For this month’s KetoNews, I requested Dr. Eva Catenaccio from Johns Hopkins College College of Drugs to summarize her current paper revealed in Pediatric Neurology. Dr. Catenaccio is presently finishing her coaching as a baby neurologist at Johns Hopkins College. She shall be beginning epilepsy fellowship on the Kids’s Hospital of Philadelphia in July. – Eric Kossoff
The ketogenic diet is having fun with a interval of immense reputation, each inside the medical group and with most of the people. Its advantages have been confirmed in epilepsy, and are being explored in diabetes, most cancers, and Alzheimer’s illness. It has obtained celeb endorsements and there was an explosion of “keto” merchandise in the marketplace. However this isn’t the primary time the ketogenic food plan has been #trending. As we strategy its 100-year anniversary, many people within the subject have gone again in time to take a look at its superb historical past…and located some surprises!
How was the ketogenic food plan found?
Within the early 1900s, some docs have been utilizing fasting to control seizures. However fasting solely labored to scale back seizures for so long as a person might go with out consuming. Then, a pioneering endocrinologist from the Mayo Clinic in Rochester, Minnesota questioned if the identical advantages might doubtlessly be achieved by utilizing a high-fat food plan that triggered ketosis the identical manner fasting did. Ketosis happens when the physique doesn’t have sugar (glucose) available and as a substitute metabolizes fat into ketone our bodies for vitality.
And it turned out the ketogenic food plan labored! Pediatricians on the Mayo Clinic, Harvard College, and the Johns Hopkins Hospital began utilizing the ketogenic food plan to deal with youngsters and adults with epilepsy with promising outcomes.
The hospitals who performed a job within the historical past of the ketogenic food plan (all photos are within the public area):
The Johns Hopkins Hospital (1900)
The Mayo Clinic (St. Mary’s Hospital) (1910)
Massachusetts Normal Hospital (1941)
So, why did the ketogenic food plan fall out of favor?
The standard story is that docs misplaced curiosity within the ketogenic food plan due to the invention of medications to prevent seizures, beginning with phenytoin in 1938 and valproic acid in 1967. Why would anyone wish to stick with a strict food plan once they might simply take a tablet? However, when my co-authors, Drs. Pinto and Bergin (Harvard), Dr. Kossoff (Hopkins) and Dr. Nickels (Mayo Clinic) and I began digging again by the scientific literature, we realized that there could be one other, extra difficult, rationalization…
It seems that a number of the early researchers of the ketogenic food plan within the Nineteen Twenties weren’t collaborating and weren’t mentoring youthful colleagues in the usage of the food plan. They tended to publish papers as sole authors and didn’t refer to one another’s work throughout establishments. One physician revealed over ten papers on the ketogenic food plan, however didn’t publish a single one with a co-author. When the docs who found the ketogenic food plan retired, handed away, or began researching different subjects (together with one who went on to check urinary tract infections!), there weren’t different docs educated to manage the food plan who might take over. Along with the rise of anti-seizure drugs, the absence of collaboration and mentorship we consider seemingly contributed to the lack of curiosity within the ketogenic food plan worldwide by neurologists and hospitals. This all occurred within the early Nineteen Forties, earlier than most of the newer antiseizure medicine have been out there.
How did the ketogenic food plan make a come-back?
Even through the “darkish ages” of the ketogenic food plan, physicians on the Johns Hopkins Hospital have been nonetheless utilizing it to deal with a small variety of sufferers yearly. Nevertheless it took the efforts of a really motivated household to push the ketogenic food plan again into the highlight. Jim Abrahams, a distinguished film producer, had a son, Charlie, who suffered from extreme epilepsy. Whereas researching remedies, he got here throughout a e-book written by the group at Hopkins, inspiring him to hunt out the ketogenic food plan as a therapy for Charlie. After beginning the ketogenic food plan, Charlie by no means had one other seizure and was finally in a position to cease all his anti-seizure drugs. The Abrahams household subsequently based the Charlie Foundation in 1994 to unfold consciousness in regards to the ketogenic food plan as a therapy of epilepsy. The Charlie Basis and different guardian charities like Matthew’s Associates have helped fund collaborative analysis, group trainings, multi-center research, and worldwide conferences.
What can we study from the rise, fall, and rebirth of the ketogenic food plan?
For the reason that 1990’s the usage of the ketogenic food plan has expanded dramatically. However this time docs, researchers, and sufferers and households are working collectively. Researchers are coordinating research throughout many various hospitals and universities. Younger docs, like me, are being educated in how and why to manage the ketogenic food plan. Sufferers and households are sharing data and expertise by on-line teams and foundations. Collaboration and mentorship are essential to make sure the ketogenic food plan doesn’t disappear once more. These efforts additionally resulting in discoveries of how the ketogenic food plan can assist people with quite a lot of completely different neurologic situations.
As we strategy the a hundredth anniversary of the ketogenic food plan’s creation this yr, I hope the ketogenic food plan group will preserve collaborating to boost consciousness, fund analysis, and produce collectively the perfect minds to struggle for the well being of kids with epilepsy.
Catenaccio E, Bergin AM, Pinto AL, Nickels KC, Kossoff EH. The position of mentorship and collaboration within the fall and rebirth of the ketogenic food plan. Pediatr Neurol 2021;119:11-14.