Trendy diets are doctor-prescribed treatment for some Iowa patients

Frankie Schneckloth/Little Village

It’s likely you’ve heard buzzwords like keto and paleo over the past few years. They’ve become somewhat of a cultural phenomenon, popularized in bestselling books and specialty food products. Flashy advertorials featuring celebrities and social media influencers proclaim that going keto changed their lives, helping them to “lose weight and feel more energized!”

What often gets lost behind headlines about trendy diets is the medical, or therapeutic, use of such diets to help treat specific health conditions. This is where taking a deeper dive and studying the history and science behind these eating styles is important. Adapting your diet to adhere to ketogenic or paleo principles is not meant for everyone, but many individuals have relied on therapeutic benefits of such diets over the past century in order to be able to live a safe and healthy life.

The origins of what we call keto today date back to the early 1920s when Dr. Russell Wilder of the Mayo Clinic coined the term “ketogenic diet.” He was the first to use ketogenic therapy to help treat epilepsy in children. Epilepsy is a neurological condition of the brain resulting in seizures; oftentimes, the cause of the seizures isn’t known, but may be related to genetics, brain injury, illness or abnormal brain development. The “classic” ketogenic diet involves a specially designed high-fat, low-carbohydrate diet that is prescribed by a doctor and monitored closely by a registered dietitian. More specifically, the diet usually has a 4:1 ratio of fat to carbohydrates and protein combined. Approximately 90 percent of calories come from fat, with 6 percent from protein and 4% from carbohydrates. For comparison purposes, a standard American diet contains about 45-65 percent of calories from carbohydrates. This classic ketogenic diet is still widely used today in children whose seizures have not responded to medication and requires careful measuring and weighing of all food and liquids consumed.

Locally, it’s prescribed at the University of Iowa Stead Family Children’s Hospital, which is home to Iowa’s only Level 4 epilepsy center with state-of-the-art technology and therapies to both diagnose and treat complex cases of epilepsy. Stephanie Borst, MS, RDN, LD, is the primary registered dietitian who oversees pediatric patients on the ketogenic diet at the hospital. Working alongside a team of neurologists, nurses and nurse practitioners, she sees children from infancy to adolescence.

“The youngest patients we’ve had to get started on the diet have been between four to five months of age,” said Borst. When asked how long patients typically stay on the diet, she reports, “We do say, at a minimum, to try it for three months. It may take a three-month trial period on the diet so that we can see if it is working for that patient. If it’s working to help control seizures, then most patients can plan to stay on it for at least two to three years.” Furthermore, “If the diet is working and the patient is not having any side effects, they may stay on it longer than two to three years.”

The goal of eating a ketogenic diet — characterized by a high fat and low carbohydrates — is to get the body into a state known as ketosis. Carbohydrates are our body’s primary source of energy. When you eat carb-rich foods, the body breaks them down into individual sugar molecules called glucose. The pancreas then releases insulin, a hormone that allows glucose to enter cells to provide you with energy. Any excess glucose is delivered to the liver and stored as glycogen. When the body is deprived of carbohydrates, insulin secretion is reduced and glycogen stores get depleted. During ketosis, instead of breaking down carbohydrates into glucose for fuel, the liver converts fat into ketone bodies, compounds that are formed when fat in your food or fat stored in your body is broken down. These ketones replace glucose as the body’s primary source of energy.

While following the keto diet, one can expect to eat fat from nuts, avocados, eggs, butter, cream, cheese, fatty fish, red meat, poultry and oils like extra virgin olive oil and coconut oil. Small amounts of non-starchy vegetables like leafy greens, bell peppers, tomatoes and celery are eaten while foods rich in carbohydrates, including grains, beans, fruit and starchy vegetables are excluded. Borst says that people often don’t realize just how much fat is needed on the diet.

“Looking at a meal that is 90 percent fat, you don’t really comprehend it until you visualize it.”

For general information and resources on epilepsy, Borst recommends checking out The Charlie Foundation. “They have pictures of meals and you can see that the meals are smaller in size because so much of the meal is fat and it doesn’t take up that much space. That is something I always talk to families about when switching from a general diet to a keto diet. They need to know that, yes, this meal is going to look smaller, but it’s not any less calories than what you’re used to.”

Variations of the keto diet began emerging in the 1970s. The Atkins diet, created in 1972 by Dr. Robert C. Atkins, is a low-carbohydrate diet plan but allows for more moderate protein intake and was developed as a weight reduction therapy. By the early 2000s, a mix between the Atkins diet and the classic ketogenic diet began to be studied at Johns Hopkins Hospital. Known as the Modified Atkins Diet (MAD), there are no restrictions on protein, fats are strongly encouraged and foods do not need to be measured or weighed, but carbohydrate intake is monitored to generally be less than 20 grams per day.

The MAD is helpful for families lacking the resources to adhere to a more restrictive keto diet. It is actively used in both adolescents and adults for seizure control, with studies showing it to be similar to the classic ketogenic diet in efficacy. Borst has done the MAD a handful of times herself.

“It helps me most because it gives me a full understanding of what my patients are going through,” she said. “As their dietitian, it helps me with some of those challenges for them like eating out and recipe and meal ideas. Every time I do it, I have a whole new understanding and new ideas for them because I’m trying new things myself.”

Beyond epilepsy, potential benefits of a ketogenic diet have been emerging for other health conditions. There are currently more than 70 trials underway or in the beginning stages looking at its impact on brain, cardiovascular and metabolic health. For individuals with Type 2 diabetes, adapting a very low carbohydrate diet may offer benefits in managing blood sugar and lowering A1C levels, with one review finding it may reduce or eliminate the need for medication.

The ketogenic diet has shown to induce rapid weight loss in patients with obesity. Initially, weight loss is mostly water weight because of the limited amount of carbohydrates in the diet, which hold onto water in the body. Further weight loss may be due to the satiety that comes with filling up with high-fat foods; research shows a keto diet may lead to fewer hunger pangs. Despite some findings that low carb diets may cause individuals to lose more weight compared to lower fat diets, there is a lack of long-term research that suggests a highly restrictive keto diet is better for weight loss than other diet plans. It’s also difficult to reach definitive answers on any diet because of the huge variations in how people’s bodies respond to different diets.

Illustrations by Glen Lowry

Accompanying keto in the headlines as of late has been the paleo diet. Often referred to as the “Caveman” or “Stone-Age” diet, the idea is that by eliminating modern highly processed foods, you can lose weight and avoid diabetes and heart disease. Basically, if a caveman didn’t eat it, you shouldn’t either. There is heavy debate about many aspects of the diet, such as the variation in diets depending on regions, what foods truly existed in these “caveman” times, and how today’s modern fruits and vegetables bear little resemblance to prehistoric wild produce.

Due to these differences, you’ll find many variations of the diet. Overall, it is high in protein and fiber, moderate in fat, low to moderate in carbohydrates and low in sodium and added refined sugars. It includes a lot of grass-fed beef, fruits and vegetables, olive oil and omega-3-rich fish, nuts and seeds. While there are some randomized controlled trials showing short-term benefits of weight loss, decreased blood pressure, improved cholesterol and increased insulin sensitivity, many of these studies were short in duration with a small group of participants.

The paleo diet has garnered further attention for its potential to help control symptoms of multiple sclerosis (MS), a disease impacting the brain and spinal cord, which make up the central nervous system. In MS, the immune system attacks myelin, the protective layer that surrounds nerves. This results in communication problems between the brain and the rest of the body. Duration and severity of symptoms vary from person to person, but may include fatigue, memory problems, numbness, impaired coordination, vision loss and/or paralysis.

There is currently no cure for MS, with many individuals seeking therapy through their diet. One version of the paleo diet that has specifically been looked at to help ease symptoms and flare-ups is the Wahls Protocol, also known as the Wahls diet. It was created by Dr. Terry Wahls, Clinical Professor of Medicine at the University of Iowa, who ultimately reduced her own MS symptoms dramatically with a nutrient-rich paleo-style diet, filled with vitamins, minerals, antioxidants and essential fatty acids. The Wahls Protocol encourages grass-fed beef, wild fish, vegetables (especially leafy greens), colorful berries and fat from animal and plant sources.

Another contrasting eating style some individuals with MS have claimed to help manage their symptoms is the Swank diet. Created by Dr. Roy Swank in the 1950s, it is low in fat, particularly saturated fat, and focuses on lean fish, fruits, vegetables, whole grains and nonfat dairy products. Recently, with the help of the National Multiple Sclerosis Society, Dr. Wahls and a team at the University of Iowa conducted a study comparing the two diets in MS treatment. Both diets ended up being associated with a significant reduction in fatigue and improved mental and physical quality of life, showing how important diet and lifestyle has the potential to be in managing a chronic disabling disease.

While the benefits of using food as therapy for various health conditions is promising, it is important that whenever you are considering making significant changes to your diet to consult with your doctor and a registered dietitian. Not all diets are appropriate for everybody. Given the highly restrictive nature of ketogenic diets, factors including nutrient deficiencies, past medical history, any past eating disorders, access to food and current medications must all be taken into consideration. Working with qualified medical professionals can help you come up with a plan that’s right for you.

Mo Nasr, Keto Master

Mo Nasr — Zak Neumann/Little Village

Speak with Mo Nasr for a few minutes and it’s plain to see he’s an exuberant and confident young man with a passion for helping others. For Nasr, owner of Keto Kitchen (116 E Washington St, Iowa City), adopting a ketogenic diet was a major turning point. After significant weight loss and a noticeable improvement in the myriad health issues he’d been plagued by for years, he’s on a mission to help others feel better, too.

“Growing up, I had really bad asthma and used an inhaler; it was hard to even make it up a flight of stairs. I was prediabetic and had food allergies. I was diagnosed with eczema. I was depressed. I was really, really overweight,” Nasr remembers. After a particularly discouraging period, Nasr said he gave up on any real change. He let his health go and saw his weight balloon.

Trendy fad diets are a dime a dozen, but after hearing success stories others had experienced with the keto diet, Nasr decided to look into it, mostly to see if he could debunk it. After months of research, he came to understand the science behind the principles and decided he wanted to try it himself.

Nasr followed a strict keto diet for three years and lost over 140 pounds, but he said there were other significant benefits aside from the dramatic weight loss. “After three months on the diet, I remember thinking, ‘My brain feels better!’ I was able to process and recall things more quickly. I was emotionally in control. I looked and felt better,” he said.

For Nasr, the high-fat, low-carbohydrate diet offered a solution to a very real problem. Rather than looking at it as a temporary fix, it quickly became a lifestyle for him, one he was eager to share with others. That’s his ultimate goal with Keto Kitchen: “How can I help as many people as possible feel well-fed, well-maintained and healthy?” Nasr asks.

His downtown Iowa City restaurant offers an assortment of low-carb substitutes for carb-heavy comfort foods that can be hard to give up when making the switch to keto, making it easier for those who are curious to get started. His wife Dani Rose is the creative force in the kitchen. Look for her low-carb lasagna loaded with vegetables, chicken tenders with a housemade “breading,” or breakfast sandwiches on almond flour toast. If you’re on the hunt for something to satisfy your sweet tooth, sample the cheesecake, cookies or chocolate waffles. Rest assured everything hits the macros and what the food lacks in carbohydrates, it more than makes up for in quality and flavor.

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