Why the fourth food group?
This web site uses on line course software to support learning communities for people interested in ketogenic diet. I call it the fourth food group rather than ketones or ketone bodies. As a chemist the word ketone implies a ketone functional group. The most important "ketone body" R-3-hydroxybutyrate or D -beta-hydroxybutyrate is not a ketone. So, I prefer to call ketones the fourth food group.
For People with Parkinson's and caregivers:
I asked some friends to put this site up so that people with Parkinson's and caregivers could get answers to questions and report on successes and struggles. It is not a simple to use web site, but I wanted it to be interactive without requiring me to answer emails directly. There is a troubleshooting discussion forum that you can read through and see if someone has had a similar problem before posting the same question. If you wish to participate, you have to create a login and sign up for the course.
A short video introducing a ketogenic program used by Bill Curtis
Some short videos on how I think this works:
You should start with this video explaining what one must know to understand the work of Dr. Richard Veech. For other videos see youtube.com/thefourthfoodgroup.
For Doctors when your patients ask you about intermittent ketosis as an adjunctive therapy for Parkinson's:
If you are a doctor seeking information to advise patients on safety or want to know the known complications and contraindications, Here is some material for your consideration:
There has been a published paper on a feasibility study by Ted VanItallie of the ketogenic diet in treatment of Parkinson's disease.
This excerpt from a book by Miriam Kalamian addresses contraindications and complications of a full ketogenic diet:
Before you commit to a ketogenic diet, it’s essential that you look objectively
at your current situation and weigh its possible benefits against potential risks.
Let’s look at some of the most common exclusions and limitations. It’s a small
but important list: In fact, it consists mainly of genetic disorders that would
interfere with your body’s ability to utilize fats as fuel. Because these disorders
cause major problems very early in life, it’s very unlikely that you would have
reached adulthood without a diagnosis. A more complete description of these
conditions can be found in the book The Ketogenic and Modified Atkins Diets,
coauthored by the ketogenic diet team at Johns Hopkins Hospital.
1 If you know that you have one of these genetic disorders, you should definitely NOT
begin this diet:
• a primary (i.e., inborn, not acquired) carnitine deficiency
• a fatty acid oxidation pathway defect
• pyruvate carboxylase deficiency
• porphyria (usually inherited, but possibly acquired)
The following list of “relative contraindications” is much broader, and if one
or more of these apply to you and you decide to proceed with the diet anyway,
you may require specialized medical and nutritional oversight. In other words,
you may still be able to implement the diet, but it’s essential that you have a supportive
and readily available keto-savvy team before you begin. Here they are:
1. You are currently either pregnant or lactating.
2. You are considering implementing this diet for a child.
3. You are unable or unwilling to restrict alcohol intake until after you
are keto adapted.
4. You have:
• either primary or metastatic liver cancer
• elevated liver enzymes (high enough to suggest liver damage)
• a history of a surgery that affects the structure or function
of your gastrointestinal tract (e.g., esophageal surgery, a
• type 1 diabetes
• type 2 diabetes that is poorly controlled or for which you take
a medication that puts you at high risk for ketoacidosis
(e.g., an SGLT2 inhibitor, such as canagliflozin [Invokana])
• a history of gastric bypass surgery (or currently have a lap band)
• intractable constipation as a side effect of painkillers (opiates)
• difficulty swallowing
• slowed gastrointestinal motility due to neurological impairment
or neurodegenerative disease
• gallbladder obstruction or a history of pancreatitis
• heart disease (including an elongated QT interval or a
• renal disease
• short bowel syndrome
• cachexia due to cancer (which needs intense management)
• red flags in your bloodwork (high or low values) that suggest
underlying metabolic issues or impaired immune function
It’s often difficult to predict if the challenges you’re facing are just a bump in
the road or significant enough to stop you in your tracks. Be realistic in the assessment
of your situation and seek medical advice from members of your team.
... On its own, a chronic bowel disease (such
as Crohn’s disease or ulcerative colitis) won’t prevent you from starting the
diet, but if your symptoms are not well controlled, or if the only way you
can get through the day is with a bland diet of easily digestible carbohydrates,
then you may want to rethink moving to keto right now. On the other hand, if
your only gastrointestinal symptom is uncomplicated gastroesophageal reflux
disease (GERD), then you may be happy to learn that this may improve with a
ketogenic diet (despite the frequently given advice that cutting out fatty foods
will improve your GERD symptoms).
Other health issues, such as kidney stones or gout, usually don’t preclude
embarking on a ketogenic diet, though you should work closely with a practitioner
who can monitor both symptoms and treatment (if any is needed). If
you do have a personal or family history of kidney stones, discuss prophylactics
(such as potassium citrate) with your doctor before you start the diet. For those
of you without a gallbladder, it may ease your mind to know that you certainly
can adopt a ketogenic diet. All of these issues are discussed in more detail in
chapter 15 (“Challenges Introduced by Other Chronic Diseases,” page 277).
In some cases medications may need to be monitored or adjusted. Examples
include drugs used to treat high blood pressure (including diuretics), diabetes
drugs (including those noted previously), steroids used to control inflammation
(such as prednisone or dexamethasone), and opiates used for pain relief (such as
hydrocodone or fentanyl). Hormones used to treat thyroid disease may cause a
rise in morning glucose levels, and some people prefer to switch to overnight dosing.
But as with all medications, talk to your doctor before you make any changes.
If you currently have malabsorption problems, or you have little to no appetite,
those issues should be addressed by your team before implementing a ketogenic
diet. Also, if you are on the path to recovery but are still at too low a weight, or
at risk of losing weight because of known side effects of your treatment, then
you must be followed closely by a clinical nutritionist. (Expect to hear that you
need to eat a “balanced diet” or drink “nutritional” shakes to increase your calories
using easily digestible carbs.) Under these circumstances, you should first
gradually increase your intake of fats while simultaneously removing foods with
added sugars. If you can hold your weight steady, then you may be able to slowly
transition to a ketogenic diet over a period of several weeks. Again, it’s best to do
this with guidance—preferably from a keto-savvy nutrition specialist.
On its own, use of a feeding tube is not a strong enough reason to dismiss
the diet. There are commercially available keto formulas, but many people
who have tubes prefer to blenderize their meals instead. In fact, it’s often easier
to keep to your targets this way; meals can be prepared in batches well in
advance, then frozen for future use. I cover this option in chapter 15 (“Blender
Ketogenic Diets,” page 287).