Facebook Fails: The Ketogenic Diet and Food Allergies
One of Facebook’s flaws is how it pushes hazardous recommendations to people with medical issues. The ketogenic diet is popular for weight loss these days. Keto isn’t exactly a new diet — a ketogenic diet has been around nearly a century for epilepsy management — and recent research is exploring possible benefits ranging from Parkinson’s Disease to cancer. Yet suppose you don’t have a weight control problem or any of those medical conditions; instead you have food allergies. Facebook still suggests the ketogenic diet. Yet no evidence shows that ketogenic dieting does any good for food allergies, and keto may do real harm to people who have this condition.
Questions about keto and allergies have been coming up on Facebook’s food allergy groups, apparently because joining a food allergy group gets into Facebook’s user profile database as “interested in health and wellness” which means spam for the health fads of the season. So when people with food allergies ask about keto I head over to the US National Institutes of Health database to see what the science has to say. Not only have multiple topic searches turned up zero evidence of benefit, the only relevant journal article warns about the danger of nutritional deficiencies from unnecessarily restrictive diets.
People who manage severe food allergies are already at risk of nutritional deficiencies because the only effective management strategy to prevent life threatening anaphylaxis is a complete avoidance of allergens. This risk has gained attention among medical researchers in part because food allergies are often a childhood ailment: serious nutritional deficiencies in growing children could cause lifelong problems even if a child outgrows the allergies. The nutritional risks in any given case would vary according to which allergies the individual has, but generally speaking this is not a condition that lends itself to fad dieting.
Fair disclosure: I am not a healthcare professional and this is not medical advice. What I am saying is, you know how TV segments about weight loss dieting include advice to check with your doctor in a tone that hints our lawyers made us say this? — that disclaimer really means something if you’re already avoiding a bunch of foods because your doctor has diagnosed you with food allergies. It might take professional guidance to choose a weight loss plan that works around your restrictions without leaving you short on essential nutrients. Although nutritional supplements do exist, lax regulation on that industry presents a separate set of risks.
Facebook’s health suggestions don’t carry any disclaimer.
Why write this post? Because today I responded to someone with Oral Allergy Syndrome who has been on a keto diet for four weeks and has resumed eating the foods that cause his symptoms. He thinks the diet is making his OAS subside, but for all anyone knows he may live in region that’s having a late spring. Oral Allergy Syndrome is related to pollen count (there’s complicated biochemistry behind that connection) and I’ve seen people before who thought a keto diet had cured their OAS when, really, the more likely explanation was that the foods which caused their symptoms were cross-reactive with ragweed and there wasn’t much ragweed in bloom when they tried keto in November. Today was one interaction too many.
People who have Oral Allergy Syndrome run a 1 in 60 chance of developing life threatening anaphylaxis. If a case crosses that rubicon, as mine has, there’s no going back. It means managing a life threatening food allergy forever. Oral Immunotherapy is not in clinical trials for anaphylactic OAS so there’s no cure on the horizon for this condition. Anaphylactic OAS is not covered under the 2004 FALCPA food allergy law, so those of us who have it are on our own in terms of management. Our allergens could be hidden in any product that contains “natural flavors” and most manufacturers don’t even keep track whether their equipment shares lines with OAS allergens. Although most cases of Oral Allergy Syndrome are mild, I’ve lived with its most severe manifestation for decades and don’t wish anaphylactic OAS on anyone.
Facebook is vaunted for its supposed “very granular micro-targeting” so a reasonable adult could suppose a recommendation that carries no disclaimer has been vetted. Actually this is scattershot, which might not be so bad for healthy people who restrict their diets as a matter of fashion but it can lead to real problems for actual wheat allergy or Celiac disease or other serious diagnoses. Below is a sample screen shot of today’s recommendations. To be clear about how badly mistargeted these are, the anti-vax group is getting aimed even though the pages I like include Science-Based Medicine and Scientific American.
Anyone can start a group or buy an ad on Facebook. If the site makes any attempt at vetting it’s so porous that it’s meaningless.
