Talk:Ketogenic diet/GA1

GA Review

Good article nomination on hold

This article's Good Article promotion has been put on hold. During review, some issues were discovered that can be resolved without a major re-write. This is how the article, as of July 6, 2008, compares against the six good article criteria:

1. Well written?:

• Generally too complex and often in passive voice. Try simplifying sentences and switching to active voice. For example, just from the lead:

"primarily used in the treatment of difficult-to-control (refractory) epilepsy in children." - "primarily used to treat difficult-to-control (refractory) epilepsy in children."

Think you fixed that one. Colin°^Talk 22:43, 7 July 2008 (UTC)

"The diet is calculated to have just enough protein..." - "The diet has just enough protein..."

Changed. Colin°^Talk 22:43, 7 July 2008 (UTC)

"To achieve this, a number of foods are effectively eliminated (for example, starchy fruits and vegetables, bread, pasta, grains and sugar)." - "This is achieved by eliminating foods containing large amounts of starch and sugar, such as starchy fruits and vegetables, bread, pasta, grains and sugar."

I've rephrased this with a sentence that discusses reducing carbs and increasing fat. Colin°^Talk 22:43, 7 July 2008 (UTC)

"which allows for some relaxation of the carbohydrate and protein restriction." - "allowing less restrictive carbohydrate and protein intakes.

I've rephrased this and added the consequential benefit. Colin°^Talk 22:43, 7 July 2008 (UTC)

• Unclear what the "normal metabolic process" is, Would be simpler to just say "Normally glucose is used as fuel for the body and the brain. However, if carbohydrate..."

If the primary author of metabolism is unclear then I must be doing something wrong :-). Can you elaborate? The problem I see with the suggestion, particularly as the third sentence of the article, is that it says nothing about how glucose is acquired (might someone even think we consume sufficient quantities of glucose?). Is the transformation of carbs (and protein) into glucose not a "metabolic process"? I need a bit of help here. Colin°^Talk 22:43, 7 July 2008 (UTC)

I think we can ignore gluconeogenesis in the lead, just for simplicity's sake. What do you think of the new version?

Much better. However, we've got two "body"s in the sentence. Can the first one be replaced by an organ (is it the liver)? Colin°^Talk 10:23, 9 July 2008 (UTC)

• I've always disliked the use of science as an adjective eg "scientifically developed" or "scientifically study", you could either say "study" or "developed" or "developed by nutritionists"

I've dropped it. But you've just offended a bunch of (medically and scientifically trained) dietitians by confusing them with nutritionists (Gillian McKeith, need I say more?) That's the distinction I was trying to emphasise by the use of "scientifically". Colin°^Talk 22:43, 7 July 2008 (UTC)

Oh dear. Me too. Colin°^Talk 16:15, 8 July 2008 (UTC)

• Describing somebody as a "disciple" is a bit overblown.

The word appears in most of my sources and originally comes from the great Lennox's contemporary account. Reading about the two characters, I think it is appropriate and I can't think of a good alternative. Colin°^Talk 22:43, 7 July 2008 (UTC)

• Unclear what the idea is in "The idea was to maintain the benefits of fasting over a much longer period."

I've rephrased this, does that help? Colin°^Talk 22:43, 7 July 2008 (UTC)

• This sentence is hanging "and first used urine testing to monitor the level of ketosis." - do you mean was the first to use urine testing?

Changed. Colin°^Talk 22:43, 7 July 2008 (UTC)

• "difficult to produce palatable meals, which led to problems with compliance." - recast this in terms of the patient's view. eg "which meant that people found it difficult to follow the diet for long periods."

I've rephrased this, closer to the source too. The suggested alternative would produce two "difficult"s. Colin°^Talk 22:43, 7 July 2008 (UTC)

• Unclear what culture has to do with this dies, in the sentence "The form of classic or MCT ketogenic diet offered varies with the hospital and also culturally."

I'll come back to this and expand. Colin°^Talk 22:43, 7 July 2008 (UTC)

• for a period of time this is always a phrase to avoid. It is vague and adds nothing to the sentence. Either say abut how long "about 2-3 months" or give a range "ranging from 2 months, up to five years" (numbers invented, don't quote me!)

Rephrased but there are no number to give. Colin°^Talk 22:43, 7 July 2008 (UTC)

• "spotting issues with compliance" - "checking if the patient is following the diet"

Rephrased, but can't say "check" twice so I've gone with "confirm". Colin°^Talk 22:43, 7 July 2008 (UTC)

• "The initial fast has been likened to an intravenous loading dose of medication, used with certain anticonvulsants, where treatment begins with a large dose of the drug and maintained on a lower dose." - you could probably cut this, it is a bit of a digression

Dropped. Colin°^Talk 22:43, 7 July 2008 (UTC)

• The sentence "Children with refractory epilepsy are more likely to find the ketogenic diet to be effective than trying an alternative anticonvulsant drug" needs to be merged with the rest of the text, rather than being a paragraph on its own.

Moved to end of earlier paragraph. Colin°^Talk 22:43, 7 July 2008 (UTC)

• The section on MCT oil repeats some of the material from earlier.

I'll come back to this. Colin°^Talk 22:43, 7 July 2008 (UTC)

• "liquid feed that has none of the palatability issues" - what palatability issues? Unclear what this is referring to, is it comparing the liquid feed to the classic ketogenic diet?

I've rephrased and expanded this a little. Perhaps I need to make it clear that the MCT diet also has palatability issues (consuming that much oil-emulsion isn't fun). Colin°^Talk 22:43, 7 July 2008 (UTC)

2. Factually accurate?:

• "There are no harmful or beneficial interactions between anticonvulsant drugs and the ketogenic diet." - this needs a citation, it is also unlikely to be true, since RCTs are lacking and all we can probably say is that no interactions are known at present.
• "These are generally less severe and less frequent than with anticonvulsant medication or surgery." - needs a citation, perhaps the Paediatrics review?
• "the combination of these anticonvulsants and the ketogenic diet does not appear to elevate that risk." - needs a citation
• "Oral potassium citrate is preventative and has no clear disadvantages; its routine use is under investigation." - needs a citation

3. Broad in coverage?: Pass

4. Neutral point of view?: Pass

5. Article stability? Pass

6. Images?:

• The caption "Urinary ketones are tested daily." doesn't tell you what the image actually is.

Please address these matters soon and then leave a note here showing how they have been resolved. After 48 hours the article should be reviewed again. If these issues are not addressed within 7 days, the article may be failed without further notice. Thank you for your work so far. Tim Vickers (talk) 17:49, 6 July 2008 (UTC)

I believe I've fixed the issues in section 2. I'll try and address the specific issues from section 1 tomorrow (but will let you know if I can't manage that in time). Then I'll work on the more general complex/passive issues. Wrt "cultural" issues, Graham had the same query in his review above. I will try to add something here, I've got a source that covers it. Colin°^Talk 22:59, 6 July 2008 (UTC)

You've made more than enough progress for this to be a GA. To be honest it didn't need much! Tim Vickers (talk) 03:05, 9 July 2008 (UTC)