Milly Gaines
The ketogenic diet is a treatment for epilepsy that has been used since the 1920s. It involves eating a high-fat, low-carbohydrate diet that changes how the body uses food for energy, reducing seizures in many people. There are several versions of the ketogenic diet, including the classic ketogenic diet, the modified Atkins diet, and the low glycemic index diet, which differ in their restrictiveness and the ratio of fats to proteins and carbohydrates. The diet is typically recommended for children whose seizures have not responded to medication, but it can also be used to treat adults. To calculate the ketogenic diet for epilepsy, various factors are considered, including laboratory evaluations, nutritional evaluations, and individual patient characteristics such as age and route of administration.
| Characteristics | Values |
|---|---|
| Purpose | Manage treatment-resistant epilepsy |
| How it works | Changes how the brain gets energy to function |
| Food sources | Cream, butter, oil, and other naturally fatty foods |
| Types | Classic Ketogenic Diet (CKD), Modified Ketogenic Diet, Medium Chain Triglyceride (MCT) Diet, Modified Atkins Diet (MAD), Low-Glycemic Index Treatment (LGIT) |
| Nutritional composition | High fat, low protein, and low carbohydrate |
| Calories and fluids | Restricted |
| Who can benefit | Children and adults with epilepsy |
| Effectiveness | Reduced seizures in many people |
| Precautions | Should be carefully monitored by a dietitian and a doctor |
| Evaluation | Laboratory, nutritional, electroencephalogram (EEG), MRI, renal ultrasound, electrocardiogram, and carotid ultrasound |
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What You'll Learn
Classic Ketogenic Diet (CKD)
The Classic Ketogenic Diet (CKD) was designed for the treatment of epilepsy by Dr. Russell Wilder of the Mayo Clinic in 1923. It is a high-fat, low-carbohydrate, and controlled-protein diet that helps control seizures in some people with epilepsy. The diet is typically recommended for children whose seizures have not responded to several different seizure medications. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. Foods are weighed and measured. The CKD is an individually tailored, structured regimen that requires a gram scale to weigh single ingredients.
The dietary prescription of the classic diet follows either a 4:1 or 3:1 ratio of fat to protein and carbohydrate. In the 4:1 ratio, 90% of calories come from fat, 6% from protein, and only 4% from carbohydrates. The ratio of the diet can be adjusted based on the outcome; it can be increased for a more therapeutic effect or liberalized for improved tolerance. In general, the CKD is reserved for infants, small children, and those receiving enteral feeds due to its restrictive nature.
The ketogenic diet works by changing how the brain gets energy to function. Usually, carbohydrates from foods like sugars and starches provide most of the body's energy. The keto diet lowers the amount of carbohydrate intake and teaches the body to burn fat for energy instead. This metabolic state is called ketosis, where the body uses ketones or fat for energy instead of glucose. Ketones are not dangerous and can be detected in the urine, blood, and breath.
The ketogenic diet for epilepsy is a specialised meal plan that requires supervision by trained medical specialists. It is usually prescribed by a physician and carefully monitored by a dietitian. The diet can be adapted to suit different cultures, allergies, and modified texture diets. The dietitian will calculate the diet and try to include foods that the patient likes.
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Modified Atkins Diet (MAD)
The Modified Atkins Diet (MAD) is a less restrictive version of the classic ketogenic diet, which is often used as a treatment for epilepsy. The MAD was developed at Johns Hopkins Hospital to offer a less restrictive dietary treatment primarily for teenagers and adults. It is a mix between the classic Ketogenic Diet and the Atkins diet, limiting carbohydrates while allowing for more protein and fat.
The MAD does not require the weighing and measuring of foods, but patients and/or their parents must monitor their carbohydrate intake. It is flexible with proteins and strongly encourages fats, with a 1:1 macronutrient ratio of fat to protein and carbohydrates. The diet allows for 15 to 20 grams of carbohydrates per day, a reduction from the traditional Atkins diet.
The MAD does not restrict fluids or calories, and foods can be eaten freely in restaurants and outside the home. It is often used as a transition to or from a more strict Ketogenic Diet, as well as for families who lack the resources to administer a more restrictive Keto plan. The MAD is usually initiated in an outpatient setting, but the person must be monitored to ensure safety.
Before starting the MAD, it is important to consult a neurologist and dietitian to determine if it is a suitable treatment option. Blood tests may be required to determine if the diet is safe, including metabolic tests to rule out fatty acid disorders or a carnitine deficiency. Medical supervision and laboratory surveillance are recommended during the MAD, similar to the Ketogenic Diet.
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Low Glycemic Index Diet (LGID)
The Low Glycemic Index Diet (LGID) is a dietary treatment for epilepsy that was developed in 2002 as an alternative to the ketogenic diet. It is a flexible treatment option that allows for an increased intake of carbohydrates, with a typical goal of 40-60 grams per day. The focus is on consuming carbohydrates that have a low glycemic index, which refers to how much a food raises your blood glucose levels after eating compared to a reference food like sugar.
The LGID does not require the strict procedures of weighing and measuring foods that are high in fat and very low in carbohydrates, as seen in the ketogenic diet. Instead, it focuses on monitoring the total amount of carbohydrates consumed daily and ensuring they are from low glycemic index sources. This can be achieved by consuming carbohydrates with fats and proteins, as this further reduces the glycemic index. For example, buttering a piece of bread can reduce its glycemic index.
The LGID is a suitable option for those with refractory epilepsy, whose seizures have not been controlled despite trying multiple anti-seizure medications. It is often prescribed to children with seizures, as it allows for freedom in food choices while still inducing stable blood glucose levels. It is important to note that the mechanism of action of the LGID remains unknown, but it is thought that the metabolic changes, such as reduced blood glucose levels and the production of ketones, may have a therapeutic effect on the brain.
While on the LGID, multivitamin, mineral, and calcium supplementation is required to reduce the risk of deficiencies due to dietary changes. Additionally, there is an increased risk of acidosis, a blood condition characterised by low bicarbonate concentration, which can be treated with a bicarbonate solution without affecting the treatment's efficacy.
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Calculating the ketogenic ratio
The ketogenic diet is a high-fat, low-carbohydrate meal plan that has been used to treat epilepsy since the 1920s. It is a strict regimen that changes the way the body uses food for energy, inducing a metabolic state known as ketosis. While the diet has been shown to reduce seizures in many people, it may not work for everyone.
There are several variations of the ketogenic diet, including the Classic Ketogenic Diet (CKD), the Modified Atkins Diet (MAD), and the Low-Glycemic Index Treatment (LGIT). The "classic" version is the most restrictive, requiring careful measurements of calories, fluids, and proteins. The Modified Ketogenic Diet, on the other hand, is slightly less restrictive and follows a ratio range of 3:1 (3 grams of fat for every 1 gram of protein and carbohydrate) down to a 1:1 ratio. The Modified Atkins Diet is even less restrictive, allowing for more flexibility in protein intake and generally following a 1:1 ratio.
The ketogenic ratio is an important aspect of the diet, determining the ratio of fat to protein and carbohydrate intake. The classic KD follows a ratio of 4:1 or 3:1, while the modified KD follows a ratio range of 3:1 down to 1:1. The MAD typically follows a 1:1 ratio, but can vary depending on individual needs and preferences.
To calculate the ketogenic ratio, it is necessary to consider the patient's baseline weight, height, and ideal weight for stature and body mass index (BMI). Additionally, a nutritional evaluation is conducted, including a 3-day food report, food habits, allergies, aversions, and intolerances. This information is used by a knowledgeable ketogenic diet team, including a doctor and a licensed dietitian, to correctly calculate and monitor the diet for each individual. The diet can also be adapted to fit different cultural diets and personal preferences, with most of the fat coming from natural sources such as cream, butter, and oil.
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The role of fats and oils
The ketogenic diet is a high-fat, low-carbohydrate, and controlled-protein meal plan that has been used to treat epilepsy since the 1920s. The diet works by changing how the brain gets energy to function, reducing seizures in many people. The classic ketogenic diet is the most restrictive, providing 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. That is about 80-90% of calories from fat, 6-8% from protein, and 2-4% from carbohydrates.
The main sources of fat in the ketogenic diet for epilepsy include butter, heavy whipping cream, mayonnaise, and oils such as canola, olive, and medium-chain triglycerides (MCT). MCTs are a type of fat made by processing coconut and palm oils. They are more easily digested by the body than the fat typically found in food, and they produce more ketones. As a result, people following the MCT diet can include more protein and carbohydrates in their meals compared to the classic ketogenic diet.
The ketogenic diet for epilepsy focuses on fresh, nutrient-dense meals, including meat, fish, vegetables, and healthy oils. Olive oil, butter, mayonnaise, fatty meat, and dairy are the main sources of lipids. It is important to note that the diet may not be suitable for everyone, especially those with severe feeding problems or conditions where a high-fat diet could cause issues.
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Frequently asked questions
The ketogenic diet is a way of managing treatment-resistant epilepsy. It is a high-fat, low-carbohydrate diet that works by changing how your brain gets energy to function. The diet lowers the amount of carbs you eat and teaches your body to burn fat for energy instead.
The ketogenic diet can be calculated by a trained medical specialist, such as a neurologist or a dietitian. They will take into account your age, baseline weight, height, ideal weight, body mass index (BMI), food habits, allergies, and intolerances.
There are five versions of the ketogenic diet: the Classic Ketogenic Diet (CKD), the Modified Ketogenic Diet, the Medium Chain Triglyceride (MCT) Diet, the Modified Atkins Diet (MAD), and the Low-Glycemic Index Treatment (LGIT). The Classic Ketogenic Diet is the most restrictive, while the Modified Atkins Diet is the least restrictive.
