Talk:Ketogenic diet

Autism

Colin, I just came across this in a (frustrating) autism literature search: PMID 25072037 SandyGeorgia (Talk) 16:58, 6 April 2015 (UTC)

Bipolar removed for discussion

This text (copyedited a bit) was added by an IP:

Because many anti-epileptic treatments are also effective for bipolar disorder, the ketogenic diet has been suggested as a potential treatment; two case studies were reported in which patients with bipolar II disorder achieved remission on the diet and discontinued medication. As of yet, no clinical trials have been conducted to assess its potential effectiveness.

References

1. Please note that this Featured article uses list-defined references; per WP:CITEVAR, please attempt to respect the citation style.
2. See the prominent edit notice that pops up whenever editing this article.
3. This text discusses two case studies and uses a citation from 2001 for which no article title or PMID is given.

Including this text is likely WP:UNDUE, but a correct citation would be helpful. SandyGeorgia (Talk) 18:58, 30 April 2015 (UTC)

The ketogenic diet is not the same as chemical anticonvulsants. Two cases doesn't prove anything. Until more research on manic-depressives is done, it is best to leave that out. Andrea Carter (at your service | my good deeds) 07:47, 21 August 2015 (UTC)

As great as this article is.....

Many of its sources are outdated. How to proceed? You want a page header template? Each outdated reference identified with an in-line template?

  Bfpage |leave a message  19:37, 5 May 2015 (UTC)

Since Colin stays pretty well on top of this article, I suggest you list sources that are not included on this talk page. Just because a source appears dated doesn't mean there is anything newer with which to replace it ... if you have instances where there are newer sources that aren't used, please list here. (Defacing an FA with tags without discussing first on talk isn't usually a good thing :) SandyGeorgia (Talk) 19:39, 5 May 2015 (UTC)

Bfpage, I see you went ahead with tagging without responding here first. Sometimes an old source may be the best source, or the only source. Unless you have indications that these are bad sources, tagging the articles isn't the best.[1] Do you have sources indicating this information is no longer good? SandyGeorgia (Talk) 19:50, 5 May 2015 (UTC)

Greetings! I see there is much interest in this topic. I am not familiar with Colin. My edits are really very minor, feel read to revert them and if you don't have roll-back permissions I'll do it myself. I meant no offense. I was under the impression that medical articles are supposed to be cited with references within the past five years. There even templates that automatically display an update tag after a certain period of time so that when an article is written initially, they can be edited to flag that it needs to be updated. I saw that there were no automated update tags in the article and assumed that I was doing the editors a favor by bringing these possibly outdated references to your attention. Please assume good faith on my part. I don't believe I've that ever been accused of defacing an article before, that's a new one. Let me know if you want to rollback my edits, I will not be offended. If you would like me to perform the rollback also please let me know I can do it with a click.

  Bfpage |leave a message  20:02, 5 May 2015 (UTC)

DO you have any reason to believe that information is outdated, or any indication that there are newer and better sources? If not, then you can just edit the article and remove the tags you added. I already removed them once, and you reinstated them. (I presume you saw this message in your edit screen?) SandyGeorgia (Talk) 20:12, 5 May 2015 (UTC)

We got caught up in an edit conflict. Which means I saw your message AFTER I applied the last tag. It is gone now. My evidence for believing that the information is outdated is that the year is 2004, eleven years ago. I presume that there are better sources. ... Now that I've thought about it for a little bit, I have to quietly disagree with you when you say that an old source is better than no source. That may not necessarily be true. When we edit Wikipedia we also have to decide what to leave out and as time goes by some of those references get more and more unreliable. I would be glad to help you out except that I'm trying to get some of the missing articles created on pathogenic bacteria. I have not had any problems finding references or pathogenic bacteria that have been published in the past five years, so I'm not sure why it would be difficult to find references to support information in this article that has been published in the past five years. There is nothing wrong with another well-intentioned, experienced editor like myself applying maintenance tags to an article with the best of intentions and in good faith. I thought you could use some help and identifying some of your older sources. The Very Best of Regards,   Bfpage |leave a message  20:19, 5 May 2015 (UTC)

No problem-- I was just trying to get your attention, and you are reading intent into my message that isn't there. The idea is that, just because a source appears old, doesn't mean there is something newer or better to replace it with. SandyGeorgia (Talk) 20:23, 5 May 2015 (UTC)

This source is over my head:

• Paoli A, Bosco G, Camporesi EM, Mangar D. Ketosis, ketogenic diet and food intake control: a complex relationship. Front Psychol. 2015 Feb 2;6:27. doi:10.3389/fpsyg.2015.00027. PMID 25698989.

SandyGeorgia (Talk) 20:23, 5 May 2015 (UTC)

I can understand it, do you want me to take a crack at it and see if it updates some of the older references?

  Bfpage |leave a message  00:17, 6 May 2015 (UTC)

Wow! I got about 32 returns on review articles on this topic for the past five years...hmmm, perhaps it is possible to update with more recent med journal review articles. Just saying,

  Bfpage |leave a message  00:22, 6 May 2015 (UTC)

This one looks like a good replacement for your 2004 reference but I can't pay for it:

<ref name="GlauserLoddenkemper2013">{{cite journal|last1=Glauser|first1=Tracy A.|last2=Loddenkemper|first2=Tobias|title=Management of Childhood Epilepsy|journal=CONTINUUM: Lifelong Learning in Neurology|volume=19|year=2013|pages=656–681|issn=1080-2371|doi=10.1212/01.CON.0000431381.29308.85}}</ref> The abstract mentions and confirms (generally) the diet for epilepsy.   Bfpage |leave a message  00:35, 6 May 2015 (UTC)

Hi folks. It is good to question if an FA is up-to-date, particularly one promoted Dec 2009. My, how time flies. Bfpage, there's no need to link to MEDRS since I created that guideline back in 2006 and this page is watched by a number of editors who helped shape it. I'm quite sure your edits are good-faith. The "needs update?" tag doesn't seem that intrusive or "defacing" as some tags, but an initial talk page request is probably the most polite way of making initial enquiries about sources. There will, for sure, be quite a number of featured/good articles for which the main authors have long-since departed, and perhaps a reader of the article who is qualified to help may feel inspired to improve/update the sources. I did research some new sources a few years ago but was disappointed that there wasn't really anything new to say. There seemed little point in replacing one review for another simply because the latter had a more recent date on it. I don't think the Neal randomised trial, for example, is likely to be updated with a newer RCT. It did its job wrt providing RCT evidence for insurance and government bodies who make decisions about efficacious medical treatments they wish to fund. The basic process of ketosis has been understood for nearly a century and more modern sources add nothing new. We still really don't understand why such a diet helps with epilepsy, though. I guess that's rather frustrating for Western science, but epilepsy is a problem with the brain, not individual neurons or chemical reactions, and we don't really understand the brain either. At least it has some plausible explanations and doesn't break the laws of physics like homoeopathy :-).

Looking at the areas that were tagged. I think the lead paragraph is basic stuff that hasn't changed since the 1920s. The lead sentence and sections that deal with research and possible other disease treatments is most likely to become outdated. I'm not aware of any medical uses for the KD that have reached mainstream other than for epilepsy. Just about any brain disorder from cancer to Alzheimer's to Tourette syndrome has been considered, as well as usage for dieting and diabetes control. I don't think epilepsy's rank after stroke in terms of serious neurological disorders has changed, or may ever change. The history of the diet and its conclusion with it becoming a standard (albeit not primary) therapy once again, is unchanged.

In terms of source-aging we have to consider any article is dealing with lots of different facts. If the best history of a disease/therapy was written 10 year ago, then that's still the best source even if there are some modern sources that copy/paste/tweak it. Has anyone improved on Temkin's "The Falling Sickness: A History of Epilepsy" book, for example? Some areas of our knowledge of the body are changing faster than others. Some diseases and therapies get more research than others. I dare say that cancer therapy, particularly common cancers, is a fast moving subject. This one less so. So I wouldn't hold the "five years old" guideline as anything other than a very crude measure. My point I suppose isn't really the age of the sources, but whether, when reading new sources, one realises that the facts are now considered to be wrong or are out of date. And for that, one really needs to do a literature search, rather than just look at the references list. I guess it is time I did another search .... :-) -- Colin°^Talk 21:30, 5 May 2015 (UTC)

Thank you for such a gracious explanation. The reference I initially had problems with is 11 years old. I have found when I want to update an article, I can usually find the same information from the older article in a newer one, that is to say, the newer article becomes a possible tertiary source, confirming (updating and verifying) that the older reference is, indeed, still valid by its being quoted in a later article. The reiteration of the history of a disease/syndrome/pathology is almost always confirmed even in the abstract of a newer review article, thereby creating a source independent of Wikipedia confirming the validity of the original source. Sometimes there is a surprise waiting in a newer review article that calls into question the information in the older article. This has been my experience, and apparently I have erred thinking that this was the case for this topic.

Along the same lines, of course we have to expect that even FA articles will need to updated and being the notoriously bold editor that I am, it did not even cross my mind that there might be a problem tagging some references and just posting a passing announcement right before I began my tagging. There actually needs to be a procedure in place that delists FA articles, although it at first doesn't make sense because a featured article has the title due to the fact that it was featured. Does this happen? how does a FA go to a B or C?

  Bfpage |leave a message  00:13, 6 May 2015 (UTC)

Colin, there is something I've been wanting you to look at (above under autism), and there are three new sources I just added to the article. SandyGeorgia (Talk) 22:05, 5 May 2015 (UTC)

I see them. Will look into those too. -- Colin°^Talk 19:03, 6 May 2015 (UTC)

Asking for a review of FA status of this article

I am initiating the process of reviewing the FA status of this article by posting this message on the talk page. My main concerns are with older references which really weren't addressed adequately for me. I will take a closer look at the article to highlight more of the concerns that I see that may need improvement.

Respectfully and with appreciation toward all who have contributed to this article,

  Bfpage |leave a message  00:54, 6 May 2015 (UTC)

Bfpage, see Wikipedia:Featured article review for the process. I would appreciate that discussion be kept to the talk page and you are very patient with me wrt improvements. An article that is six years old doesn't need instant rewrite, and this article took me many many months to write. I encourage you to not be too dogmatic with reference age. For example, Wheless JW. "History and origin of the ketogenic diet" 2004 may well still be the best history of the diet. Certainly most reviews I've seen that cover the history will just cite this. Typically the introduction section of a paper is not considered first-class source material, as this may be subject to the most cursory of peer-review (it isn't really the point of the paper, after all). So even if a modern review begins with a historical overview that cites Wheless, I don't believe that makes the modern review a better source for our purpose. I get your point that second citation level adds another pair of professional eyes that confirm the validity of the material, but I also feel that generally many papers are rather poor on the history and merely plagiarise other works. For example, at least one paper has taken text from this Wikipedia article. It is obvious if you think about it, that neurologists are not actually professional historians. So they are about as competent at times as some celebrity model is competent to offer opinions on MMR :-). Another factor wrt sourcing is how contentious the fact is. Highly contentious material may demand up-to-date sources from the best journals. But material that nobody questions may be better sourced to the most comprehensive or authoritative article or book even if that's an old one.

I'd appreciate if you could point out issues where the article text is actually wrong our outdated. Having older references isn't actually an error or fault, merely a warning sign that a new review of the literature may be helpful. If you have found newer sources that might replace older ones, then that could be a big help, though I'd want to check the source was actually better and that we weren't losing something merely to gain newer date. -- Colin°^Talk 08:40, 6 May 2015 (UTC)

Dear Colin, I can only say that the article is superb and that you deserve accolades for bringing it up to featured status. I am not on a witch hunt, or riding a very fast train. I believe at this point, improving the article can all take place right here on the talk page. I will be glad to help because at this point, I have been able to find more up-to-date sources to support statements that are sourced by older references (I believe) Since I am not an expert on the topic, I don't feel competent to 'fix it myself'. Of course, when the history of the development of the diet is sourced, we are citing history and not medical articles. The requirements for more recent med journal review articles would not apply. I will be working with you, not against you.

• first piece of good news is that there are 128 page watchers. They surely may lend a hand.

The Very Best of Regards,

  Bfpage |leave a message  12:33, 6 May 2015 (UTC)

this request seems to be based on misguided assumptions about WP:MEDDATE. Jytdog (talk) 12:38, 6 May 2015 (UTC)

Thank you for your comment. Best Regards,   Bfpage |leave a message  15:22, 6 May 2015 (UTC)

• the second piece of good news is that by entering different terms into the search parameters, you get the results you are looking to on the topic of diet and epilepsy. I apologize if I am telling you something that you already know. I will post some examples shortly.   Bfpage |leave a message  15:09, 6 May 2015 (UTC)

• Don't worry, I often find I am explaining something that the other person knows, and you don't know me. I should be able to find my way round PubMed even if I am a bit rusty, and can get hold of most sources including subscription ones. Free ones are good to have if equivalent since that benefits our readers most. I need to spend a bit of time renewing my acquaintance with the sources I have already. And also locate some possible new ones. And also give the article an inspection to see if any changes made to it need fixing. I have limited time to spend on this on any day (sometimes none) so please be patient and avoid any significant undiscussed changes. -- Colin°^Talk 18:43, 6 May 2015 (UTC)

I am glad to read this response of yours. I was reading concerns about possibly insulting you in some way, and I am glad to read that you and I have the same goals and ideals that we can work on maintaining FA status while at the same time seeing if anything better AND newer has been published. Again, it is not like this is an emergency and needs to be fixed tomorrow. It is good to know that you have subscriptions to possible review articles that I don't have. Take your time and I will be sure to let you know before I make any major edits such as replacing one source with another. Well, I have list to start with by reading some of those articles that I found in my searches. I will also look on google books to see if anything (better AND newer) has come out since 2009 which is the year that most of the references seem to cluster around. Best Regards,

  Bfpage |leave a message  19:09, 6 May 2015 (UTC)

Search results for free med journal review articles published in the past five years

• this page only results in displaying results with the keywords ketogenic diet.
• this page shows the results when I entered the keywords epilepsy and diet
• this page shows the results when I entered the keywords ketogenic and epilepsy.

  Bfpage |leave a message  17:02, 6 May 2015 (UTC)

Weak source and bold statements

"Extraordinary claims require extraordinary evidence".

The claim made in this edit that "The treatment results of the [diet] are better than most of the new antiepileptic medications." is an extremely bold claim. The source used (PMID 25221391) does confirm this but then doesn't actually present any evidence to back it up. Firstly, one must ask "in what kind of patients" and secondly one must ask "in what trials". Today, the KD is only used after many medications have failed and mostly in children. So we don't really have any modern experience of the KD as a first-line treatment (except perhaps in some rare metabolic disorders, or for trials in infantile spasms) nor do we have good contemporary evidence of its use in adults. Secondly, to state that it is better, one really requires a trial comparing it against "new anti-epileptic medications". And this hasn't been done. The closest is a randomised trial where the control group got "continuing treatment (on their existing AEDs) for three months" versus "adding the KD (on top of any existing AEDs) for three months". Advocates of the diet reckon that after you've tried several drugs, and for children especially, the diet is probably more likely to be successful than trying yet another drug. But that's their expert opinion rather than fully evidence-based results. So the issue is complicated and is mostly covered by the existing article text.

The addition of the above source as a reference in this edit is problematic. This paragraph, and that sentence is history. There's no better source for that that the current source which is an entire chapter in a professional textbook on the history. Every single article, just about, on the KD has a short "Introduction" section that covers the history in a sentence or two. The source given here is no different and adds nothing. I could pick a hundred other sources that do the same. I've already mentioned how history does not need up-to-the-minute sources. The state of epilepsy treatment in the 1920s is well documented already. But further, the source does not actually support any of the sentence. It doesn't say it was widely used or studied and doesn't mention bromides or phenobarbital. It merely says it was "initially devised in the 1920" and puts the decline down to "phenytoin and sodium valproate" (the latter drug is from late 20th century). Even if it did support the text, the source is so shallow that any reader following the link would learn nothing new about the history.

The citations in this featured article, support all the text preceding them in the paragraph up to the previous citation. So if a paragraph has one citation at the end of it, then the whole paragraph is sourced to that source. One cannot just add further citations against random sentences and phrases within the paragraph, without ideally also having access to and reading the original citation for the paragraph as a whole. Otherwise, the link between article text and sources begins to rot and soon nobody is sure what is backed up by what.

Lastly, a featured article is not written by finding random papers on PubMed (or by just reading the free ones) and inserting random facts or adding citations here and there. That approach might work for start-class articles but not when we're trying to write at this level. It will taken some time. -- Colin°^Talk 21:54, 11 May 2015 (UTC)

I am not very good at answering many points all at once and so will have to respond slowly and methodically to help myself remain on track. First of all, if any of the perceived problems described above can be solved by simply reverting my edits, then please feel free to do so and know that there is only good faith efforts on my part to improve the article. I will not be offended in the least.

Concerning the statement (and WP policy): "Extraordinary claims require extraordinary evidence"; the statement and reference I inserted "The treatment results of the [diet] are better than most of the new antiepileptic medications." I have to say that I don't realize or recognize the 'boldness' of the statement, but at the same time defer to your greater experience on the topic when you say that it is a bold statement. The statement, though not copied word for word, simply appears along with other statements in the journal article and didn't appear any bolder than any of the other statements. The evidence to support this statement comes later in the journal article where the author describes at least seven studies to support the statement. To ask "what kind of patients" I can answer 317 Chinese children, 972 children studied by Keene et al., 54 children another systematic review by Neal, 27 children in a Sharma study, and 289 children referred to in a 'Cochrane' study. I've read the rest of the first paragraph of the comments above and remain puzzled because I am not in a position to evaluate the quality of the studies that were conducted. Nor do I have access to the protocols. I simply found a med journal review article, assuming that it has gone through a thorough peer-review process, with well-cited sources and found the information to be applicable to the topic.

Concerning "...a featured article is not written by finding random papers on PubMed (or by just reading the free ones) and inserting random facts or adding citations here and there...It will taken some time." I would not describe the process of improving this article as "finding random papers......", or at least that is not what I am doing. As for adding citations 'here and there', when content and citations are added, it happens in a piece meal fashion unless you are suggesting that a total rewrite is performed when ALL updated content and references are added at the same instance. How does editing progress unless statement by statement and reference by reference? This is only a partial response to your concerns above, I will be able to respond to more of your concerns when I have gathered the information necessary to provide a more complete response. Best Regards,

  Bfpage |leave a message  23:22, 11 May 2015 (UTC)

To expand a little on the "The efficacy of KD is better than most of the new antiepileptic drugs" claim made in the source, I think their main problem was that they weren't precise enough about the scope of that claim. For paediatric refractory epilepsy (children who have tried several drugs and are still having lots of seizures) then it may well be better than most of the new drugs -- they have probably tried the new drugs by then. But of adults -- we really don't have sufficient data. And for people newly diagnosed with epilepsy? Very much no. Most people with epilepsy achieve control of their seizures by popping a (potentially very cheap) pill once or twice a day, with manageable side-effects, and can then get on with their life and eat anything they want. In contrast the KD has a high drop-out rate and is very very expensive in terms of the trained staff needed to supervise it. To give you an idea of how unattractive it is, if the drugs haven't worked then you will be investigated for brain surgery before attempting this. If it turns out you have a focal seizure that might be helped/cured by surgery then that may be recommended. And they don't open up your head and snip things out for the fun of it :-)! So the evidence presented is on very sick children who have tried many drugs already and have been turned down for surgery. We can't, in the second sentence in the lead, make the unqualified and bold claim this is better than most drugs.

On editing. I don't think featured articles are written the same way as most WP articles are. They can be a collaborative effort for sure. But the general WP approach of a little here and a little there will at most generate something barely readable, disjointed and only moderately well sourced. I don't think a rewrite is needed, though some sections and paragraphs might well be. The history section is unlikely to change IMO unless someone feels the actual text could be written better or there are some recent developments to add. I plan to locate some improved sources and present them on the talk page along with some words about how they may affect the text. Then do some editing at a later stage. The paper you found PMID 25221391 refers to some recent studies (the older ones are already considered in this article) and cites some other recent reviews. Let's collect that info and see what new there is to say. -- Colin°^Talk 07:52, 12 May 2015 (UTC)

Freeman's most recent book

Freeman's most recent book came out in 2011 and contains the same information as the 2007 text. It is not a medical textbook, but it is more recent. Is that a helpful source? Dr. James W. Wheless's newest medical textbook on epilepsy is from 2012. Why wouldn't this be a better source than his old one?

  Bfpage |leave a message  23:46, 11 May 2015 (UTC)

Clarification?

I've only read the lede, so perhaps it's explained in the body of the article, but I don't understand this addition from last July bolded below:

The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories to maintain the correct weight for age and height. This classic ketogenic diet contains a 4:1 ratio (although a 3:1 ratio has also been used) by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as nuts, cream and butter. Thus, an individual's diet is composed of 90% and 86% of calories coming from fat, respectively.

What does the 90% and 86% refer to? The 3:1 and 4:1 ratios? Whatever, it could be clearer. --Anthonyhcole (talk · contribs · email) 06:09, 13 May 2015 (UTC)

It probably does, but this is getting a bit too specific for the lead. The 4:1 ratio is the classic diet's aim, but in individual patients, this may be less or more depending on how they are responding and tolerating. The difference between 90% and 86% is small. I've reverted the change for now. The message the lead should be getting across is that nearly all the calories come from fat, so perhaps we should say that rather than giving figures. -- Colin°^Talk 07:29, 13 May 2015 (UTC)

Yes. That would be a lot clearer. :o) --Anthonyhcole (talk · contribs · email) 08:00, 13 May 2015 (UTC)

Guideline update

Source NICE Guideline CG20:

• Stokes T, Shaw EJ, Juarez-Garcia A, Camosso-Stefinovic J, Baker R. The diagnosis and management of the epilepsies in adults and children in primary and secondary care. (PDF). London: Royal College of General Practitioners; 2004. ISBN 1-84257-808-1

has been superseded by

• The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care. (PDF). January 2012. National Institute for Health and Care Excellence.

• They request research on the use of the diet in adults.
• The guideline is: "Refer children and young people with epilepsy whose seizures have not responded to appropriate AEDs to a tertiary paediatric epilepsy specialist for consideration of the use of a ketogenic diet."
• Section 11.3 discusses the diet. Some useful details could be added to the article. Consideration of cost and difficulty of adherence means they recommend reserving this for children who have failed other approaches. Similarly, the additional cost of the MCT variant means it should not be tried first.

The Evidence update notes the Modified Atkins diet may be effective for children with refractory epilepsy, but they do not regard this as a fact to update in the guidance. They cite Use of the modified Atkins diet for treatment of refractory childhood epilepsy: A randomized controlled trial as evidence. This definitely looks like a fact to include in our article. However, NICE have three problems with the trial. It is not blinded (but then that is essentially impossible for this therapy), 77% participants were male and 44% vegetarian, which may limit its applicability to the UK. These issues meant they didn't recommend it in their guidance, recommneding a European setting for future trials. -- Colin°^Talk 15:20, 17 May 2015 (UTC)

British English?

The population of the United States is roughly 5 times that of the UK. In order to ensure that Wikipedia serves as wide an audience as possible, I propose changing the style of this article to U.S. English instead of British English. — Preceding unsigned comment added by 139.78.252.149 (talk) 21:50, 10 June 2015 (UTC)

See MOS:ENGVAR. This is the "International English" Wikipedia, not the US Wikipedia. This is no persuasive argument that this article topic should be written in US English. -- Colin°^Talk 07:38, 11 June 2015 (UTC)

According to http://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Dates_and_numbers#Strong_national_ties_to_a_topic this should be in US English, as the scientific research in this field has been done overwhelmingly in the US. In addition, even the images used on the page are primarily of US origin. — Preceding unsigned comment added by 139.78.252.149 (talk) 17:41, 11 June 2015 (UTC)

A lot of research is done by the Johns Hopkins Hospital team but by no means the majority never mind an "overwhelming" amount. There are doctors, patients and researchers all over the world. Perhaps the most significant trial of the KD (both classic and MCT oil), Neal's randomised controlled trial, was based in London. And the biggest study of the Modified Atkin's Diet was a recent randomised controlled trial in India. The four photographs were taken in the UK. The actual topic is a medical diet used all over the world, which has no regional association at all. The "strong national ties" is for topics like NASA being US or Big Ben being British. -- Colin°^Talk 12:06, 12 June 2015 (UTC)

Cyclic ketogenic diet?

Dear ketogenic diet editors. I've just come across:

• Cyclic ketogenic diet (edit | talk | history | protect | delete | links | watch | logs | views)

- a rather poor article. Is this a viable distinct topic? And if so does it merit its own article, or at most a mention here? Alexbrn (talk) 05:30, 23 July 2015 (UTC)

• • Various low-carbohydrate diets are used for slimming or body-building or as a lifestyle choice. Some are ketogenic and some are only ketogenic for a phase of the diet. Most are also high protein. Most are followed by adults rather than sick children. Etc, etc. There's an adjective in common with the medical therapy discussed here, but that's about all. -- Colin°^Talk 15:54, 24 July 2015 (UTC)

Proceeding with review of FA status

To those who have contributed to the improvement to this article I need to let you know that I am proceeding with the request to have this featured article reviewed. Little to no progress has been made to update references that comply with WP:MEDRS. I completely understand that older references are not necessary better references but is likely not true for the whole article. Almost every reference cited is sourced to publications that are more than five years old. I might be missing something but it doesn't appear that any references include review articles, systematic review articles, meta-analyses, reliable and official webpages by the CDC or WHO or medical textbooks.

I am not criticizing the article; It's prose is excellent, it flows naturally point by point. Obviously, a lot of hard work has gone into it, but few if any significant edits have been added that provided good sources.

I am no way suggesting that this article is less than a good article and I know it was created and edited in good faith (except by vandals). Best Regards,

  Bfpage |leave a message  10:33, 23 July 2015 (UTC)

@Bfpage: this is the job of Wikipedia:Featured article review, which would be the logical next step. Cas Liber (talk · contribs) 15:11, 23 July 2015 (UTC)

MEDRS says "five years or so", not "five years", and also says "These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published." We normally use ten years as the approximate rule of thumb for rare diseases, and it seems likely to me that this rare treatment should be handled in the same manner. By that standard, about a quarter of sources are "outdated", but that includes items that are one of multiple citations and/or in the ==History== section or otherwise not covered by MEDDATE anyway. Also, quite a lot of those "outdated" sources are exactly one year "too old", which does not worry me very much.

Also, the actual point of MEDDATE is to present accurate, current information. Is there anything in there that you think is sourced to something "outdated" and the actual content of the sentence or paragraph needs to change? WhatamIdoing (talk) 16:46, 23 July 2015 (UTC)

Whenever I have written content that contained a reference that was before 2008, my edit has been reverted. Therefore I assumed that this was the standard for every editor. Wrong assumption on my part. I am pleased to read that it doesn't worry you too much. I also am not worried too much. As I said before, my intent was to suggest that outdated references be updated. Apparently, no one wants to update the references. As for being rare disease, the information on the diet has expanded to include other disorders other than epilepsy. In that way the article isn't as comprehensive as it could be. I intend to walk away from this. It really isn't worth the contentiousness. In the spirit of civility and assuming good faith on the part of other editors I will withdraw my request and stay away from featured articles. It just isn't worth it. There is no cabal but I have never gotten any support from other medical editors. I was enlisted to help you out in reviving the haitian wikipedia, but that wasn't an encouraging action for me, even though you and Doc James seemed pretty enthusiastic. I feel that my participation was something you could 'check off' on a to-do list and fulfill the goals of reviving the haitian wikipedia. This is how I feel, it is not an accusation. I felt the same way about Doc James enthusiasm about my translating medical articles. I am very discouraged regarding my participation in Project Medicine. If you care to see how discussions have typically been regarding topics with which I am involved, you will notice a pattern of opposition on the talk page. I feel that I am not helping the Project at this time. This is not an accusation, it is an expression of my discouragement in editing. Best Regards,

  Bfpage |leave a message  13:18, 24 July 2015 (UTC)

Bfpage, I don't mind you querying the quality of articles, particularly FAs. And I did forget all about this page again. When you say that you've had work reverted because the sources were old, then I wonder... Was the edit you added contentious at all and the other user was using the age of the source as a proxy rather than directly raise issues with the text? Or was the text fine and uncontentious, and the editor was being rather picky? For new work, I'd prefer to use a recent source unless one couldn't be found. But if your edit genuinely improved WP with new information that isn't out-of-date, and all you add access to was an old source, then perhaps the revert was unfair and uncollaborative. But it doesn't follow that we need to go around deleting or demoting existing text just when the sources get old. I think your focus should instead be on the article text and comparing that to what you think recent sources say. I'm sorry I don't have time to investigate your contributions/opposition any further -- these sort of interpersonal problems are part of the reason I don't edit much here -- it's such a timesink. All I can suggest is that WP is a big place and I'm sure there must be a part of that you can usefully contribute to without making you depressed. Regards, Colin°^Talk 14:21, 24 July 2015 (UTC)

Colin, I did not have any edits reverted in your article. I removed the tags myself. I was making a comment about my edits in general. You are courteous and considerate. I am not depressed-only discouraged. I'll get over it. It is a timesink, one good reason to end the discussion, friend. Best Regards,

  Bfpage |leave a message  15:08, 24 July 2015 (UTC)

Sorry. In May I promised I'd look at researching new sources for this article but I have not got round to doing that. I don't really understand the comment made elsewhere that the article lacks sources that are "academic journal review articles, systematic review articles, governmental websites and policies and medical textbooks". It includes each of these. I discussed the issue of ageing sources earlier on this talk page, so won't repeat. Ok, I will make a renewed effort this weekend to do some research and post my findings here as a step towards updating the article. My main concern isn't really about updating sources for the sake of it. Are there facts that are now considered incorrect or otherwise superseded? Is there information missing from the article? Is the weight given to aspects of the subject appropriate when reviewing the current literature? I firmly believe in applying WP:WEIGHT and building an article from the body of literature, rather than accumulating random factoids. -- Colin°^Talk 10:21, 24 July 2015 (UTC)

My impression that the sources didn't meet MEDRS was was based on the titles of the journal articles that were cited. When challenged, I began to read the references (if I had access) and saw that just because the work 'review' isn't in the reference title, doesn't mean it isn't a review article. There is more research indicating that the diet helps in the treatment of brain cancer, reverses the expression of some alleles and a few other new things I referenced above. I am sorry if you think I am collecting random factoids-that is not my intent. I found the new research intriguing and thought it would be a good addition to the article. Best Regards,

  Bfpage |leave a message  15:08, 24 July 2015 (UTC)

(edit conflict)@Bfpage: questioning and reviewing articles is important and valid. I am not familiar with the article, but if you find review articles that are more recent or cover broader aspects then they most certainly should be included. However, querying content here solely because your edits were reverted elsewhere is not the right way to go. Furthermore, medical articles do get eroded steadily on wikipedia and are important to keep an eye upon. Please discuss specific issues as you find them. Cas Liber (talk · contribs) 14:15, 24 July 2015 (UTC)

Thank you for your response. I gave links to recent developments in the discussion above. Of course I'm not querying content solely because my edits were reverted elsewhere, I'm not sure what that even means. Actually the reversion of my edits in Project Medicine is something I have come to expect and in good faith the editors that revert my edits are doing their very best to improve the encyclopedia. There are some high numbers in my editor interaction with an editor and I need a break from that. It doesn't look good and I have had trouble with administrators before over my interactions. There really isn't a need to discuss the eroding references, I typically just update content with more recent references. Editors in Project Medicine work hard to replace outdated references. I will certainly take your advice to discuss specific issues as I find them...that is what I thought I was doing on this talk page. Best Regards and thank you for your interest,

  Bfpage |leave a message  14:49, 24 July 2015 (UTC)

suggested update

In the Other Applications section, the third paragraph cites a 2013 review and says "the only evidence of benefit is anecdotal". This article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215472/ has a slightly stronger conclusion and cites clinical studies that I think can be described as preliminary rather than anecdotal. Since I've never edited a featured article, I'll leave that observation here for consideration. JonSidener (talk) 17:30, 15 May 2016 (UTC)

Thanks JonSidener. The article cites some preclinical studies (i.e. non-human) and some pilot and phase 1 trials, which are not designed to provide "evidence of benefit". See Phases of clinical research. And those phase 1 trials were cited via ClinicalTrials.gov -- i.e. they hadn't actually published. So I don't think we've even got preliminary evidence of benefit for humans, published in a form we can cite per WP:MEDRS. Perhaps there is a newer review? -- Colin°^Talk 07:26, 16 May 2016 (UTC)

Review

doi:10.1136/practneurol-2015-001288 JFW | T@lk 11:40, 17 May 2016 (UTC)

Doesn't merit Featured Article status

This is essentially an article about the ketogenic diet as a treatment for epilepsy. If it were titled as such, it might merit the star. As a general treatment of the subject, it is too specific. It doesn't have much to say about the widespread use of the diet for weight-loss and treatment of diabetes. It doesn't say anything about how the diet actually works - the chemistry. — Preceding unsigned comment added by 80.174.78.122 (talk) 09:33, 20 July 2016 (UTC)

As it says at the top of the article; "This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see Low-carbohydrate diet and No-carbohydrate diet." In serious literature, the discussion of this topic is predominantly as an epilepsy treatment. Alexbrn (talk) 09:39, 20 July 2016 (UTC)

Plus, as indicated in the "Seizure Control" section, we don't actually know all that much about how the ketogenic diet works as a treatment for epilepsy. An article can be well written and well sourced (and therefore deserving of FA status) even if its subject is not well understood. Kajabla (talk) 15:55, 22 July 2016 (UTC)

Axona claims

The "Other applications" section claims the product Axona was granted status as a "medical food" by the FDA in 2009. The citation does not support this claim. It also runs counter to the Axona page itself, which states that Axona was declared MISBRANDED as a medical food by the FDA in 2013, which has a very good citation, specifically the warning letter from them. Due to this, I'm removing the whole chunk, also someone else more knowledgeable is welcome to add back in (correct and cited) information about the product.

epilepsy only

If this article is only about Ketogenic diet and epilepsy then why is it not in the heading?

quote: "This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see Low-carbohydrate diet and No-carbohydrate diet." Alexbrn (talk) 15:09, 13 September 2017 (UTC)

Aging

Where do I put this in the article? https://www.sciencedaily.com/releases/2017/09/170905145551.htm BernardZ (talk)

Nowhere, it has no encyclopedic value. Alexbrn (talk) 15:09, 13 September 2017 (UTC)

Why do you think so? BernardZ (talk) 16:41, 18 September 2017 (UTC)

It's a piece of churnalism based on some primary research - which we avoid. Alexbrn (talk) 16:45, 18 September 2017 (UTC)

Article is well-written and informative but had to correct a defect in the discussion of "Mechanism of Action"

The article is very good but ran into a problem when it described propagation of a nerve impulses. It stated that the charge propagated from one neuron's synapse to another. Actually the synapse is the shared gap between two (or usually many) neurons. I also thought the contrast with "electrical pathways" was not particularly useful. In general the concept of a physical electrical connection, like with electric circuits, is misleading. There are ion channels which speed up charge-potential propagation. It is unlike the conductance of electrons through a copper wire. But since the article is portraying the seizures as a chemical imbalance, the mention of the other method of charge propagation in the brain is a distraction.The age of fable (talk) 05:23, 16 September 2017 (UTC)

I re-edited the page, and provided information on the talk page of the person who rolled back my previous correction. Please review the Wikipedia page on "Synapse." The diagram clearly shows that the synapse is the space between two neurons. So it is not correct to state that a charge is propagated from "one neuron's synapse to another."The age of fable (talk) 07:41, 26 September 2017 (UTC)

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Epilepsy section

The Epilepsy section seems out of place here. At best, a single sentence from this section could be incorporated elsewhere in the article, but its placement (as the first section) and content (which is mostly about Eplipesy as a disease and other treatments of it) seems very out of place. The ketogenic diet's role in the treatment of epilepsy is only mentioned in passing, and with almost no usable detail. This needs to be worked on by someone with some knowledge of how to incorporate it better into the narrative flow of the article. For an FA level article, it's quite substandard! --Jayron32 15:36, 27 March 2018 (UTC)

@Jayron32: the point of it is to offer a brief summary of epilepsy, because this diet is used to treat it. SarahSV ^(talk) 15:41, 27 March 2018 (UTC)

Yes, that's fine, but we can a) incorporate such information into another section instead of giving it the prominence of the first such section and b) phrase it better to indicate why the diet is used and how it is kept to treat it. Your explanation is fine, the actual placement and specific text used in this article does not adequately convey that. Someone needs to fix that. --Jayron32 15:45, 27 March 2018 (UTC)

It's a background section, leading into the article, which is about how the diet is used as a treatment. It's a standard way of handling something like this. SarahSV ^(talk) 15:54, 27 March 2018 (UTC)

@Jayron32: I'm not sure what solution you're looking for. This article is about a treatment for epilepsy, so it is natural to begin with a background section briefly describing the salient points about epilepsy. It covers very concisely: epidemiology, diagnosis, etiology, symptoms, classification and treatment – which is where the ketogenic diet is mentioned, of course. Which of those background points do you wish to see removed? Personally, I can clearly see the relevance of that chain of information to this article, and I'm surprised that you can't. --RexxS (talk) 16:18, 27 March 2018 (UTC)

You're quite right. I apologize for being confused myself. Re-reading it all, it seems to be fine. That's what happens when I find myself outside of my area of expertise. Mea culpa, you're all correct, and I'll go back in my corner and stop trying to be useful (and failing miserably). --Jayron32 16:28, 27 March 2018 (UTC)

A "background" section is not a standard section in MEDMOS which is designed not to be medical marketing. (A background section is extremely common in medical marketing material.) This whole page ignores MEDMOS as well as MEDRS in several places. Very surprising to see it is an FA. Jytdog (talk) 21:13, 27 March 2018 (UTC)

Water fluoridation is a health article, that starts with a "Goal" section. It is not possible for a MEDMOS guideline to envision every possible type of article. If you can find a better structure in a dietary article, please suggest it, but MEDMOS doesn't seem to have a Dietary organization structure, and there is no other dietary FA I can find. I also wanted to mention that, on the image you object to, it is easy to replace. That's the advantage of images :) Also, speaking in capacity as former FAC delegate, objections (re WP:WIAFA) must be "actionable". SandyGeorgia (Talk) 21:25, 27 March 2018 (UTC)

Actually MEDMOS sections are very much suggestions only and writers are encouraged to diverge should an alternative be more appropriate. I should know, Jytdog, because I wrote it. And MEDRS. When I wrote the suggested sections in MEDMOS, it was based on a handful of FACs and I found absolutely no consistently whatsoever. Nor is there consistency today. It was purely a "you might want to start with this" idea. Unfortunately, Doc James took this as literal gospel truth and went around modifying articles "per MEDMOS" and thus totally destroying the flow the writer had created. Ironically, "Changing an established article simply to fit these guidelines" is explicitly discouraged by MEDMOS. Nothing less than vandalism, and very very sad. -- Colin°^Talk 21:29, 27 March 2018 (UTC)

Painful reminder that what User:Tony1 created, one crusade destroyed! I had forgotten ... darn you for the reminder. SandyGeorgia (Talk) 21:40, 27 March 2018 (UTC)

POV pushers tend to treat policies and guidelines as "suggestions". We obviously have a walled garden fanpage here. I will leave you all to play in it. Jytdog (talk) 22:09, 27 March 2018 (UTC)