Ketogenic diet in refractory migraine: possible efficacy and role of ketone bodies-a pilot experience.

INTRODUCTION: Refractory migraine is a particularly disabling form of chronic migraine, unresponsive to multiple prophylactic strategies. Ketogenic diet (KD) is useful to treat migraine but poorly tested for refractory migraine. OBJECTIVE: We started exploring the efficacy and safety of KD, as compared to a non-ketogenic dietary regimen similar in reduction of carbohydrate intake (low-carb diet, LCD), in refractory migraine. Secondary objective was to explore whether ketones have a role in the prophylaxis induced by KD on migraine. RESULTS: In a first trial, 22 patients with refractory migraine were included and completed the study. Thirteen (mean age 36.8 ± 12.9 years, 11 females, 2 males) were assigned to the KD arm and eight (mean age 50.9 ± 10.8 years; all females), not eligible for KD, to LCD. Patients treated with KD showed a significant reduction in the frequency of migraine attacks, intensity of headache, and amount of drug intake. No significant benefit was seen in the LCD group. A relationship between ketone production and effect on headache was observed among patients with a good response to KD. In a second study, additional 31 refractory migraineurs were treated with these two dietary regimens, 26 with the same KD scheme and 5 with a LCD. Results were comparable with those of the first study. CONCLUSIONS: KD might be a useful option in refractory migraine. Ketones seem to have a role in migraine modulation and their regular measurement might be useful to monitor KD in migraineurs. Larger, randomized, and controlled trials are needed to confirm these data.

Dietary Fiber and Gut Microbiota in Renal Diets.

Nutrition is crucial for the management of patients affected by chronic kidney disease (CKD) to slow down disease progression and to correct symptoms. The mainstay of the nutritional approach to renal patients is protein restriction coupled with adequate energy supply to prevent malnutrition. However, other aspects of renal diets, including fiber content, can be beneficial. This paper summarizes the latest literature on the role of different types of dietary fiber in CKD, with special attention to gut microbiota and the potential protective role of renal diets. Fibers have been identified based on aqueous solubility, but other features, such as viscosity, fermentability, and bulking effect in the colon should be considered. A proper amount of fiber should be recommended not only in the general population but also in CKD patients, to achieve an adequate composition and metabolism of gut microbiota and to reduce the risks connected with obesity, diabetes, and dyslipidemia.

Effects of moderate variations in the macronutrient content of the diet on cardiovascular disease risk factors in obese patients with the metabolic syndrome.

BACKGROUND: The metabolic syndrome is a cluster of abnormalities that is accompanied by a 2-fold increase in the risk of cardiovascular disease. Even if there is full agreement that lifestyle changes to induce weight loss are the first-line approach, the ideal diet for the treatment of the metabolic syndrome remains uncertain. OBJECTIVE: The objective was to compare the effects of 2 diets on cardiovascular disease risk factors in obese patients with the metabolic syndrome. DESIGN: The study was carried out in 100 patients randomly assigned to either a diet relatively rich in carbohydrate [65% of energy as carbohydrate, 13% as protein, and 22% as fat (17% as unsaturated fat)] or a diet that was low in carbohydrate and high in protein and in monounsaturated fat [48% of energy as carbohydrate, 19% as protein, and 33% as fat (24% as unsaturated fat)]. RESULTS: All 100 patients completed the 5-mo study. At the end of the study, all the components of the metabolic syndrome (except HDL, which did not change) decreased significantly in both groups. With the high-carbohydrate diet, a significant decrease in LDL-cholesterol concentrations was also observed. Although the extent of the resolution of the metabolic syndrome was not different between groups, the low-carbohydrate diet was associated with a greater decrease in the prevalence of hypertension (P < 0.05) and of hypertriacylglycerolemia (P < 0.001). CONCLUSION: Tailoring diet interventions to the specific presentation of the metabolic syndrome may be the best way of reducing the risk factors for cardiovascular disease.

Nutritional status and body composition by bioelectrical impedance vector analysis: A cross sectional study in mild cognitive impairment and Alzheimer's disease.

AIMS: Analysis of nutritional status and body composition in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). METHODS: A cross-sectional study was performed in a University-Hospital setting, recruiting 59 patients with AD, 34 subjects with MCI and 58 elderly healthy controls (HC). Nutritional status was assessed by anthropometric parameters (body mass index; calf, upper arm and waist circumferences), Mini Nutritional Assessment (MNA) and body composition by bioelectrical impedance vector analysis (BIVA). Variables were analyzed by analysis of variance and subjects were grouped by cognitive status and gender. RESULTS: Sociodemographic variables did not differ among the three groups (AD, MCI and HC), except for females' age, which was therefore used as covariate in a general linear multivariate model. MNA score was significantly lower in AD patients than in HC; MCI subjects achieved intermediate scores. AD patients (both sexes) had significantly (p<0.05) higher height-normalized impedance values and lower phase angles (body cell mass) compared with HC; a higher ratio of impedance to height was found in men with MCI with respect to HC. With BIVA method, MCI subjects showed a significant displacement on the RXc graph on the right side indicating lower soft tissues (Hotelling's T2 test: men = 10.6; women = 7.9;p < 0,05) just like AD patients (Hotelling's T2 test: men = 18.2; women = 16.9; p<0,001). CONCLUSION: Bioelectrical parameters significantly differ from MCI and AD to HC; MCI showed an intermediate pattern between AD and HC. Longitudinal studies are required to investigate if BIVA could reflect early AD-changes in body composition in subjects with MCI.

Is thyroid-stimulating hormone within the normal reference range a risk factor for atherosclerosis in women?

The relationship between overt hypothyroidism and cardiovascular risk has been well documented and some data also suggest an association between cardiovascular risk and subclinical hypothyroidism. The aim of our study was to investigate, in a large cohort of euthyroid women, the association of thyroid stimulating hormone (TSH) within the normal reference range with cardiovascular risk factors. The study was carried out on 744 women with normal thyroid function (TSH 0.3-4.9 µU/mL). Women with TSH above the median (≥2.1 µU/mL) were more obese, had greater waist girth, were more hypertensive and had higher levels of total cholesterol (TC), serum triglycerides (TG), blood sugar (BG) and lower levels of HDL-cholesterol (HDL-C) than women with TSH below the median. TSH was significantly correlated with body mass index (BMI), waist circumference, BG, TG, TC, HDL-C and hypertension. Multiple backward stepwise regression analysis with age, waist circumference and TSH as independent variables confirmed the strong association of TSH with BG, TG, HDL-C and hypertension. A total of 205 patients (28%) fulfilled the definition criteria of the metabolic syndrome and the prevalence of metabolic syndrome was significantly greater in patients with TSH above than in patients with TSH below the median. Results of logistic analysis, including age and TSH as predictor variables, confirmed the association of TSH with metabolic syndrome.The results of this study suggest that TSH in the upper limits of the reference range (above 2.1 µU/ml) is associated with a less favourable cardiometabolic profile and consequently with a higher risk of developing cardiovascular diseases.