Dr. Wolfgang Marx

If you're, yeah.

And I think that's really where, you know, that dietary education also comes into it,

there are various flavors of ketogenic diet.

There is vegan, there is vegetarian, there are whole food versions of ketogenic diets that can mitigate some of these risks.

But if you go on it and it's primarily meat and high saturated fat and all the rest of it, then I think there's a risk that you might be increasing your cholesterol levels, which has long-term cardiovascular risks associated with that.

The other area is around fiber and constipation.

So again, if you move on to a ketogenic diet where you're cutting out grains, which are a decent source of insoluble fiber, you're cutting out fruits, which again, great source of fiber, there's a risk of constipation.

Again, that can be managed with proper dietary education and planning, but it is something to be aware of.

And then I think the other area that I think needs to be managed and again leads to that importance of that medical supervision is that with any restrictive diet, not just ketogenic diet, but any type of significant dietary change, there is that

risk of disordered eating behavior either being revealed or exacerbated.

And so I think we don't want a therapeutic diet causing distress.

And so that sort of needs to be managed as well because I think it's very easy to get into that sort of mindset of carbs equal bad and all the rest of it.

So I think that disordered eating is something that really needs to be managed closely.

And particularly, I say that in light of our recent clinical trials where we have actually been formally screening for disordered eating in our dietary interventions.

And we see really substantial levels of possible indicators for eating disorders and disordered eating.

So it's not something that is a niche problem.

It's something that can be quite widespread.

And so, yeah, again, it just needs to be managed.

Yeah, so I guess as we've sort of said along the podcast, that is where the importance of individualization sort of comes in.

And I think Cherie and I have obviously been sharing notes or something because I feel like a lot of what she said rings true to a lot of the work that we're doing.