Talk:Ketogenic diet

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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 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)

Medium-chain fatty acids

I see that Iztwoz added the text "Medium-chain fatty acids octonoic and heptanoic acids can cross the barrier and be used by the brain." with a few sources. They don't appear to meet WP:MEDRS as they seem to be studies on mice and rats, rather than humans. We need secondary sources that directly discuss these acids wrt the ketogenic diet's mechanism in humans. If we can't find suitable sources for this, it should be removed. -- Colin°^Talk 14:06, 31 March 2018 (UTC)

Yes I added that taking it from Brain metabolism section - was unaware at the time of need for MEDRS (and also of need to make clear ref to mouse and rat models)....The material has been there for almost three years so am pleased that you have now removed it. There are some good recent reviews PMID 21855298 on Triheptanoin and PMID 27868154 that might be of help. Best --Iztwoz (talk) 17:08, 31 March 2018 (UTC)

Hi Colin have just seen same info added on Human brain page which passed GA and has refs:PMID 22403540; PMID 23072752; and PMID 15717057 --Iztwoz (talk) 17:18, 31 March 2018 (UTC)

Iztwoz, thanks for this. I'll certainly consider this role in possible mechanism as I read more. To avoid WP:OR I really need a review on the KD in humans that links this research. Like PMC 3534786 but perhaps newer still. -- Colin°^Talk 17:26, 31 March 2018 (UTC)

Revert

I am rather puzzled by this revert by User:Zefr with summary "Preliminary research; speculative" The edit removed several updates I made to the article today:

• this: I added another, new, source for the treatment of glucose transporter 1 deficiency syndrome. This is very much the established treatment for the disease and has been for many years.
• this: I liked to "Warburg effect" which is the name being given to the reason why cancer cells are particularly susceptible to changes in glucose metabolism
• this: I replaced the existing text on cancer research with a newer review. The text makes it very clear that this is at the trial stage and is very much appropriate WP:WEIGHT for the topic (other professional resources on the KD give a similar, if not more, amount of room to potential new treatment uses of the KD, particularly cancer).
• this: I removed text based on an old review. The research has moved on from "anecdotal".
• this: I add the results of a 2018 systematic review on the KD for epilepsy in adults. This is neither "research" nor "speculative". The KD is offered to adults at many highly respected epilepsy specialist centres. Again, this is something noted in all reviews and texts on the KD. The lack of a paragraph on this topic meant the article was under-WP:WEIGHT.

I ask Zefr to restore my edits and to take more care in future. I'm not some random newbie here. -- Colin°^Talk 15:59, 2 April 2018 (UTC)

The edits and sources used confirm the KD is a speculative format that does not yet meet encyclopedic information, as revealed in this edit and source. None of this is proven conclusively, so fails WP:MEDASSESS. For treating epilepsy, the most recent Cochrane review, PMID 26859528 as shown in the conclusions, describes this area as preliminary, inconclusive, and to date, poorly studied, i.e., unencyclopedic because it fails WP:V. --Zefr (talk) 16:19, 2 April 2018 (UTC)

(ec) Zefr I'm quite familiar with the literature on this topic, as I wrote the article, and have spent the weekend refreshing my appreciation of the topic. I know about the Cochrane review because I added it to the article yesterday. The world does not revolve round Cochrane, which is merely one form of systematic review with limitations to their approach. The text I added was based on a systematic review, and was one of two systematic reviews I looked at, but decided to only cite one. WP:MEDASSESS has systematic reviews at the top, which this is. Btw, "None of this is proven conclusively" is perhaps a suitable game for hard sciences like physics but never true for medicine, and the KD has never been suggested as a first line treatment, except for some rare conditions. Have a look at this recent review from Norway. Search for the word "adult". You will find this article gives similar weight to that. There are plenty other examples. It most certainly does not fail WP:V as the statements added can be sourced to multiple first-class reviews. It also does not fail WP:WEIGHT as the topic is entirely appropriate to cover based on the literature. It is also not speculative, as the KD is indeed offered to adults in epilepsy centres across the world, and not just as part of some trial. That last point is a basic fact that should make you pause and think.

Additionally you removed other edits unrelated to the complaint you made above. That was simply disruptive. -- Colin°^Talk 16:38, 2 April 2018 (UTC)

Another revert

There's quite a bit in this article that doesn't meet the standards of WP:MEDRES. Consider this material: "The ketogenic diet may be a successful treatment for several rare metabolic diseases. Case reports of two children indicate that it may be a possible treatment for astrocytomas, a type of brain tumour. Autism, depression, migraine headaches, polycystic ovary syndrome and diabetes mellitus type 2 have also been shown to improve in small case studies. There is evidence from uncontrolled clinical trials and studies in animal models that the ketogenic diet can provide symptomatic and disease-modifying activity in a broad range of neurodegenerative disorders including amyotrophic lateral sclerosis, Alzheimer's disease and Parkinson's disease, and may be protective in traumatic brain injury and stroke." Case reports on two children, small case studies, uncontrolled clinical trials, and studies in animal models are not appropriate grounds for claims of efficacy. Peter coxhead (talk) 16:32, 2 April 2018 (UTC)

Wrt, this revert with comment "the fact that randomized trials were recommended shows that the evidence does not meet WP:MEDRS". Peter, I trust you also are unfamiliar with the topic, nor have carefully read the article. The text you removed is not in the "efficacy" section nor is in the "indications" section. If I was claiming the KD was indicated as a treatment for cancer, then you'd be quite right to demand better quality evidence. But this is a section on possible future uses of the KD and quite clearly so. I am planning to update some of the text here as I find newer sources. The KD is actively being studied clinically for certain cancers, which, as I note, appear "promising", and no more. Some of those cancers, particularly brain cancers, have no effective treatment at all. Please can you restore your text and can you guys try to edit more constructively and collaboratively. Particularly as neither of you are familiar with the topic, your first step should be to ask question. If you can't edit constructive, take this off your watchlist and find something else to do. -- Colin°^Talk 16:46, 2 April 2018 (UTC)

And Peter, you've even broken the references on the page. Wikipedia does not need careless uncollaborative editors. -- Colin°^Talk 16:53, 2 April 2018 (UTC)