Leena Watts
The ketogenic diet is a treatment option for children and adults with epilepsy whose seizures cannot be controlled with anti-seizure medications. It is a high-fat, low-carbohydrate diet that has been used to treat epilepsy since the 1920s. The diet is typically recommended for children and is usually prescribed by a physician and monitored by a dietitian. There are five versions of the ketogenic diet, including the classic ketogenic diet, the modified ketogenic diet, and the modified Atkins diet. The diet is usually started in the hospital, with the child fasting under medical supervision for 18-24 hours before slowly introducing the diet. The ketogenic diet has been shown to be effective in reducing seizures and has other positive effects, but it is important to consult with a medical professional before starting this diet as it may not be suitable for everyone.
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What You'll Learn
Ketogenic diet foods
The ketogenic diet is a high-fat, low-carbohydrate diet that can help control seizures in people with epilepsy. It is usually prescribed by a physician and monitored by a dietitian, especially when it comes to children. The diet typically includes:
- Meat and poultry, preferably grass-fed, as they have more omega-3 fats and conjugated linoleic acid (CLA) than meat from grain-fed animals.
- Fish and shellfish, which are very keto-friendly as they are carb-free.
- Eggs, preferably whole, as most of an egg's nutrients are found in the yolk.
- Dairy products such as butter, heavy whipping cream, full-fat cheese, plain Greek yogurt, and cottage cheese.
- Oils and fats like olive oil, canola oil, coconut oil, and cocoa butter.
- Low-carb vegetables like leafy greens, peppers, and broccoli.
- Other plant-based foods including nuts, seeds, and avocados.
It is important to note that the ketogenic diet restricts calorie, fluid, and protein intake, and completely avoids starchy foods like pasta, rice, potatoes, bread, corn, peas, beans, and legumes. Desserts and other high-carb foods are also not part of the diet. The diet may be challenging to follow due to its restrictive nature, and it is always recommended to consult with a medical professional before starting any new diet, especially one as specialised as this.
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Who can use the diet
The ketogenic diet is a treatment option for children or adults with epilepsy whose seizures are not controlled with anti-seizure medications (ASMs). The ""classic" ketogenic diet is a special high-fat, low-carbohydrate, and low-protein diet that helps to control seizures in some people with epilepsy. It is usually used in children with seizures that do not respond to medications. The diet is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. The ketogenic diet has been used to treat epilepsy since the 1920s.
The ketogenic diet can be used by children with epilepsy, with close supervision from a neurologist and dietitian. The Modified Atkins Diet is a less restrictive alternative that may be more suitable for older children, as it allows for more protein and carbohydrates, does not require the weighing of foods, and can be started at home. The Modified Atkins Diet may be a good option for patients who are unable to tolerate the more restrictive classic ketogenic diet.
The ketogenic diet can also be used by adults with epilepsy, although the classic diet is usually not recommended due to its restricted food choices. The Modified Atkins Diet is a more flexible option for adults, and has been shown to lower seizure rates in nearly half of adults who try it. It is important for adults to consult with a team of neurologists and dietitians before starting the diet.
The ketogenic diet may be suitable for people with different types of epilepsy and associated comorbidities such as cognitive impairment, psychiatric disturbance, and sudden unexplained death. It can also be adapted to fit different cultural diets, as well as for people with allergies or those on modified texture diets. However, the diet may not be suitable for those with severe feeding problems or conditions where a high-fat diet would cause problems.
The decision to use the ketogenic diet should be made in consultation with a knowledgeable ketogenic diet team, including a doctor and a licensed dietitian, who can correctly calculate and monitor the diet for each individual. It is important to have strict compliance with the diet and plenty of patience, especially in the beginning.
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How the diet works
The ketogenic diet is a treatment option for children or adults with epilepsy whose seizures cannot be controlled with anti-seizure medications (ASMs). The diet is usually considered when at least two suitable medications have been tried and failed.
The ""classic" ketogenic diet is a high-fat, low-carbohydrate, and low-protein diet that helps to control seizures in some people with epilepsy. The diet is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. Foods are weighed and measured. The name "ketogenic" means that it produces ketones in the body. Ketones are formed when the body uses fat for energy instead of carbohydrates. The body can work well on ketones and fats, which are not dangerous and can be detected in the urine, blood, and breath.
The ketogenic diet fundamentally changes the body's metabolism, so that fat is used for energy instead of glucose. This creates a cascade of metabolic changes, some of which can reduce the likelihood of seizures. While the exact mechanism of action is not yet fully understood, scientists are learning more each year. Overall, about half of children who try the diet experience at least a 50% reduction in seizures, and 10–15% become seizure-free. The foods consumed in the diet typically include high-fat ingredients like oils, butter, cream, mayonnaise, avocado, eggs, and cheese, along with limited amounts of meat.
The ketogenic diet can be adapted to suit different cultures and individual requirements, such as allergies or modified-texture diets. The diet is usually started in the hospital, with the patient fasting (except for water) under close medical supervision for 18–24 hours. However, it is important to note that there is growing evidence that fasting is not necessary for long-term efficacy. The diet is then started, either by slowly increasing the calories or the ratio. The modified Atkins diet, on the other hand, does not require a hospital stay, an initial fasting period, food weighing, fluid measuring, or calorie counting.
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The different types of ketogenic diets
The ketogenic diet is a high-fat, low-carbohydrate, controlled-protein diet that has been used to treat epilepsy since the 1920s. The diet is typically recommended for children whose seizures have not responded to medication. The diet is usually started in the hospital, with the patient fasting (except for water) under close medical supervision for 18-24 hours.
There are five versions of the ketogenic diet used to treat epilepsy:
- The Classic Ketogenic Diet (CKD): This is the original version of the diet, created in 1923. It is the most restrictive of the five versions, following a ketogenic ratio of 4:1 or 4 grams of fat for every 1 gram of protein and carbohydrate. People following this diet can expect to consume about 80-90% of their calories from fat, 6-8% from protein, and 2-4% from carbohydrates.
- The Modified Ketogenic Diet: This version is slightly less restrictive than the classic KD, following a ratio range of 3:1 (3 grams of fat for every 1 gram of protein and carbohydrate) down to a 1:1 ratio. This diet may be a more comfortable way to start or taper off the classic KD.
- The Medium-Chain Triglyceride (MCT) Diet: This version follows a ketogenic ratio of 1.9:1 or 1.9 grams of fat for every gram of protein and carbohydrate. Medium-chain triglycerides are a type of fat made by processing coconut and palm oils. The body digests MCTs more efficiently than other fats, and they produce more ketones. As a result, people following this diet can incorporate more protein and carbohydrates into their meals.
- The Modified Atkins Diet (MAD): This version is less restrictive than the classic KD, allowing more protein and not restricting calories, fluids, or food types. It aims to provide increased flexibility and palatability, with a 1:1 ratio of fat to carbohydrates and protein.
- The Low-Glycemic Index Treatment (LGIT): This version of the ketogenic diet is less restrictive than the classic KD, allowing for a broader range of food choices.
In addition to these five versions, there are several other variations of the ketogenic diet, including:
- Keto 2.0: This is a less restrictive version of the keto diet, which may be used as a bridge from higher-carb eating to more traditional keto approaches.
- Dirty Keto: This version focuses on the macronutrient distribution of the standard keto plan, but the source of these macros can come from any kind of food, including highly processed and prepackaged meals.
- Clean Keto: This version focuses on the healthiest possible foods, including a fridge-full of plants.
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The benefits and drawbacks
The ketogenic diet is a high-fat, low-carbohydrate diet that has been used to treat epilepsy since the 1920s. It is typically recommended for children whose seizures have not responded to medication, but it can also be effective for adults. The diet is carefully monitored by a physician and a dietitian and may lead to reduced seizures and other positive effects.
Benefits
The ketogenic diet has been shown to be beneficial for people with epilepsy, particularly children. A clinical trial at Great Ormond Street Hospital in 2008 found that 38% of children who started the ketogenic diet had reduced seizures and were able to reduce their anti-seizure medication. Other benefits observed included increased alertness, awareness, and responsiveness. The diet has also been shown to be effective in infants and adults with epilepsy.
The ketogenic diet is an established treatment option for children with hard-to-control epilepsy. It can help to reduce seizures and may even lead to improved efficacy in infants and gastrostomy-tube-fed children. The diet can always be considered as long as there are no clear metabolic or mitochondrial reasons not to use it. Additionally, the diet can help reduce or eliminate the need for anti-seizure drugs.
Drawbacks
One of the main drawbacks of the ketogenic diet is that it is very restrictive, making it difficult to follow, especially for adults. The diet requires careful measurements of calories, fluids, and proteins, and foods are weighed and measured. It is also important to prepare meals carefully as no other sources of carbohydrates can be eaten. The diet may not be suitable for people with severe feeding problems or conditions where a high-fat diet would cause problems. Additionally, it may take at least three months to see if the diet is effective, and individuals may need to follow it for up to two years.
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Frequently asked questions
The Ketogenic Diet (KD) is a high-fat, low-carbohydrate, and controlled-protein diet that has been used to treat epilepsy since the 1920s. The diet changes the body's metabolism, using fat as its primary fuel source instead of glucose.
The Ketogenic Diet is suitable for both children and adults with epilepsy whose seizures are not controlled with anti-seizure medications (ASMs). It is particularly recommended for children with seizures that do not respond to medications.
Foods that provide fat for the Ketogenic Diet include butter, heavy whipping cream, mayonnaise, oils (e.g. canola or olive oil), avocado, eggs, and cheese. Carbohydrates and proteins are restricted on this diet, so foods like sugar, bread, and pasta are not eaten.
The Ketogenic Diet has been shown to reduce seizures in people with epilepsy. Overall, about half of children who try the diet experience at least a 50% reduction in seizures, and 10-15% become seizure-free. The diet may also have positive effects on associated comorbidities such as cognitive impairment and psychiatric disturbances.
Starting the Ketogenic Diet for epilepsy requires a joint team approach, including neurologists, dietitians, and primary care providers. It is important to first consult with a knowledgeable ketogenic diet team to determine if the diet is suitable for you and to ensure it is correctly calculated and monitored. The diet is usually started in the hospital with a fasting period under close medical supervision.
