Consumer Reports of "Keto Flu" Associated With the Ketogenic Diet.

Background: The ketogenic diet (KD) is a high-fat, low-carbohydrate diet that limits glucose and results in the production of ketones by the liver and their uptake as an alternative energy source by the brain. KD is an evidence-based treatment for intractable epilepsy. KD is also self-administered, with limited evidence of efficacy, for conditions including weight loss, cognitive and memory enhancement, type II diabetes, cancer, neurological and psychiatric disorders. A commonly discussed side effect of KD in media and online forums is "keto flu," a cluster of transient symptoms generally reported as occurring within the first few weeks of KD. This study aimed to characterize the pattern of symptoms, severity and time course of keto flu as related by users of online forums. Method: Online forums referring to "keto flu," "keto-induction," or "keto-adaptation" in the URL were identified in Google. Passages describing personal experiences of keto flu were categorized manually with reference to pattern of symptoms, severity, time course, and remedies proposed. Results: The search criteria identified 75 online forums, 43 met inclusion criteria and contained 448 posts from 300 unique users. Seventy-three made more than one post (mean 3.12, range 2-11). Descriptors of personal experience of keto flu, reported by 101 of 300 users, included 256 symptom descriptions involving 54 discrete symptoms. Commonest symptoms were "flu," headache, fatigue, nausea, dizziness, "brain fog," gastrointestinal discomfort, decreased energy, feeling faint and heartbeat alterations. Symptom reports peaked in the first and dwindled after 4 weeks. Resolution of keto flu symptoms was reported by eight users between days 3 and 30 (median 4.5, IQR 3-15). Severity of symptoms, reported by 60 users in 40 forums, was categorized as mild (N = 15), moderate (N = 23), or severe (N = 22). Eighteen remedies were proposed by 121 individual users in 225 posts. Conclusions: Typically, individual posts provided fragmentary descriptions related to the flow of forum conversations. A composite picture emerged across 101 posts describing personally experienced symptoms. User conversations were generally supportive, sharing remedies for keto flu reflecting assumptions of physiological effects of KD

Determining the association between fibromyalgia, the gut microbiome and its biomarkers: A systematic review

Background: The association between fibromyalgia and irritable bowel syndrome is well-established. Alterations inthe composition and diversity of the gut microbiome in irritable bowel syndrome have been reported, however,this association is poorly understood in fibromyalgia.Our aim was to summarise the research reporting on the gastrointestinal microbiome and its biomarkers in peoplewith fibromyalgia.Methods: A systematic review of published original research reporting on the gastrointestinal microbiota and itsbiomarkers in adults with a diagnosis of fibromyalgia was undertaken.Results: From 4771 studies, 11 met our inclusion criteria and were separated into four main groups: papersreporting Helicobacter pylori; other gut bacterial markers; metabolomics and other biomarkers, which includedintestinal permeability and small intestinal bacterial overgrowth.Conclusion: The results suggest there is a paucity of quality research in this area, with indications that the gutmicrobiota may play a role in fibromyalgia within the emerging field of the gut-musculoskeletal axis. Furtherinvestigations into the relationship between the gut microbiota, gut dysfunction and fibromyalgia are warranted

Mediterranean diet or extended fasting's influence on changing the intestinal microflora, immunoglobulin A secretion and clinical outcome in patients with rheumatoid arthritis and fibromyalgia: an observational study

BACKGROUND: Alterations in the intestinal bacterial flora are believed to be contributing factors to many chronic inflammatory and degenerative diseases including rheumatic diseases. While microbiological fecal culture analysis is now increasingly used, little is known about the relationship of changes in intestinal flora, dietary patterns and clinical outcome in specific diseases. To clarify the role of microbiological culture analysis we aimed to evaluate whether in patients with rheumatoid arthritis (RA) or fibromyalgia (FM) a Mediterranean diet or an 8-day fasting period are associated with changes in fecal flora and whether changes in fecal flora are associated with clinical outcome. METHODS: During a two-months-period 51 consecutive patients from an Integrative Medicine hospital department with an established diagnosis of RA (n = 16) or FM (n = 35) were included in the study. According to predefined clinical criteria and the subjects' choice the patients received a mostly vegetarian Mediterranean diet (n = 21; mean age 50.9 +/-13.3 y) or participated in an intermittent modified 8-day fasting therapy (n = 30; mean age 53.7 +/- 9.4 y). Quantitative aerob and anaerob bacterial flora, stool pH and concentrations of secretory immunoglobulin A (sIgA) were analysed from stool samples at the beginning, at the end of the 2-week hospital stay and at a 3-months follow-up. Clinical outcome was assessed with the DAS 28 for RA patients and with a disease severity rating scale in FM patients. RESULTS: We found no significant changes in the fecal bacterial counts following the two dietary interventions within and between groups, nor were significant differences found in the analysis of sIgA and stool ph. Clinical improvement at the end of the hospital stay tended to be greater in fasting vs. non-fasting patients with RA (p = 0.09). Clinical outcome was not related to alterations in the intestinal flora. CONCLUSION: Neither Mediterranean diet nor fasting treatments affect the microbiologically assessed intestinal flora and sIgA levels in patients with RA and FM. The impact of dietary interventions on the human intestinal flora and the role of the fecal flora in rheumatic diseases have to be clarified with newer molecular analysis techniques. The potential benefit of fasting treatment in RA and FM should be further tested in randomised trials

A Meta-Analysis of Probiotic Efficacy for Gastrointestinal Diseases

Background: Meta-analyses on the effects of probiotics on specific gastrointestinal diseases have generally shown positive effects on disease prevention and treatment; however, the relative efficacy of probiotic use for treatment and prevention across different gastrointestinal diseases, with differing etiology and mechanisms of action, has not been addressed. Methods/Principal Findings: We included randomized controlled trials in humans that used a specified probiotic in the treatment or prevention of Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, Antibiotic Associated Diarrhea, Traveler’s Diarrhea, or Necrotizing Enterocolitis. Random effects models were used to evaluate efficacy as pooled relative risks across the eight diseases as well as across probiotic species, single vs. multiple species, patient ages, dosages, and length of treatment. Probiotics had a positive significant effect across all eight gastrointestinal diseases with a relative risk of 0.58 (95 % (CI) 0.51–0.65). Six of the eight diseases: Pouchitis, Infectious diarrhea, Irritable Bowel Syndrome, Helicobacter pylori, Clostridium difficile Disease, and Antibiotic Associated Diarrhea, showed positive significant effects. Traveler’s Diarrhea and Necrotizing Enterocolitis did not show significant effects of probiotcs. Of the 11 species and species mixtures, all showed positive significant effects except for Lactobacillus acidophilus, Lactobacillus plantarum, and Bifidobacterium infantis. Across all diseases and probiotic species, positive significant effects of probiotics were observed for all age groups, single vs. multiple species, and treatment lengths

Could test preparation & interpretation impact hydrogen-methane breath testing results? A survey of current practices

Background: Hydrogen-methane breath testing is widely used in both gastroenterology andcomplementary therapies practice, yet current guidelines do not detail preparatory oral hygiene, norprovide standards for basal gas levels.Aims: To review and compare a range of instructions for oral hygiene prior to hydrogen-methane breathtesting provided by facilities offering hydrogen-methane breath testing services; and to investigatelaboratory interpretation of basal gas values and describe similarities, differences and management.Results: Twenty-five laboratories from six countries provided information regarding breath testingpreparation. In practice, there is a lack of uniformity in instructions for oral hygiene prior to breathtesting, and where instructions exist, little or no attention is given to adherence. A wide variance inaccepted norms for basal gases exists between centres, which may impact on whether testingcommences or not. It remains unknown whether elevation at baseline negates test results or shouldindicate deferring the test.Conclusion: There is no consensus on management of elevated basal gas levels. To improve the reliabilityof diagnostic results obtained from breath testing there is a pressing need for clarification of the impact ofthe role of oral hygiene on results, which should guide standardisation of instructions to includepreparation of the oral cavity

A systematic review of the association between fibromyalgia and functional gastrointestinal disorders

Background:Fibromyalgia and functional gastrointestinal disorders (FGID) includingirritable bowel syndrome (IBS) are common conditions presenting in clinical settings and aremore prevalent in women. While the relationship between IBS and fibromyalgia has beendemonstrated, a review of the prevalence of the broader group of FGID in adults with fibromyalgiahas not been undertaken. The aim of this review was to systematically review the publishedliterature, identifying the comorbidity of FGID in people with fibromyalgia, and to discuss theclinical implications, limitations of current research and areas of interest for future research.Methods:Medline, Embase, CINAHL and Web of Science were searched during June 2019.Results were screened for original research articles meeting established criteria foridentification of FGID in adults diagnosed with fibromyalgia.Results: A total of 14 studies involving 1340 adults with fibromyalgia, 363 healthy controlsand 441 adults with other pathologies were included in this review. Only 1 of the 14 studiesincluded surveyed the full range of FGID . Functional gut disorders were matched to RomeIIcriteria for reporting and comparison. In addition to increased abdominal pain and functionalbloating or gas, IBS of mixed-pattern and constipation-types appear to be more prevalent thandiarrhoea-predominant IBS in adults with fibromyalgia.Conclusion: This review confirms previous reports that IBS is common in people living withfibromyalgia and suggests that IBS-mixed and constipation types predominate. An associationwith a range of FGID other than IBS is suggested, but data are limited. Research exploring theassociation between fibromyalgia and functional gastrointestinal dysfunction beyond IBS arewarranted