Ketogenic Diet: Science or Cult?

In 1916, Dutch physician Cornelis de Langen studied the high prevalence of cardiovascular disease in Europeans with western diet, compared to the Javanese diet, poor in cholesterol and lipids, with a low level of blood cholesterol and low incidence of the disease. By 1951, it was accepted by most of the scientific community that fat deposition was a major feature of cardiac coronary  disease.  Later, Dr. Ancel Keys hypothesized that cholesterol was the main factor of coronary heart disease, a mediterranean-style diet low in animal fat was widely spreaded.

Importance of carbohydrates in food was noted by the term glycemic index (GI ) introduced in 1981. Dr. David J. Jenkins for the first time used GI for quantifying the available carbohydrate in food,  and applied it in the treatment of diabetes. Apart from the cholesterol and lipids, carbohydrate was considered to be a crucial factor in the process of diabetes and obesity and cerebral-cardiac disease, as well.

ketogenic diet, carbohydrates are restricted and provide limited suger for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel through fatty-acid oxidation in the cell's mitochondria. Humans can convert some amino acids into glucose by a process called gluconeogenesis. The liver can use fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone that enter the brain and partially substitute for blood glucose as a source of energy. ketogenic diet, originated from the improvement of the attack of child epilepsia, was in the usage of obesity and type II diabetes, with the  mechanism to decrease the brain the glucose supply and mobinize of keto body as the source of energy in place of glucose, to decrease the body fat mass. It is widely defined low-carbohydrate diets containing less than 25% of calories from carbohydrates, with 50 g of carbohydrate per day, and very low carbohydrate diets being those containing less than 10% carbohydrates.

To evaluate effectiveness and safety of the diet application, the objective, measurable factors rather than subjective opinions should be addressed to a standard set of criteria and benchmarks. The standard relies on quantifiable metrics such as blood pressure, body mass index (BMI), cholesterol levels, blood glucose levels, and other related laboratory test results to assess various aspects of health. Mortality rates, readmission rates, infection rates, functional capacity and individual satisfaction scores based on the scientific evidence and clinical guidelines that allow for comparison with established benchmarks or previous assessments to track progress over time. A range of measures including behavioral factors and mental health indications should provide a holistic view of an individual's situation. To ensure that the criteria used are reliable, valid, and appropriate, the systematic assessments are necessary to develop an overall review of every person.

However, any subjective effect could change the outcome of study conclusions.  Strong pressure imposes on researchers to publish their work in prestigious journals to advance their careers and to produce results that are novel or groundbreaking. Researchers could be inclined to select report data that supports their hypotheses while ignoring or downplaying contradictory findings, leading to a higher risk of bias or fabrication. Industry funding or personal financial interests can create conflicts of interest that may influence the design, analysis, or reporting of research studies. The biased results are pro for the sponsor's agenda to favor the funding support.

In some extreme cases, researchers may engage in deliberate misconduct, such as falsifying data, manipulating results, or plagiarism, to enhance the impact of their work or secure funding. Studies that cannot be replicated may indicate fraudulent or unreliable data in the original publication. Flawed or insufficient peer review processes may fail to catch errors, bias, or misconduct in submitted manuscripts. The withdrawal of scientific papers often happens when irregularities, errors, or ethical breaches are discovered after publication.

To prevent fake data and biased results from experiment, the study design, methodology, sample size and random selection are well-criticized. Small sample sizes studies or methodology and statistics flaws would be very wary of. Any conflicts of interest that could bias the results, such as funding sources or affiliations may influence the findings should be avoided. Peer review helps ensure that the research is rigorous and meets scientific standards before publication. Detailed handling for multiple sources on the same topic to get the information accurately from different sources is pivotal for starting research. Also, be cautious of sensationalist or exaggerated language in media reports such as a clip of video on a cell phone that may indicate bias or manipulation of information, and the claims that sound too good to be true or do not align with established scientific knowledge should be questioned.

Science relies on hypotheses, conducting experiments, gathering empirical evidence. Scientific findings are open to peer review to scrutiny, criticism, and revision based on new evidence. The primary goal of science is to understand and explain natural phenomena through objective investigation. The theories must be falsifiable, but it evolves as new evidence emerges.  Cult, on the other hand, often relies on unquestioning acceptance of beliefs and faith, without requiring proof. It tends to have authoritarian structures or small groups dictating beliefs and behaviors that are often unfalsifiable and resistant to change regardless of evidence. Science and cult are so close that the difference between them is just one single line apart. No over-caution would not be too emphasized to the very extent that any minor mistakes in reasoning could lead to a wrong, ridiculous conclusion.

As for the ketogenic diet, the topic has been argued for decades. With the undeniable facts obtained from vast sources, using ketogenic food will benefit in 1, children epilepsy, 2, losing weight by decreasing body lipid mass, 3, improving the glycemic index for type II diabetes, 4, refreshing the insulin resistance.

On the other hand, the ketogenic diet shows shortcomings, obviously. The restrictive nature of the diet can lead to inadequate intake of essential vitamins, minerals, and phytochemicals. Since the diet is typically high in saturated fats, which may increase the risk of heart disease by raising LDL cholesterol levels. The high fat content can potentially worsen existing liver conditions, while the increased protein metabolism may overload the kidneys. Some people experience the "keto flu" when starting the diet, which can include symptoms like headaches, fatigue, and irritability. The low carbohydrate intake may affect high-intensity exercise performance, and for growing youth and pregnant women. Any persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet will cause ketoacidosis.

Before starting the ketogenic diet, it is recommended to adjust carbohydrate ratio based on body composition, activity level and health goals,  with a lower amount and gradually adjust as needed. Use a food tracking app or journal to monitor calorie and macronutrient intake, especially in the beginning of the food application. Customize the schedule on food preferences and any dietary restrictions to create a personalized meal plan. Remember that the ketogenic diet may not be suitable for everyone,  especially those who have any pre-existing health conditions.  A personalized plan that meets individual needs should be taken to ensure the diet program safely and effectively.

Written by  Dr. Haining Jin ,  and  Dr. Bin Xu