Ketogenic Diet
"One of the most exciting recent developments in the treatment of epilepsy has been the 'rediscovery' of the ketogenic diet. This diet is helping children whose seizures have resisted even the best of the modern anticonvulsant drugs."
-C Dr. McIntyre Burnham, President, Epilepsy Ontario.
The ketogenic diet is a rigid, strictly calculated, therapeutic diet used in the treatment of difficult to control epilepsy in children. This diet is very high in fats and very low in protein and carbohydrates.
There are a few different ways to do a keto-diet, the first is a 'Standard Ketogenic Diet', or a SKD. This is where you just restrict carbs, go into ketosis, and stay there for long periods until you've reached your fat loss goals, sometimes going back on carbs for a couple days or a week at a time. Next is a 'Targeted Ketogenic Diet', or TKD. A TKD is the same as an SKD, but you take in 25-50 grams of carbs about 30-60 minutes before weightlifting workouts to supply energy for the muscles (Note: These carbs will be burned during the workout, and should not be counted towards the 30g/day limit). Last is a 'Cyclic Ketogenic Diet', a CKD, which is much more complex. On a CKD, you go into ketosis during the week, and do 'carb-ups' on the weekends.
Who can use the Ketogenic Diet?
The ketogenic diet is used to treat intractable epilepsy in children. It may be prescribed when seizures are out of control, and when the side effects of anticonvulsant drugs and/or surgery are considered unacceptable. It may effectively treat some cases of childhood myoclonic, absence and atonic seizures as well as tonic clonic seizures, multi focal seizures, and Lennox Gastaut Syndrome. It has also been used to treat structural brain disorders such as microcephaly, hypoxic brain damage, prior strokes, and developmental abnormalities.
The ketogenic diet is usually directed at children one to eight years of age. Children below the age of one are not usually put on the diet as they may experience side effects, such as hypoglycemia. The diet has had some success with select older children and adolescents too. It is prescribed only when both the child and the family are highly motivated. The diet may be prescribed for two to three years.
It is said that adults may have problems maintaining essential nutrients, and therefore may not benefit from the diet, but in depth studies are rare and inconclusive. Many adults would not want to follow such a diet C most adults find it unpalatable C and find it very difficult to stick to it.
How does the Diet Work?
To start the diet, children are admitted into the hospital, where they fast for two to three days. They receive only water, diet Kool-Aid, or diet Jell-O until tests for urine ketones are strongly positive, usually within 24 hours. By doing this, all of the glucose (sugar) in the blood will be used up for energy. The ketogenic diet works by tricking the body into reacting as if it is starving or fasting: it causes the body to burn fats rather than carbohydrates. When fats are burned in the absence of sugars, they do not burn completely. Instead, a residue of ketone bodies remains: the body is in a state of ketosis. After the fasting period, children are started on a one-third fat shake then gradually introduced to the full diet. During the hospital stay, blood glucose levels and urinary ketone levels are monitored daily. Parents are instructed in diet preparation and informed how to handle illness in children on the diet. They are also taught to read product labels to determine the carbohydrate content of various foods. At discharge, parents receive information on how to handle children on the ketogenic diet in the classroom.
Despite the use of this diet in the treatment of seizure disorder since the 1920s and before, its exact mechanism is unknown. Research was largely discontinued when newer anti epileptic drugs became available in the 1940s.
Safety & Side Effects
The ketogenic diet is both safe and effective, with rare side effects only when it is not strictly followed. There is documentation of dehydration, constipation and a rare account of kidney stone formation, lowered immune functions, low blood sugar, and implication of increased serum lipid profile, which requires close monitoring. During the initial fast, your child's blood sugar level should be checked every four to six hours. The level often falls, which may lead to hypoglycemia.
The ketogenic diet must be supervised by qualified specialists.
Is the Diet Nutritionally Complete?
Dietary supplements, such as multivitamins and calcium, must be taken. These must be given in sugar free form.
Living with the Diet
After consultation, if you opt for the diet, you may be asked to participate in a trial period. Also, there may be several days of training time when you will be given a diet designed specifically for your child. Everything your child consumes must be weighed and accounted for in the diet. The child may feel hungry during the first week or two. However, ketosis decreases the appetite. Some children on the ketogenic diet will feel very thirsty. Some parents give their children a regular dose of water or caffeine free diet soda every one or two hours during the day. Always consult your child's pediatrician or neurologist about the specifics of the ketogenic diet in your case.
Success
When rigidly adhered to, the ketogenic diet may successfully control epilepsy in 30 50% of children with intractable seizures. Many others will experience a marked decrease in seizure frequency. A child on the diet usually continues taking anti-epileptic medicine, but may be able to take less of it later on. Many will be able to return to a normal diet within two to three years, free of seizures or medication. Most people investigate this diet as a last resort. The diet can be unpalatable and demands a great commitment from the entire family for a considerable period of time. Most people who make it past the first month will stick with the diet until they can return to a normal diet.
Sample Meal Plan:
Breakfast: - Scrambled eggs with butter
- Diluted cream
- Orange juice
Lunch: - Spaghetti squash with butter and Parmesan cheese
- Lettuce leaf with mayonnaise
- Orange diet soda mixed with whipped cream
Dinner: - Hot dog slices with sugar-free catsup
- Asparagus with butter
- Chopped lettuce with mayonnaise
- Sugar-free vanilla cream popsicle
These examples do not show the exact amounts for each food because those have to be worked out for each child by the dietician.
Where is the Diet Administered?
In Ontario, the ketogenic diet is administered at the larger children's hospitals and several clinics. Some hospitals and clinics are now considering the implementation of the ketogenic diet for adults.
The following centres (neurology departments) in Canada are able to start children on the diet: IWK Hospital for Children, Halifax, NS; Hospital Sainte -Justine, Montreal, QC; Montreal Children's Hospital, Montreal, QC; Bloorview-MacMillan Centre, No. York, Toronto, ON; Children's Hospital of Eastern Ontario, Ottawa, ON; BC Children's Hospital, Vancouver, BC.
Parents and others are warned against trying to institute any part of the diet on their own. The ketogenic diet is a complex medical treatment therapy that requires close supervision by a physician.
Medium-Chain Triglyceride (MCT) Diet
An alternative to the "classic" ketogenic diet is the MCT (medium-chain triglyceride) diet, which involves the use of a special oil to attain ketosis. Although this diet is less unsettling and more flexible than the ketogenic diet, it is generally not as effective and less well tolerated.
