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Ketogenic diet
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The ketogenic diet is a high-fat, medium protein, low [[carbohydrate]] diet primarily used for children with treatment-resistant [[epilepsy]]. It induces [[ketosis]], a metabolic state in which the body derives most of its energy from [[ketones]] rather than [[glucose]]. A ketogenic diet increases blood ketone bodies: β-hydroxybutyrate, acetoacetate, and acetone. β-hydroxybutyrate comprises 70% of the ketone bodies produced from a ketogenic diet<ref>{{Cite journal | last = Dedkova | first = Elena N. | last2 = Blatter | first2 = Lothar A.| date = 2014 | title = Role of β-hydroxybutyrate, its polymer poly-β-hydroxybutyrate and inorganic polyphosphate in mammalian health and disease | url = https://www.ncbi.nlm.nih.gov/pubmed/25101001|journal=Frontiers in Physiology|volume=5|pages=260|doi=10.3389/fphys.2014.00260|issn=1664-042X|pmc=4102118|pmid=25101001}}</ref>. The therapeutic benefits of a ketogenic diet are believed to be due to β-hydroxybutyrate which acts as a signalling molecule.<ref name=":2">{{Cite journal | last = Achanta | first = Lavanya B. | last2 = Rae | first2 = Caroline D. | date = Jan 2017 | title = β-Hydroxybutyrate in the Brain: One Molecule, Multiple Mechanisms | url = https://www.ncbi.nlm.nih.gov/pubmed/27826689/|journal=Neurochemical Research|volume=42|issue=1 | pages = 35–49|doi=10.1007/s11064-016-2099-2|issn=1573-6903|pmid=27826689}}</ref> Ketone bodies are a more efficient fuel than glucose. The brain can derive up to 60% of energy from ketones. The metabolic breakdown of ketone bodies produces more ATP per oxygen molecule consumed than other metabolic substrates. The ketone body β-hydroxybutyrate is converted to acetyl-CoA and distributed to metabolically active tissues as a fuel source (e.g. brain, skeletal muscle, heart). This acetyl-CoA is cycled directly into the Kreb’s cycle for energy production thereby bypassing glycolysis and [[Pyruvate dehydrogenase|pyruvate dehydrogenase (PDH)]].<ref>{{Cite journal | last = Achanta | first = Lavanya B. | last2 = Rae | first2 = Caroline D. | date = Jan 2017 | title = β-Hydroxybutyrate in the Brain: One Molecule, Multiple Mechanisms | url = https://www.ncbi.nlm.nih.gov/pubmed/27826689/|journal=Neurochemical Research|volume=42|issue=1 | pages = 35–49|doi=10.1007/s11064-016-2099-2|issn=1573-6903|pmid=27826689}}</ref> Ketones may enhance antioxidant defenses by multiple mechanisms. β-hydroxybutyrate promotes transcription of genes associated with protective mechanisms including mitochondrial superoxide dismutase (MnSOD), catalase, and metallothionein. The effect is therefore reduced oxidative stress and lipid peroxidation. β-hydroxybutyrate upregulates production of the antioxidant [[glutathione]] likely through activation of the nrf2 pathway.<ref>{{Cite journal | last = Gross | first = Elena C. | last2 = Klement | first2 = Rainer J. | last3 = Schoenen | first3 = Jean | last4 = D’Agostino | first4 = Dominic P. | last5 = Fischer | first5 = Dirk | date = 2019-04-10 | title = Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention | url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520671/|journal=Nutrients|volume=11|issue=4|doi=10.3390/nu11040811|issn=2072-6643|pmc=6520671|pmid=30974836}}</ref> == Types of Ketogenic Diets == A ketogenic diet is comprised of a dietary fat to carbohydrate ratio of 3:1 or 4:1. The diet should include <20 grams of carbohydrate per day, or 15-10% of total caloric intake. Ketogenic diets can be less strict if using exogenous ketones.<ref>{{Cite journal | last = Hashim | first = Sami A. | last2 = VanItallie | first2 = Theodore B. | date = Sep 2014 | title = Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester |url =https://www.ncbi.nlm.nih.gov/pubmed/24598140|journal=Journal of Lipid Research|volume=55|issue=9|pages=1818–1826|doi=10.1194/jlr.R046599|issn=1539-7262|pmc=4617348|pmid=24598140}}</ref> == Evidence for a ketogenic diet == === General Effects === In an animal model, a ketogenic diet was shown to increase [[Mitochondrion|mitochondria]]l biogenesis.<ref name="RhoJM2007" /> A similar result was found in a study of fasting mice.<ref name="Cerqueira2011" /> Ketone bodies scavenge free radicals ''in vivo''.<ref>{{Cite journal | last = Haces | first = María L. | last2 = Hernández-Fonseca | first2 = Karla | last3 = Medina-Campos | first3 = Omar N. | last4 = Montiel | first4 = Teresa | last5 = Pedraza-Chaverri | first5 = José | last6 = Massieu | first6 = Lourdes | date = May 2008 | title = Antioxidant capacity contributes to protection of ketone bodies against oxidative damage induced during hypoglycemic conditions | url = https://www.ncbi.nlm.nih.gov/pubmed/18339375|journal=Experimental Neurology|volume=211|issue=1 | pages = 85–96|doi=10.1016/j.expneurol.2007.12.029|issn=0014-4886|pmid=18339375}}</ref> Ketogenic diets reduce circulating levels of insulin and insulin-like growth factors.<ref name=":0" /> Acute nutritional ketosis is shown to reduce lactate production and improve performance potential in cycling activity. It is shown to prevent muscle wasting.<ref>{{Cite journal | last = Cavaleri | first = Franco | last2 = Bashar | first2 = Emran | date = 2018-04-01 | title = Potential Synergies of β-Hydroxybutyrate and Butyrate on the Modulation of Metabolism, Inflammation, Cognition, and General Health | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902005/|journal=Journal of Nutrition and Metabolism|volume=|doi=10.1155/2018/7195760|issn=2090-0724|pmc=5902005|pmid=29805804}}</ref> === Epilepsy === [[Neurotransmitter]]s regulate nerve impulses in the brain by either inhibiting impulse firing or exciting the [[neuron]] to fire. A primary inhibitory neurotransmitters is [[GABA]] and a primary excitatory neurotransmitters is [[glutamate]]. In patients with epilepsy, if the normal balance of inhibition and excitation is disrupted, a seizure can occur. It is unknown why ketogenic diets are protective against epilepsy. In animal models, the ketone bodies [[acetoacetate]] and [[acetone]] have anticonvulsant properties through a novel pathway.<ref name="Hartman2007" /> The Charlie Foundation supports the use of ketogenic diets with children with severe epilepsy.<ref name="CharlieFoundation" /> === Neurodegenerative Disease === There is evidence from uncontrolled clinical trials and animal models that ketogenic diets may be protective in neurodegenerative disorders including [[Alzheimer's|Alzheimer's disease]] and [[Parkinson's disease]].<ref name="Gasior2006" /> Mice fed a ketogenic diet had increased activity of [[dopamine]]rgic neurons.<ref name="ChurchWH2014" /> In a rat model of Parkinson's, a ketogenic diet was protective against neurotoxicity by up-regulating glutathione.<ref name="ChengB2009" /> A clinical trial of Parkinson’s disease compared a ketogenic diet to a low-fat diet with improvement in motor symptoms in both groups after 8 weeks but greater improvement in non-motor symptoms (fatigue, pain, and cognitive impairment) in the ketogenic group. <ref>{{Cite journal | last = Phillips | first = Matthew C.L. | last2 = Murtagh | first2 = Deborah K.J. | last3 = Gilbertson | first3 = Linda J. | last4 = Asztely | first4 = Fredrik J.S. | last5 = Lynch | first5 = Christopher D.P. | date = Aug 2018 | title = Low-fat versus ketogenic diet in Parkinson's disease: A pilot randomized controlled trial | url = https://www.ncbi.nlm.nih.gov/pubmed/30098269/|journal=Movement Disorders: Official Journal of the Movement Disorder Society|volume=33|issue=8|pages=1306–1314|doi=10.1002/mds.27390|issn=1531-8257|pmc=6175383|pmid=30098269}}</ref> Another study found dietary ketosis enhanced memory in patients with mild cognitive impairment.<ref name="Krikorian2012" /> ===Traumatic Brain Injury (TBI) === The ketogenic diet is an effective treatment for TBI recovery in rats and shows potential in humans.<ref>{{Cite journal | last = McDougall | first = Alexandre | last2 = Bayley | first2 = Mark | last3 = Munce | first3 = Sarah Ep | date = 2018 | title = The ketogenic diet as a treatment for traumatic brain injury: a scoping review | url =https://www.ncbi.nlm.nih.gov/pubmed/29359959|journal=Brain Injury|volume=32|issue=4 | pages = 416–422|doi=10.1080/02699052.2018.1429025|issn=1362-301X|pmid=29359959}}</ref> === Migraine === A study of 96 migraine patients on a 1-month ketogenic diet experienced up to 80% fewer migraines, less severity, and less reliance on medications.<ref>{{Cite journal | last = Di Lorenzo | first = C. | last2 = Coppola | first2 = G. | last3 = Sirianni | first3 = G. | last4 = Di Lorenzo | first4 = G. | last5 = Bracaglia | first5 = M. | last6 = Di Lenola | first6 = D. | last7 = Siracusano | first7 = A. | last8 = Rossi | first8 = P. | last9 = Pierelli | first9 = F. | date = Jan 2015 | title = Migraine improvement during short lasting ketogenesis: a proof-of-concept study | url = https://www.ncbi.nlm.nih.gov/pubmed/25156013|journal=European Journal of Neurology|volume=22|issue=1|pages=170–177|doi=10.1111/ene.12550|issn=1468-1331|pmid=25156013}}</ref> === Multiple Sclerosis === A ketogenic diet reduced the expression of enzymes involved in the biosynthesis of pro-inflammatory eicosanoids and improved quality of life as measured by the Multiple Sclerosis Quality of Life-54 index.<ref>{{Cite journal | last = Bock | first = Markus | last2 = Karber | first2 = Mirjam | last3 = Kuhn | first3 = Hartmut | date = 2018-10-03 | title = Ketogenic diets attenuate cyclooxygenase and lipoxygenase gene expression in multiple sclerosis | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6197715/|journal=EBioMedicine|volume=36|pages=293–303|doi=10.1016/j.ebiom.2018.08.057|issn=2352-3964|pmc=6197715|pmid=30292675}}</ref> === Chronic Fatigue Syndrome === No studies have been done on the effects of ketogenic diets in [[Chronic fatigue syndrome]]. Some CFS clinicians recommend ketogenic diets as a management strategy<ref name="Myhillketo1" /><ref name="Craig20150325" /> citing [[Mitochondrion|mitochondria]]l dysfunction<ref name="Myhill2009" />, [[immune system|immune]] dysfunction, and [[neuroinflammation]] as pathways through which ketogenic diets could confer some benefit. ==Risks & Side Effects== *The ketogenic diet was found to regulate [[Glucose|blood sugar]] but over the long term cause fat to accumulate in the [[liver]] in an animal model of Type II [[Diabetes]].<ref name="ZhangX2016" /> An open label, non-randomized, controlled study of the ketogenic diet in Type II Diabetes patients showed sustained long-term beneficial effects on multiple clinical markers of diabetes and cardiometabolic health at 2 years while utilizing less medication.<ref name=":0">{{Cite journal | last = Athinarayanan | first = Shaminie J. | last2 = Adams | first2 = Rebecca N. | last3 = Hallberg | first3 = Sarah J. | last4 = McKenzie | first4 = Amy L. | last5 = Bhanpuri | first5 = Nasir H. | last6 = Campbell | first6 = Wayne W. | last7 = Volek | first7 = Jeff S. | last8 = Phinney | first8 = Stephen D. | last9 = McCarter | first9 = James P. | date = 2019 | title=Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial | url = https://www.ncbi.nlm.nih.gov/pubmed/31231311|journal=Frontiers in Endocrinology|volume=10 | pages = 348|doi=10.3389/fendo.2019.00348|issn=1664-2392|pmc=6561315|pmid=31231311}}</ref> *Two children on the diet for [[refractory epilepsy]] had [[selenium]] deficiency which resulted in sudden cardiac death.<ref>[http://www.pedneur.com/article/S0887-8994(08)00399-8/abstract?cc=y= Sudden Cardiac Death in Association With the Ketogenic Diet - Pediatric Neurology - December 2008]</ref> *Up to 6% of those on a ketogenic diet may experience kidney stones.<ref name=":1">{{Cite journal | last = Hartman | first = Adam L. | last2 = Vining | first2 = Eileen P.G. | date = Jan 2007 | title = Clinical aspects of the ketogenic diet | url = https://www.ncbi.nlm.nih.gov/pubmed/17241206|journal=Epilepsia|volume=48|issue=1 | pages = 31–42|doi=10.1111/j.1528-1167.2007.00914.x|issn=0013-9580|pmid=17241206}}</ref> *Ketogenic diets may require additional supplemental nutrition to prevent deficiencies. Common deficiencies include calcium, zinc, selenium, and copper.<ref name=":1" /> *Ketogenic diets are not recommended for those with genetic primary carnitine deficiencies [including mutations in carnitine palmitoyl transferase (CPT) I or II and mitochondrial translocase] and fatty acid β-oxidation abnormalities (e.g., medium-chain acyl dehydrogenase deficiency). <ref>{{Cite journal | last = Stafstrom | first = Carl E. | last2 = Rho | first2 = Jong M. | date = 2012-04-09 | title = The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321471/|journal=Frontiers in Pharmacology|volume=3|doi=10.3389/fphar.2012.00059|issn=1663-9812|pmc=3321471|pmid=22509165}}</ref> It is safe for those with mitochondrial defects in complexes I, II, and IV<ref>{{Cite journal | last = Kang | first = Hoon-Chul | last2 = Lee | first2 = Young-Mock | last3 = Kim | first3 = Heung Dong | last4 = Lee | first4 = Joon Soo | last5 = Slama | first5 = Abdelhamid | date = Jan 2007 | title = Safe and effective use of the ketogenic diet in children with epilepsy and mitochondrial respiratory chain complex defects | url = https://www.ncbi.nlm.nih.gov/pubmed/17241212|journal=Epilepsia|volume=48|issue=1 | pages = 82–88|doi=10.1111/j.1528-1167.2006.00906.x|issn=0013-9580|pmid=17241212}}</ref> and pyruvate dehydrogenase complex deficiency.<ref>{{Cite journal | last = Sofou | first = Kalliopi | last2 = Dahlin | first2 = Maria | last3 = Hallböök | first3 = Tove | last4 = Lindefeldt | first4 = Marie | last5 = Viggedal | first5 = Gerd | last6 = Darin | first6 = Niklas | date = 2017 | title=Ketogenic diet in pyruvate dehydrogenase complex deficiency: short- and long-term outcomes | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306430/|journal=Journal of Inherited Metabolic Disease|volume=40|issue=2|pages=237–245|doi=10.1007/s10545-016-0011-5|issn=0141-8955|pmc=5306430|pmid=28101805}}</ref> == Notable studies == *[https://clinicaltrials.gov/ct2/show/NCT01906398 Efficacy and Safety of Ketogenic Diet as Adjunctive Treatment in Adults With Refractory Epilepsy (KD)] (This study is ongoing, but not recruiting participants.) *[https://www.frontiersin.org/articles/10.3389/fendo.2019.00348/full Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial.] *2019, Potential benefits of a ketogenic diet to improve response and recovery from physical exertion in people with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A feasibility study<ref>{{Cite journal | last = Cossington | first = Jo | author-link = | last2 = Coe | first2 = Shelly | authorlink2 = | last3 = Liu | first3 = Yaomeng | authorlink3 = | last4 = Dawes | first4 = Helen | authorlink4 = | date = Nov 2019 | title = Potential benefits of a ketogenic diet to improve response and recovery from physical exertion in people with Myalgic encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): A feasibility study | url = http://www.sportscienceresearch.com/IJSEHR_201932_02.pdf | journal=Sport Science Research|volume=3|issue=2 | pages = 33 - 39|doi=|pmc=|pmid=|access-date=2020-03-24|quote=|via=}}</ref> - [http://www.sportscienceresearch.com/IJSEHR_201932_02.pdf (Full text)] ==Medium chain triglycerides (MCT)== Supplementation with [[medium-chain triglycerides]] (MCTs) increases blood levels of ketones.<ref name="WikiMCT" /> They are often used in ketogenic diets to help maintain ketosis at a lower proportion of fat intake. Regular intake of MCTs can increase expression of ketone transporter MCT1 at the brain, increasing uptake of ketones<ref>{{Cite journal | last = Achanta | first = Lavanya B. | last2 = Rae | first2 = Caroline D. | date = Jan 2017 | title = β-Hydroxybutyrate in the Brain: One Molecule, Multiple Mechanisms | url = https://www.ncbi.nlm.nih.gov/pubmed/27826689/|journal=Neurochemical Research|volume=42|issue=1 | pages = 35–49|doi=10.1007/s11064-016-2099-2|issn=1573-6903|pmid=27826689}}</ref>. A study showed improved cognition in [[Alzheimer's|Alzheimer's disease]] patients taking MCTs.<ref name="RegerMA2004" /> ==Exogenous ketones== A challenge of exogenous ketones is in the ability to deliver sufficient β-hydroxybutyrate to the brain and to sustain high levels of β-hydroxybutyrate. Uptake can be increased with a ketogenic diet or regular ingestion of MCT and/or supplemental ketones.<ref name=":2" /> Exogenous ketones have been found to increase blood ketone bodies without requiring such strict dietary measures. Exogenous ketones come in esters and salts, both have been found to raise β-hydroxybutyrate to therapeutic levels that can last for hours. <ref>{{Cite journal | last = Hashim | first = Sami A. | last2 = VanItallie | first2 = Theodore B. | date = Sep 2014 | title = Ketone body therapy: from the ketogenic diet to the oral administration of ketone ester |url =https://www.ncbi.nlm.nih.gov/pubmed/24598140|journal=Journal of Lipid Research|volume=55|issue=9|pages=1818–1826|doi=10.1194/jlr.R046599|issn=1539-7262|pmc=4617348|pmid=24598140}}</ref> ==Clinical use== Doctor [[Sarah Myhill]] has a page on her web site describing the ketogenic diet.<ref name="Myhillketo2" /> Dr. [[Courtney Craig]] has published a hypothesis on the use of ketogenic diets in [[ME/CFS]] and offers dietary consulting to patients.<ref name="Craig2015" /> ==Learn more== *2017, [https://www.healthrising.org/blog/2017/06/16/ketogenic-diets-fibromyalgia-mecfs-review/ Getting Clear on Ketogenic Diets (for Fibromyalgia and ME/CFS): A Review] *[https://en.wikipedia.org/wiki/Ketogenic_diet Wikipedia - Ketogenic diet] *[http://www.ketogenic-diet-resource.com/ Ketogenic Diet Resource] *[https://en.wikipedia.org/wiki/Fatty_acid_metabolism Wikipedia - Fatty acid metabolism] == See also == *[[Fasting]] *[[Ketosis]] ==References== <references> <ref name="Cerqueira2011">{{Citation | last1 = Cerqueira | first1 = Fernanda M | last2 = Laurindo | first2 = Francisco R M | last3 = Kowaltowski | first3 = Alicia J | title = Mild Mitochondrial Uncoupling and Calorie Restriction Increase Fasting eNOS, Akt and Mitochondrial Biogenesis | journal =PLOS ONE | volume = 6 | issue = 3| pages = 18433 | date = 31 Mar 2011 | doi = 10.1371/journal.pone.0018433 | url = http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0018433 }}</ref> <ref name="CharlieFoundation">| title = The Charlie Foundation for Ketogenic Therapies | url = http://www.charliefoundation.org/ </ref> <ref name="ChengB2009">{{Citation | last1 = Cheng | first1 = Baohua | last2 = Yang | first2 = Xinxin | last3 = An | first3 = Liangxiang | last4 = Gao | first4 = Bo | last5 =Liu | first5 = Xia | last6 = Liu | first6 = Shuwei | title = Ketogenic diet protects dopaminergic neurons against 6-OHDA neurotoxicity via up-regulating glutathione in a rat model of Parkinson's disease | journal =Brain Research | volume = 1286| pages = 25–31 | date = 2009-08-25 | doi = 10.1016/j.brainres.2009.06.060 | url = http://www.sciencedirect.com/science/article/pii/S0006899309012797 }}</ref> <ref name="ChurchWH2014">{{Citation | last1 = Church | first1 = William H | last2 = Adams | first2 = Ryan E | last3 = Wyss | first3 = Livia S | title = Ketogenic diet alters dopaminergic activity in the mouse cortex | journal =Neuroscience Letters | volume = 571| pages = 1–4 | date = 2014-06-13 | doi = 10.1016/j.neulet.2014.04.016 | pmid = 24769322 | URL = http://www.ncbi.nlm.nih.gov/pubmed/24769322 }}</ref> <ref name="Craig2015">{{Citation | last1 = Craig | first1 = Courtney | authorlink1 = Courtney Craig | title = Mitoprotective dietary approaches for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Caloric restriction, fasting, and ketogenic diets | journal =Medical Hypotheses | volume = 85 | issue = 5 | page = 690-693 | date = November 2015 | pmid = 26315446 | doi = 10.1016/j.mehy.2015.08.013 }}</ref> <ref name="Craig20150325">{{citation | last1 = Craig | first1 = Courtney | authorlink1 = Courtney Craig | title = A Ketogenic Diet for ME/CFS & Fibro | date = Mar 30, 2015 | url = http://www.drcourtneycraig.com/blog/2015/3/25/a-ketogenic-diet-for-mecfs-fibro }}</ref> <ref name="Gasior2006">{{Citation | last1 = Gasior | first1 = Maciej | last2 = Rogawski | first2 = Michael A | last3 = Hartman | first3 = Adam L | title = Neuroprotective and disease-modifying effects of the ketogenic diet | journal =Behavioural Pharmacology | volume = 17 | issue = 5-6| pages = 431–439 | date = Sep 2006 | pmid = 16940764 | url = http://www.ncbi.nlm.nih.gov/pubmed/16940764/ }}</ref> <ref name="Hartman2007">{{Citation | last1 = Hartman | first1 = Adam L | last2 = Gasior | first2 = Maciej | last3 = Vining | first3 = Eileen P G | last4 = Rogawski | first4 = Michael A | title = The Neuropharmacology of the Ketogenic Diet | journal =Pediatric neurology | volume = 36 | issue = 5| pages = 281–292 | date = May 2007 | pmid = 17509459 | doi = 10.1016/j.pediatrneurol.2007.02.008 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1940242/ }}</ref> <ref name="Krikorian2012">{{Citation | last1 = Krikorian | first1 = Robert | last2 = Shidler | first2 = Marcelle D | last3 = Dangelo | first3 = Krista | last4 = Couch | first4 = Sarah C | last5 =Benoit | first5 = Stephen C | last6 = Clegg | first6 = Deborah J | title = Dietary ketosis enhances memory in mild cognitive impairment | journal =Neurobiology of Aging | volume = 33 | issue = 2| pages = 425–19-27 | date = Feb 2012 | pmid = 21130529 | doi = 10.1016/j.neurobiolaging.2010.10.006 | url = https://www.ncbi.nlm.nih.gov/pubmed/21130529/ }}</ref> <ref name="Myhill2009">{{citation | last1 = Myhill | first1 = S | authorlink1 = Sarah Myhill | last2 = Booth | first2 = NE | authorlink2 = Norman Booth | last3 = McLaren-Howard | first3 = J | authorlink3 = John McLaren-Howard | title = Chronic fatigue syndrome and mitochondrial dysfunction | journal =Int J Clin Exp Med | volume = 2 | issue = 1| pages = 1–16 | date = 15 Jan 2009 | pmid = 19436827 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680051/ }}</ref> <ref name="Myhillketo1">{{citation | last1 = Segura | first1 = Gabriela | title = Ketogenic diet - a connection between mitochondria and diet | date = 9 Aug 2013 | url = http://www.drmyhill.co.uk/wiki/Ketogenic_diet_-_a_connection_between_mitochondria_and_diet }}</ref> <ref name="Myhillketo2">{{citation | last1 = Myhill | first1 = Sarah | authorlink1 = Sarah Myhill | title = Ketogenic diet - the practical details | url = http://www.doctormyhill.co.uk/wiki/Ketogenic_diet_-_the_practical_details }}</ref> <ref name="RegerMA2004">{{citation | last1 = Reger | first1 = Mark A | last2 = Henderson | first2 = Samuel T | last3 = Hale | first3 = Cathy | last4 = Cholerton | first4 = Brenna | last5 =Baker | first5 = Laura D | last6 = Watson | first6 = G S | last7 = Hyde | first7 = Karen | last8 =Chapman | first8 = Darla | last9 = Craft | first9 = Suzanne | title = Effects of beta-hydroxybutyrate on cognition in memory-impaired adults | journal =Neurobiology of Aging | volume = 25 | issue = 3| pages = 311–314 | date = Mar 2004 | doi = 10.1016/S0197-4580(03)00087-3 | pmid = 15123336 }}</ref> <ref name="RhoJM2007">{{Citation | last1 = Rho | first1 = Jong M | last2 = Rogawski | first2 = Michael A | title = The Ketogenic Diet: Stoking the Powerhouse of the Cell | journal =Epilepsy Currents | volume = 7 | issue = 2| pages = 58–60 | date = Mar 2007 | doi = 10.1111/j.1535-7511.2007.00170.x | pmid = 17505556 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1867088/ }}</ref> <ref name="WikiMCT">{{citation | title = Wikipedia - Ketogenic diet, MCT oil | url = https://en.wikipedia.org/wiki/Ketogenic_diet#MCT_oil }}</ref> <ref name="ZhangX2016">{{citation | last1 = Zhang | first1 = Xiaoyu | last2 = Qin | first2 = Juliang | last3 = Zhao | first3 = Yihan | last4 = Shi | first4 = Jueping | last5 =Lan | first5 = Rong | last6 = Gan | first6 = Yunqiu | last7 = Ren | first7 = Hua | last8 =Zhu | first8 = Bing | last9 = Qian | first9 = Min | last10 = Du | first10 = Bing | title = Long-term ketogenic diet contributes to glycemic control but promotes lipid accumulation and hepatic steatosis in type 2 diabetic mice | journal =Nutrition Research | volume = 36 | issue = 4| pages = 349–358 | date = 1 Apr 2016 | doi = 10.1016/j.nutres.2015.12.002 | url = http://www.nrjournal.com/article/S0271531715003012/abstract }}</ref> </references> [[Category:Potential treatments]] [[Category:Diets]]
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