Ketogenic Diet

What is ketogenic diet?
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.

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 seizures such as 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 seizures, which are due to 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 low blood sugar. 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 need for two to three years.

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, or non-carbohydrate liquid, such as 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 and the residual chemical substance, which is called ketone bodies, is produced, and then 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.

Despite the use of this diet in the treatment of seizure disorder since the 1920s, its exact mechanism is unknown. It is speculated that the accumulation of ketones in the blood tends to inhibit seizures.

What are safety and side effects?
The ketogenic diet is both safe and effective, with rare side effects, such as dehydration, constipation and a rare account of kidney stone formation, lowered immune functions, low blood sugar, and implication of increased blood fat level, 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 low blood sugar.

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.

How is your child 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, ketone body may decrease the appetite. Some children on the ketogenic diet will feel very thirsty. Always consult your child's pediatrician, dietician, or neurologist about the specifics of the ketogenic diet in your case.

How is success of the diet?
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 if during that period there are no seizures. Most people use this diet as a last resort. The diet requires great commitment from the entire family for a considerable period of time.

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.