WINCHESTER — Food can have a big impact on health, and area experts are using two popular diets — the ketogenic diet and the plant-based diet — to help treat a slew of conditions and diseases from epilepsy to cancer.
At a recent Wednesday seminar at Winchester Medical Center, a roomful of health professionals enjoyed a vegan lunch and listened to Dr. Neal Barnard discuss how plant-based diets high in fiber and low in oils can help ease or eliminate symptoms of obesity, autoimmune disease, infertility, menstruation and Type 2 diabetes.
“If you have a patient with rheumatoid arthritis, Sjogren’s disease, asthma — run, do not walk, to a completely plant-based diet,” Barnard said. “Do it for a couple of months and just see.”
Plant-based diets can also ease symptoms of endometriosis in women and erectile dysfunction in men, said Barnard, founder and president of the Barnard Medical Center in Washington and the Physicians Committee for Responsible Medicine. He is an adjunct professor of medicine at the George Washington University School of Medicine and is a fellow with the American College of Cardiology.
Though potentially treatable through medication, erectile dysfunction is, in many cases, caused by atherosclerosis, Barnard said — a disease of the arteries characterized by fatty buildup that, if left untreated, will likely cause a patient to have a stroke or heart attack within a few years.
“The erectile dysfunction is the canary in a coal mine,” he told physicians.
Sometimes erectile dysfunction is caused by alcohol or medication, he said, but not usually. He cautioned physicians never to prescribe a patient erectile dysfunction medication without also instructing the patient on the risks of atherosclerosis.
“You must talk to him about his diet,” Barnard said. With dietary changes, erectile dysfunction in most cases will go away, but more importantly, he said, the patient may live longer.
Barnard has been studying plant-based diets for many years, advising patients to record their symptoms and their progress. He referenced various other studies during his talk on Dec. 11, including studies out of UCLA, Tufts University, the American Health Foundation and the Women’s Healthy Eating and Living Study.
It isn’t enough for a diet to be vegan, he said. It also needs to be high in fiber from foods like fruit and vegetables and low in fat, particularly oils. It’s this crucial combination of factors that helps reduce levels of excess estrogen in the body that cause so much pain and disease.
“I don’t know why cutting out fat reduces estrogen,” Barnard said. “I’ve never heard a good explanation. It does.”
He said evidence of the link between a plant-based diet and diminished pain and disease could be seen in a patient of his who sometimes maintained a vegan diet but would allow fatty foods to creep back in. “Her pain came back,” he said.
The benefit of high-fiber diets is easier to understand, he said.
“If you don’t have adequate fiber, then the estrogens have nothing to be sequestered by,” he said. And they end up going back into your circulation, and they go back to the liver a little while later. … So fiber interrupts them,” he said.
Too much estrogen in the body causes buildup of fat, he said, and leads to diseases such as breast cancer, ovarian cancer, heart attack and stroke.
Migraine pain might also be lessened through a plant-based diet, according to a randomized crossover trial that Barnard co-authored and published in “The Journal of Headache and Pain,” Oct. 23, 2014.
The study, indexed at ncbi.nlm.nih.gov/pmc/articles/PMC4227630/?report=classic, followed 42 adult migraine sufferers in the Washington, D.C. area, assigning half a plant-based diet and the other half a placebo supplement. The study concluded “a nutritional approach may be a useful part of migraine treatment, but that methodologic issues necessitate further research.”
Diet may also affect migraines through indirect mechanisms, the study reported.
“Changes in plasma estrogen concentrations throughout menstrual cycles are strongly associated with migraine,” it says. “Diet changes, particularly a low-fat, high-fiber, vegan diet, appear to reduce estrogen activity and the intensity and duration of premenstrual symptoms. Therefore, such a diet may be expected to reduce frequency of headaches occurring in the premenstrual period.”
Barnard recommends a plant-based diet without meat or animal products as a way of avoiding additional hormones, such as those that become biologically active in people’s bodies when they drink milk.
“There is no hormone-free milk,” he said.
Women with breast cancer have a higher chance of dying from their disease if they consume a lot of dairy, he said.
Though cheese has only trace amounts of estrogen, he said other qualities of cheese, such as the fat content, has been found to produce low sperm counts in test subjects who eat high amounts of cheese.
“Cheese is about 70 percent fat,” he said.
One of his test subjects experiencing infertility became pregnant after a couple months on a plant-based diet, and another study patient was cured of endometriosis lesions when she stopped consuming dairy and switched to a plant-based diet.
“Endometriosis is an estrogen-driven disease,” Barnard said. “And that’s why it’s worse in cycles.”
Addressing claims that soy products contribute to cancer, he said that isn’t true.
“It does not cause cancer,” he said. If anything, he said, it helps.
The keto diet
The ketogenic diet as many know it today is high in fat and low in carbs, but Dr. Paul Lyon, a neurologist with Winchester Neurological Consultants, said keto is really a group of clinical intervention diets that includes the Atkins (high protein, low carbohydrate) diet and intermittent fasting.
The purpose of a keto diet, he said, is to force the body into a state of ketosis, in which the liver is converting glycogen into ketones that the brain and other organs can use as an energy source.
Program participants aim for anywhere from about 50 to 90 percent fat in their diet, Lyon said. They basically shift the calories they would normally get from simple carbohydrates to fat, he said.
At its most perfect, a keto diet is 90 percent fat and is used to eliminate spasms in infants, a treatment that he said was championed in the 1990s by doctors at Johns Hopkins University.
This isn’t a diet for just anyone, said Laila Hammer, a clinical dietitian with Winchester Medical Center. It’s meant as a short-term intervention, she said, not a lifestyle.
“I do the diet as a treatment for epilepsy,” said Hammer. “We treat it like a medication. You can’t really have a cheat day.”
Because she treats it as medication, she said health professionals can tweak it like they would a medication.
“The research is very strong,” she said. “It’s been around since the early ’20s.”
Using a ketogenic diet to treat epilepsy was popular until the 1950s, she said, but fell out of favor with the advent of more medications.
Since medicine doesn’t work for everyone, she said epilepsy specialists have started turning to keto again.
Doctors prescribe medication before recommending the diet, since medication does work a lot of the time to manage symptoms, and keto is tough to keep up long-term. If two or more medications fail, they will suggest the diet, which Hammer has seen to have a 50 percent or greater reduction of symptoms in about half the patients who try it.
“That’s pretty impressive,” she said.
Seizures are a result of abnormal electrical activity in the brain, Hammer said. Generally epilepsy is diagnosed after a patient has two seizures.
Keto was originally designed for childhood epilepsy, and she said children who do well on the diet can usually wean off of it after two or three years and return to eating normally.
“Nobody really knows why,” Hammer said. “That is what we know and that is the plan.”
There is something neuroprotective about keto, she said. It not only helps control the number and severity of seizures, but patients report thinking more clearly.
Keto, she said, has also been shown to treat patients with other neurological conditions, such as ALS, Alzheimer’s disease and autism. Lyon said there’s research that keto could help minimize symptoms of dementia and combat tumors.
Keto can even be plant-based, based on the patient’s needs, said Lyon. The key, he said, is for the liver to produce ketones.
“A plant-based diet tends to be less calorie dense,” he said. Such a diet can mimic the effects of keto with extreme calorie restriction. Intermittent fasting and high-intensity exercise can also produce those effects, he said.
For epilepsy he said he probably would not use a plant-based diet, because there’s no evidence that it helps.
Anyone with specific dietary needs should consult a physician before starting a restrictive diet. People with genetic disorders or elevated cholesterol could have problems on a keto diet, Lyon said.