The Ketogenic Diet
A special diet may be recommended for children with intractable epilepsy (epilepsy that is not relieved by medication). The high-fat, low-carbohydrate Ketogenic Diet is carefully designed to help the patient's body make large amounts of ketones, which are produced when fats are processed in the liver. The diet helps reduce the number of seizures in some patients, although precisely why this beneficial effect occurs is not known. Researchers have been exploring the role of beta-hydrozybutyrate, a by-product of ketosis that inhibits seizures in animals.
Basics of the Ketogenic Diet
The Ketogenic Diet has been used as a treatment for epilepsy since the 1920s, but as antiepileptic drugs (AEDs) were developed, it became a less popular tool. However, there has been a renewed interest in the diet for patients who have not responded well to AEDs or for those wishing to avoid the side effects associated with those medicines.
While there are several variations of the diet, the general philosophy is the same. The diet commences with a 24- to 48-hour fasting period that begins in the hospital and is carefully monitored. Then the actual food plan, characterized by large quantities of high-fat foods, begins. The body goes into a survival phase, using the fats as a major energy source to produce the ketones. In general, of every six calories consumed, four are from fats and the other two are from protein and carbohydrates.
The Ketogenic Diet is stringent, and it requires a great deal of motivation by the patient and his or her caregiver for total compliance.
What Foods are on the Ketogenic Diet?
The diet consists of three categories of food: unrestricted, fatty, and restricted. Some examples of unrestricted foods include vegetables, such as broccoli, carrots, lettuce, and spinach, artificial sweeteners; and unsweetened fruit. The fatty foods include bacon, hot dogs, potato chips, nuts, cream, eggs, mayonnaise, and butter. Restricted foods include candy and items containing sugar. A vitamin supplement is necessary to ensure that adequate nutritional needs are met. Snacking between meals is not allowed.
A dietitian provides the patient and family with a foods list that must be strictly followed. Food portions are weighed to keep in harmony with the diet's delicate balance.
Why Try the Diet?
The Ketogenic Diet is used for patients whose seizures have not been well controlled by antiepileptic drugs (AEDs). The diet, while difficult to comply with, has had positive results. About one-third of the children who are on the diet gain full control of their seizures, while another one-third have partial seizure control. There are none of the side effects associated with AEDs. In time, the diet is tapered off so the child can resume a regular diet.
There are some aspects of the diet to consider. Children who follow this diet typically experience delays in growth; after the diet is tapered off, however, there tends to be a growth spurt. Nausea and vomiting may occur during the fasting period, and the diet itself may produce those effects as well as constipation. Kidney stones may result from a build-up of uric acid in the blood.
Perhaps the hardest part of the Ketogenic Diet is compliance. It is a challenge to avoid carbohydrates, especially for young children. A commitment by the patient's family to help him or her follow the diet is key. The University Comprehensive Epilepsy Center has treated scores of children with this diet and can provide the expertise and practical advice necessary to make the most of this treatment.