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Comment by ryukoposting | Hacker News Reader

One time, someone told my girlfriend she should try Keto to help with her Epilepsy. Maybe they were on to something, I guess.

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The Ketogenic diet is actually fully effective in many patients. Interestingly, its more commonly used as a "last resort" when patients don't respond to pharmaceutical interventions instead of a first line of treatment.

https://my.clevelandclinic.org/health/treatments/7156-ketoge...

That's terrible to hear that doctors would try pharmaceuticals before a relatively simple diet change.

I'm involved in many support forums.

A few patterns I've noticed.

The people who have been mostly managing their conditions via diet without understanding whats happening. Basically they eat healthy, and it mostly works.

People who love food / don't want to cook healthy and refuse to acknowledge the possibility that's causing problems.

People who say they eat healthy but really don't. (Salad once a week) Or a variation, people who ate a salad, didn't get better and claim diets don't work).

The ones who are at deaths door and are finally desperate enough to try anything.

Actually following a strict diet like KETO / AIP. Paying close attention to trigger foods, etc. These ones often can reduce or eliminate medication.

Learning to be honest with yourself about food is one of the major challenges. Giving up various food addictions can be brutal.

I suspect patients feel the same.

I think that happens because that is what most patients want. They don't want to give up pizza and alcohol. Give me a magic pill instead so I can do what I want.

Keto is not a simple diet change. It is very difficult to stick to and comes with a lot of prohibitions. Adherence is low and side effects do happen.

Keto worked for me only when I cut out carbs completely, I eventually switched to zero carb because it's easier to maintain. As long as I allowed myself anything carb, I'd got on a binge-frenzy, even with dairy... willpower is a terrible thing.

~zero carb is much easier to maintain than keeping track to stay under 15 Grams

yes!

I agree that on the surface, it sounds dreadful. The problem is that many doctors have found through experience that patient compliance with a daily pill is much better than with dietary changes. If a doctor wants to actually help a patient, the treatment that a patient will actually do becomes the most effective by default.

Having said that, I do think that doctors need to be aware of and make sure the alternatives are discussed with the patient. The paternal MD attitude of just tell the patient what they think the patient needs to hear should not be tolerated. If I ever get that vibe from a doc I move on and find someone who will respect me as a patient.

It's a last resort because adults can't reliably stick to the diet and doctors know it. People don't even stick to medication very well. It's really only prescribed in kids with severe forms of genetic epilepsy because it works well for those conditions, and their parents control what they eat. It's a lot easier to take a pill than to change your entire lifestyle.

Unfortunately, keto doesn't always control seizures either. Pills still work better than diet for some people.

Apparently it's helpful to more than epilepsy, from a study this month: https://www.psychologytoday.com/us/blog/diagnosis-diet/20220...

> Symptoms of depression and psychosis improved in all 28 patients who followed the diet for longer than two weeks, with improvements becoming noticeable within three weeks or less. 43% of patients achieved clinical remission, and 64% were discharged from the hospital on less psychiatric medication.

It's amazing that results were seen in just 3 weeks

Check out the LGIT (low glycemic index treatment), aka "the south beach diet". It's a more relaxed low-carb diet (80g/day), which has shown similar efficacy to keto for seizure control. It makes it much easier to feel somewhat normal at restaurants and the dinner table when out with people.

https://www.epilepsy.com/treatment/dietary-therapies/low-gly...

One interesting thing about these low-carb diet therapies is that they can result in long-term seizure control even after discontinuing the diet. They are worth trying imo. However, I'll personally attest to the fact that they are not a silver bullet.

Per this link.

https://charliefoundation.org/am-i-a-candidate/keto-for-epil...

"Ketogenic Therapies and brain surgery are the only known cures for Epilepsy. Half of the people with epilepsy who try the diet have a seizure reduction of at least 50%. Up to 25% become completely seizure free. In the sections below, we explain how Ketogenic Therapies compare to anti-epileptic medications, how keto’s mechanisms are thought to affect the body, and stories from a few of the thousands of families who have had amazing results by implementing keto for epilepsy."

I mean no harm no foul, I too have heard mostly anecdotal accounts of diet and various health conditions - migraines, allergies, ADHD, etc.

There's plenty of science out there but it's still early.

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