Ketogenic Dietary Therapies: Recent Findings and Future Perspectives

Dear Colleagues,

Ketogenic dietary therapies (KDT) are established, effective nonpharmacologic treatments for intractable childhood epilepsy and some neurometabolic disorders. Specifically, the classic ketogenic diet has been used to treat epilepsy in children continuously since 1921. Variations of this diet include the modified Atkins diet, low glycemic index treatment, and medium-chain triglyceride diet. More recently, KDT have also been studied for their therapeutic effects in other neurological disorders as well as in chronic systemic metabolic diseases and cancer.

The primary mechanism through which these diets are thought to exert their effects is a reduction in glycolysis and a promotion of ketone body formation, which can be used by the brain to generate cellular energy. This shift in energy metabolism appears to reset cellular metabolic dysfunction and neuronal activity, although the exact mechanisms remain unclear and are currently the subject of further research.

Nutritional ketosis is currently under investigation for the improvement of metabolic and inflammatory markers, including lipids, HbA1c, high-sensitivity CRP, fasting insulin and glucose levels, and as an aid in weight management.

To obtain a therapeutic effect, low amounts of carbohydrates and high amounts of fat are administered in different controlled ratios. The use of such unbalanced diets in children and adults requires particular attention in implementation and monitoring. The main nutritional problems that require careful monitoring arise from marginal or overt nutritional deficits (energy, proteins, minerals and vitamins) or from excess nutrients (lipids, saturated fat and cholesterol) that are peculiar to these diets. In addition, the usefulness of different nutritional supplements and special foods deserves deeper discussion. The long-term adverse and beneficial effects of KDT is an unexplored research fields that must receive urgent attention.

Prof. Anna Tagliabue
Dr. Bertoli Simona
Guest Editors

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