Talk:Ketogenic diet

Ketogenic diets in other applications

Look at the sources I added. They specifically describe ketogenic diets, not generic low carb. Steven Walling • talk 03:24, 8 August 2022 (UTC)

Not the medical ketogenic diet; the term has come to be used generically. Also, please see WP:FAOWN and discuss before reinstating content. SandyGeorgia (Talk) 03:26, 8 August 2022 (UTC)

So what article describes ketogenic diets in a non medical setting? There isn't one. Steven Walling • talk 03:26, 8 August 2022 (UTC)

I think there is, but Colin can better explain which is which. SandyGeorgia (Talk) 03:33, 8 August 2022 (UTC)

Actually, it's built in to the edit notice when you edit the page, but it's at the very bottom and probably gets missed very often.

This article is not about weight loss and body-building diets; it is about the physician-ordered medical nutrition therapy used to treat severe, refractory epilepsy in children by producing very high levels of ketone bodies. Non-medical diets that encourage moderate levels of ketone production are described in the article low-carbohydrate diet.

SandyGeorgia (Talk) 03:36, 8 August 2022 (UTC)

Your comment

Yeah for context, I added it because the scientific reviews--one of which is literally titled "Ketogenic low-CHO, high-fat diet: the future of elite endurance sport?"--are smart enough to discuss the difference between ketogenic and non-ketogenic LCHF diets and both have been studied fairly extensively. So the sources aren't about weight loss and body building, they're real science about other applications. Steven Walling • talk 03:38, 8 August 2022 (UTC)

Yes, but not this specific medical diet, which has to be used under strict medical supervision. Colin will explain better (or you can read through the article if you'd rather not wait for him to show up-- I'm off for the night!). SandyGeorgia (Talk) 03:44, 8 August 2022 (UTC)

Ok so then the title of the article needs to be changed, to something like "Ketogenic diet (medicine)" or "Ketogenic diets in medicine", because there is clearly scientific literature discussing real application of a ketogenic diet outside medicine, so the flat title is misleading. Just saying "ketogenic diet" is defined by Merriam-Webster as "a diet that supplies large amounts of fats, moderate amounts of proteins, and minimal amounts of carbohydrates and that is undertaken for weight loss or to control seizures in treatment-resistant epilepsy" so you can see how the generic title is deceptive. I understand wanting to keep medical information separate from weight loss fad info. Steven Walling • talk 04:07, 8 August 2022 (UTC)

There are rules about article titles, and for 100 years the dominant subject of "ketogenic diet" was as an epilepsy treatment mainly used in children. Recent years have shown a high interest in related diets for weight loss or sports in adults. There's not really a degree of overlap between those studying and writing about the former and the latter, hence Wikipedia handles them in separate articles too. The "other uses" section exists because (usually neurologists) writing about the KD in epilepsy do briefly note the research into that diet for other neurological disorders. Hence it has WP:WEIGHT here. There isn't really any literature-weight to suggest that when writing about an epilepsy diet, authors also digress into the latest research on sports nutrition or on weight loss.

You and I can see an overlap, but I can also see an overlap between a saline drip and my gran's salty chicken and leek soup. Both will provide the body salt and water nutrients, but the former needs to be sterile and is used in sick people, and the latter merely warmed up and served to anyone. -- Colin°^Talk 10:35, 8 August 2022 (UTC)

We are writing for here and now, not for 100 years ago. Wikipedia is not just an encyclopedia for doctors or people with medical conditions, and the English dictionary disagrees with your definition of scope of the term. Steven Walling • talk 15:41, 8 August 2022 (UTC)

Our encyclopaedia articles are not written such that they cover all possible meanings of a term in one article. I suggest you read some of the MOS about article titles and scope. The content of articles is determined by what reliable sources write about, not by dictionary definitions, and reliable sources do not make a habit of writing about epilepsy treatments and sports nutrition at the same time.

The point about 100 years is that there is a body of literature on the ketogenic diet for epilepsy that is huge and has endured and is still very much relevant. This isn't a historical treatment.

I accept that some readers will encounter this article while expecting to read about weight loss or sports diets. That is not a unique problem, and I guess most people searching about "Apple" are interested in the tech company, not the fruit. We can't please everyone. There's more discussion about this in the archives. -- Colin°^Talk 18:08, 8 August 2022 (UTC)

The preponderance of reliable source material most definitely does not justify zero coverage of non-medical diet interventions on the main article about ketogenic diets. Even just this one narrative review from 2020 in the Journal of Physiology notes that there is over 40 years of peer-reviewed research on the topic of ketogenic diets in sports nutrition. WP:TITLE clearly states that "The title indicates what the article is about and distinguishes it from other articles" so when there are decades of peer-reviewed studies (not to mention lay literature) with the term "ketogenic diet" in reference to non-medical interventions your argument for zero coverage doesn't hold water, unless the article is titled specifically in reference to medical treatment. Steven Walling • talk 18:43, 8 August 2022 (UTC)

You aren't looking at the right thing. There are 46 years of literature about Apple Inc. and yet weirdly there is zero coverage (beyond the hatnote) of computers and mobile phones in our apple article. This is because when reliable sources write about round fruit, they don't write paragraphs about little black rectangles with rounded corners. It isn't the quantity of articles that counts, but the fact that they are independent of each other.

If you think there is merit in expanding this article to discuss all diets that are wholly or partly ketogenic, and used for any purpose in any population group, then we need to know the literature that actually does that? This would be literature that thinks there is a core subject of "ketogenic diet" that is worth talking about in all its various forms. The closest I've found is Ketogenic Diet and Metabolic Therapies: Expanded Roles in Health and Disease which spends 9 pages out of 408 talking about sports nutrition (and 13 pages on diabetes). The rest is neurology and nearly all of that epilepsy. That's one book. Pretty much everything else I've seen is solely neurological with anything other than epilepsy as a briefly mentioned research matter, or similarly focused on sports or on weight loss or life extension or recipes or whatever.

Merging topics that the reliable sources keep distinct is bad for many reasons but a big one is original research. It makes it too likely that we'd claim something was true of "ketogenic diets" but in fact was only true of one kind of ketogenic diet in one kind of population group.

Currently, this article is not the "main topic" on ketogenic diet because the literature does not support the idea of there being a main topic. -- Colin°^Talk 20:45, 8 August 2022 (UTC)

"Currently, this article is not the "main topic" on ketogenic diet because the literature does not support the idea of there being a main topic" Right, which is why this should be specifically titled to refer to "(medicine)" or "in medicine" and then have a "Ketogenic and low carbohydrate diets" article about non-medical applications. I agree the split makes sense, but what doesn't is the current article title that reads like it's generic. Steven Walling • talk 03:10, 9 August 2022 (UTC)

We do not always add qualifiers after an article title just because there are subjects that could be in scope for that title. Please read the MOS on this. There is a reason apple (fruit) or Houston, Texas are redirects. Neither are the "main topic" on all things named "apple" or all dwellings called "Houston". -- Colin°^Talk 07:20, 9 August 2022 (UTC)

You don't need a qualifier for apple because the scope of the article matches the general understanding of the term. That's not the case here. The scope of the article is a specific medical application that's covered a lot in medical literature and isn't actually the commonly understood definition. Steven Walling • talk 08:29, 9 August 2022 (UTC)

And what do you think is the "commonly understood definition"? Could we write an article for that? Perhaps your view is influenced by how you got here (diets for exercise). See Wikipedia:Disambiguation. There isn't an algorithm for this. All choices have costs and benefits. While adding a qualifier to the name might appeal to your desire for precision, it has a cost in terms of searching and linking to this page, and it isn't like we have significant alternative articles like "ketogenic diet (sports medicine)" or "ketogenic diet (weight loss)" or "ketogenic diet (wellness fad)" to link to. We do have Keto diet that is a DAB page and uses a common short form of the name, and despite all the interest in directing readers towards content about sports or weight loss uses of a "ketogenic diet", we don't have any significant content that has been written about it. I wonder why. -- Colin°^Talk 10:01, 9 August 2022 (UTC)

The commonly defined meaning in sources is clearly "a diet that produces ketones" and there are various reasons why an individual would adhere to the diet. It's only your obsession with a focus on the medical application that excludes 100% of other ketogenic diet applications, not the source material. Steven Walling • talk 05:55, 10 August 2022 (UTC)

Perhaps revisit that remark ? SandyGeorgia (Talk) 07:17, 10 August 2022 (UTC)

I wonder if at this point we are going round in circles. The "source material" does not cover all diets that produce ketones. Each source covers one aspect of the diet, that those authors are "obsessed" about, not me. If there were books and books and articles and articles that each covered "a diet that produces ketones" as a whole topic and comprehensively discussed contrasted and compared all the different uses of such diets then sure, ketogenic diet could mirror that. But there aren't and so we don't. -- Colin°^Talk 07:58, 10 August 2022 (UTC)

A literature search for reliable sources on "ketogenic diet" overwhelmingly returns articles on epilepsy and the conditions listed in the article under the heading "Other medical applications".[1] There is little of value to a featured article on "other applications". We can only write what can be verified by reliable sources. Until sources are found, which I doubt exist, there is indeed no point in "going round in circles", in my view. Graham Beards (talk) 08:28, 10 August 2022 (UTC)

I'm a little confused by this. "Ketogenic diet (medical treatment for epilepsy)" and "Ketogenic diet (weight-loss intervention)" are the same actual diet, are they not? By contrast, "Apple (company)" and "Apple (fruit)" are completely different things. Or are they two different diets?

If they are the same food recommendations, then they are the same thing and surely belong in the same article? On the other hand, if they are different sets of food recommendations, then fair enough, they're not the same diet. —Ashley Y 05:52, 8 January 2023 (UTC)

Ashley Y, there's some info in the FAQ at the top of the talk page. Yes they are more closely related than those two examples. They have some things in common but while both might seek very few carbs, they vary a lot on protein, which is typically high on a weight loss or body-builder diet (to make you feel full and slow release energy, or to build muscle) but set only at a "necessary for growth" level for the epilepsy diet. And clearly on one, the purpose is weight loss (or muscle gain) in a fully developed body, whereas on the the other, which is typically used in children, the aim is normal growth and the weight gain that goes with that. The biggest issue which keeps the articles from merging is that our sources do not (other than as an aside) talk about them together. So all the stuff here about how the diet is started, monitored, side effects, health benefits, are very much only drawn from medical practice and research on epilepsy diets. If we combined in the weight loss and body building (of which there are numerous variants) then we'd find it very hard to not mislead the reader in thinking some fact applied to that but which we only really know applies to very sick children with epilepsy. WP:SYNTH. -- Colin°^Talk 12:47, 8 January 2023 (UTC)

Infobox

Ketogenic diet
Testing for ketone bodies in urine
Pronunciation	/ˌkiːtəʊˈd͡ʒɛnɪk/
Specialty	Neurology, endocrinology
Uses	Refractory paediatric epilepsy
Complications	Stunted growth, bone fractures, kidney stones, constipation, dyslipidemia, dysmenorrhea, low-grade acidosis
Approach	Dietary intervention
Outcomes	Seizure reduction

I haven't found any previous discussions about adding an infobox in the archives. This is the only FA-class disease or therapy article connected to WikiProject Medicine that doesn't have an infobox, which makes it a bit unusual. On the other hand, there's no rule requiring one. Do we want an infobox at the top of this article? It could look something like this. WhatamIdoing (talk) 17:42, 30 April 2023 (UTC)

I think when the article was developed, many medical infoboxes looked like the one at Hepatorenal syndrome: a list of codes only a medical professional would care about (on a project no medical professional should trust to get codes from) and all external links. I'm not sure what the above example is offering the general reader. It is such a primary region of the article, I'm loathe to distract the reader with stuff that isn't jump-out-at-you vital and easy to describe. Our lead sentence is more lay-friendly than "Refractory paediatric epilepsy" and if you know what epilepsy is, then the outcome should be obvious. We know it is a dietary intervention from the article title and lead sentence already. The "complications" are listed in a take-it-or-leave-it form, rather than explaining their frequency or degree of seriousness. One might imagine stunted-growth could be dwarfism but is more subtle than that (and may resolve when the child comes off the diet). Btw, Water fluoridation doesn't have one either, though whether that is a medical therapy is up for debate. -- Colin°^Talk 13:10, 2 May 2023 (UTC)

You are correct about the history of the infobox. I don't feel strongly either way myself. It's normal for disease articles to have an infobox, but it's not required.

I don't think that infoboxes need to contain solely vital information. The contents I've mocked up here are just an example. A lot of them have little more than the specialty identified. I think, for this article, that the "Uses" line might help reinforce the not-about-the-fad-diet theme (as could the "Complications" list). WhatamIdoing (talk) 14:55, 4 May 2023 (UTC)

Yes, I thought the same about the "Uses". Graham Beards (talk) 17:22, 4 May 2023 (UTC)

The "not-about-the-fad-diet" is only really a problem with editors. Readers already get a hat note and the lead sentence is pretty clear what the topic is. And we have a FAQ for the editors, should any of them care to read it. I'm not keen to have either medical jargon (uses) or a frightening list of complications just to scare off the health fad folk and say "this is a serious medical intervention for a serious medical condition".

I think that we have done everything we can to highlight to readers and editors what the scope is, without distracting readers who want to learn about this medical intervention. What we know is that editors who want this article to be about the fad diet, don't and won't care what the article says or what we write in a faq, because they either don't read it or think it is wrong. -- Colin°^Talk 07:29, 5 May 2023 (UTC)

Do you think that infoboxes are distracting? WhatamIdoing (talk) 00:19, 6 May 2023 (UTC)

You didn't ask me, but, yes. SandyGeorgia (Talk) 00:33, 6 May 2023 (UTC)

Yes but distraction isn't always bad, if the content is worth grabbing someone's attention for. Magazines frequently publish pictures and captions to grab a reader's attention and draw them to consider reading the body text. I can't think of any other publication aimed at general readers that would squander the real-estate at the top of the article to include a list of jargon terms and medical codes. -- Colin°^Talk 19:05, 8 May 2023 (UTC)

First umbrella review published

The first umbrella review of 68 randomized clinical trials on the effects of the ketogenic diet has been published. The results of high-quality evidence were a reduction in seizure frequency, triglycerides and a significant increase in low-density lipoprotein cholesterol. Moderate-quality evidence included a decrease in weight and an increase in total cholesterol. If the review is to be cited it would be worth citing the high-quality results. There is no long-term clinical data because the trials were between 8weeks and 9 months. But these findings suggest that the ketogenic diet is not heart healthy long-term, as they raise LDL-c and total cholesterol which will increase the risk of cardiovascular disease and events. Here is a link to the paper [2], in full [3]. High-quality evidence supports a reduction in seizure frequency but this is already stated on the article. If anyone wants to add this umbrella review to the article please add it. I wouldn't say there is anything new here that we did not know already but this is the biggest review to date that has looked at 68 trials. Psychologist Guy (talk) 11:05, 22 June 2023 (UTC)

Not fad diet

Ketogenic diet is not a fad diet. So the link to Fad diet in the "See also" section should be removed. CometVolcano (talk) 07:20, 13 January 2024 (UTC)

It is outside of epilepsy treatment. See also sections are for tangential topics, they are not categorizations. Bon courage (talk) 07:38, 13 January 2024 (UTC)

I've removed it. While diets that are (somewhat) ketogenic can be fad diets, those are covered in other articles, not this one. It is rather odd for someone to get to the bottom of a medical therapy article and be given a link to "fad diet" as though that was relevant to this topic. -- Colin°^Talk 22:37, 13 January 2024 (UTC)

harms or dietary intolerance in young children

This edit by User:FULBERT added the text "while harms or dietary intolerance in young children were rarely reported in the literature." The relevant text I can find in the source (Pharmacologic and Dietary Treatments for Epilepsies in Children Aged 1–36 Months) is "Dietary harms were not well-reported." There is a section in the source called "Harms of Dietary Treatments" It discusses four trials that report various harms along with their other findings. It isn't clear what led them to conclude "Harms of diets were rarely reported, so we drew no conclusions about harms or dietary intolerance." Possibly the wide range of occurrence reported, type of side-effect or lack of specifics of side effects mean they were unable to draw conclusions. But I think the text added to our article suggests harm or intolerance is rarely reported because it rarely occurs, rather than that details of harm or intolerance are rarely adequately collected during studies. Often there is just a non-specific rate of drop-out without going into details of why. The review is critical of current studies in this population group ("the lack of reporting on treatment outcomes beyond seizure frequency"). I would be surprised if the infant population was significantly better at tolerating this diet compared to slightly older children.

My conclusion is this is a review critical of the lack of knowledge in this field (epilepsy treatment of very young children) and a comment that they so lack information in one aspect (harm caused by diet) they can't draw any conclusions is probably not encyclopaedically relevant to this article. We certainly shouldn't give the impression that side-effects or harm is rare in infants, because it doesn't say that. If you agree, I'll remove the sentence. Perhaps there is something else we can draw from this source? -- Colin°^Talk 08:29, 1 March 2024 (UTC)