming for a lifestyle change and not a quick fix. One slip up does not mean that the entire plan should go to waste. It is all part of the journey. Ensure to have a contingency plan in place for days where you planned to make an oven roasted lemon butter chicken with Al Dente mixed veggies, but one of the kids got sick, the car broke etc. etc. Remember a quick salad with a tin of tuna is just as suitable and nowadays that roasted chicken and ready-made veggies, at your local grocery store is a lifesaver. If you skipped meals or had something that does not fit in with your plan, it is not the end of the world, just carry on as planned. Do you have a contingency plan? 

With various fad diets popping up all over the internet, I can understand that it can become challenging to find your feet when it comes to what is healthy and what not. We all want to see results within a day or two, but we know, deep down that, it is not the solution. Believe in yourself and commit to something that can change your life for the good. Even though it is March, it is not too late to stick to your resolutions, just do it and turn your life around. Great things can happen if you believe in yourself and give yourself the credit you deserve

Can a Ketogenic diet (low carbohydrate, high fat, adequate protein diet) be used as an additional metabolic therapy for Autism spectrum disorder?

According to the Autism Society in the US, about 1% of the world population has Autism spectrum disorder (ASD). The prevalence in the US is estimated at 1 in 59 births (Autism society, Online:2018). Statistics on ASD in South Africa is difficult to find. 

ASD is an umbrella term for neurodevelopmental disorders, that as of May 2013, includes what was formerly known as Asperger syndrome, and classic autism. Signs typically appear during early childhood. The disorder affects a person’s ability to communicate and interact with others. It affects individuals differently and to varying degrees (ASPEN, 2018). 

Parents of ASD children worldwide have turned to diet therapies and have experienced varying rates of success. Clinical studies with different dietary interventions are limited because of the many challenges faced by ASD children. 

Studies on mice show promising results according to Susan Masino, PhD Trinity College. Masino tested the behavioural effects of a ketogenic diet using a mouse model that has characteristics of autism including low sociability. Results from the mice fed on a normal diet displayed behavioural symptoms of autism, however, after feeding them a ketogenic diet the autistic behaviour reversed significantly. They were more social and spent more time with other mice. Masino’s study also showed that the behavioural effects of the ketogenic diet were independent of its anti-seizure effect. (Masino, Online:2017) 

It seems as if the research base regarding the ketogenic diet, other than epilepsy and seizure control, is still not substantial enough. However, more than 1,300 scientific articles have been published over 90 years regarding the ketogenic diet and epilepsy. Dr. Jong Rho a world-leading pediatric neurologist based in Canada is using this research to assess ketogenic mechanisms for other neurological and developmental conditions such as ASD (Jacqueline A. French, 2017). 

While the exact action of the ketogenic diet is not completely understood yet, there are several reasons why the ketogenic diet may be effective for improved brain function and improvements in all areas of children with neurologic conditions (Lindsey B. Gano, 2014). 

The ketogenic diet’s impact according to Dr. Rho may include the following:

Ketogenic diet 

Positive affect for ASD 

Breakdown of fat to ketones. 

Provide the energy-hungry brain with an alternate energy source than glucose and produce less oxidative stress. 

Improved cellular metabolism. 

Neuroprotective, preventing or decreasing neuronal injury or cell death. 

It is anti-inflammatory. 

Reduces inflammation which is a risk factor for seizures and other conditions. 

It has epigenetic impacts. 

It inhibits the expression of some genes linked to neurological problems. 

It alters the microbiome of the gut (Newell C1, 2016). 

It improves the cross talk between the gut and brain which has significance for ADS. 

It impacts various ion channels. 

It improves the transmission of nerve cell signals. 

It promotes homeostasis. 

Restoring physiological balance and equilibrium on cellular and systems level. 

Reduce brain inflammation. 

Implications for brain pathways. 

Stabilizing of blood glucose levels. 

More stable mood and behavior. 

Normalizing of insulin levels. 

Positive effect on inflammation. 

Circulating ketone bodies. 

Ketones have an inhibitory effect on nerve cells and therefor hyperactive behaviour. 

More ketone bodies in the brain. 

Maintains GABA, a neurotransmitter, at (Eleonora Napoli, Online:2014) a higher level. 

May contain medium triglyceride (MCT) fats. 

Control of yeast overgrowth. 

A well-formulated ketogenic diet is nutrient dense. 

Increase beneficial bacteria in the gastrointestinal system. 

More recent reports on individual ASD children showed:

Dr Julie Buckley a paediatrician from Florida believes there is enough evidence to recommend ketogenic eating to help children with neurologic, developmental or behavioural issues. She recommends a dairy-free ketogenic diet for every family having a child on the autism spectrum. Her own autistic daughter of 19 years old follows this diet with great success. 

Evidence from these studies and reports indicate that at least certain types of autism respond to metabolic diet treatments. Additional research on the Ketogenic Diet may offer further clues to reversing the symptoms of autism. 

Although the Ketogenic diet is a promising option for families of ASD children it is important to consider that ASD children have many challenges concerning feeding and nutrition (Bennie, 2015).

It is therefore important to have adequate support from a medical doctor to monitor health and progress, as well as a dietitian trained in ketogenic diet prescription to:

A multi-disciplinary team approach is important to provide the best possible support structure for families facing the daily challenges of ASD.

In conclusion, it appears that the ketogenic diet, adapted to also be gluten free and casein free, may be an important additional therapy for children with ASD for the following reasons:

Bibliography

Lindsey B. Gano, M. P. (2014). Ketogenic diets, mitochondria, and neurological diseases. Journal of Lipid Research, 2211-2228.

Jacqueline A. French, M. K. (2017, July). Clinical studies and anti-inflammatory mechanisms of treatments. Retrieved from HHS Public Access PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679081/pdf/nihms916357.pdf

Newell C1, B. M. (2016, september 1). pubmed. Retrieved from Pubmed abstract: https://www.ncbi.nlm.nih.gov/pubmed/27594980

Bennie, M. (2015, november 7). Retrieved from autiamawareness centre: https://autismawarenesscentre.com/feeding-challenges-helpful-hints-for-parents-of-children-with-autism/

Autism society. (Online:2018, July 21). Facts and statistics. Retrieved from Autism society: http://www.autism-society.org/what-is/facts-and-statistics/

ASPEN. (2018, JUly 21). What is Autism spectrum disorder. Retrieved from ASPEN: https://aspennj.org/what-is-autism-spectrum-disorder

Masino, P. S. (Online:2017, February 14). Professor Susan Masino – Metabolism and Brain Health. Retrieved from Scientia Global: http://www.scientia.global/professor-susan-masino-metabolism-brain-health/

Ryan W.Y. Lee, a. M.-J. (Online:2018). A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder. Physiol Behav, 205-211.

El-Rashidy O1, E.-B. F.-G. (Online:2017). Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Matab Brain Dis, 1935-1941.

Eleonora Napoli, N. D. (Online:2014). Potential Therapeutic Use of the Ketogenic Diet in Autism Spectrum Disorders. Frontiers in Pediatrics.

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