Epilepsy Center | Ketogenic Diet
Diet therapy for epilepsy Diet therapy can sometimes be a good alternative for childhood epilepsy when medications cannot control seizures or have intolerable side effects. While diet therapy is often worth trying in general, it can be especially helpful for certain epilepsy syndromes, such as myoclonic astatic epilepsy (Doose syndrome). There are now a number of different diets that can be used for epilepsy: the Classic Ketogenic Diet, the Modified Atkins Diet, the Medium Chain Triglyceride Diet and the Low Glycemic Index Treatment Diet. The choice is made after the initial consultation, and depends on the epilepsy diagnosis, the child’s age and feeding habits, and family needs and preferences. Ketogenic diets are the treatment of choice for glucose transporter deficiency (GLUT1DS) and should be considered in pyruvate dehydrogenase deficiency (PDH) and other mitochondrial disorders, even when these disorders do not cause seizures. Diet therapy takes care and dedication, but it may offer children a better chance of seizure control than trying a new anticonvulsant drug. Unfortunately, we don’t yet have good predictors of whether a child will respond to diet therapy, so we usually recommend a trial of three to four months. About the ketogenic diet Known for more than a century, the ketogenic diet has recently come back into use for epilepsy and has been shown to be effective for many children when drugs fail. It can provide control of seizures for about 30 percent of children with epilepsy. In its strictest form, the ketogenic diet provides more than 90 percent of its calories through fat (as compared to the 25 to 40 percent usually recommended for children). When we burn fat for energy, rather than glucose from carbohydrates, we produce compounds known as ketone bodi Continue reading >>
What Is The Ketogenic Diet For Epilepsy?
Could the solution to your child's epilepsy be a diet loaded with butter, cream, oils, and mayo? It might sound weird -- and maybe not so appetizing -- but the ketogenic diet is real. And in many kids, it works. But the super high-fat, super low-carb ketogenic diet is not for everyone. It's strict and complicated. And it's not really "healthy" in the normal sense. If you're considering it, you need to think through how it affects your child's life -- and the impact on the whole family. The ketogenic diet has been curbing seizures since it was first developed in the 1920s. About half of kids who follow it have a big drop in how many they get. As many as 1 in 7 stop having seizures completely. The diet helps with many types of epilepsy, but works especially well with Lennox-Gastaut syndrome, myoclonic astatic epilepsy (Doose syndrome), and others. It can also help people of any age, but it's mostly used in babies and children. That's mainly because teens and adults have so much trouble sticking to it. Because the ketogenic diet is so demanding, doctors usually only recommend it if a child has already tried two or three medications and they haven't worked. When the diet works, kids can often lower their medication doses or stop taking them. What's more, most kids who stay on the ketogenic diet for at least 2 years have a good chance of becoming seizure free -- even after they go back to eating normally. Your child's diet will have a lot of fat. To put it in perspective, in a healthy diet for kids, about 25% to 40% of calories come from fat. In the ketogenic diet, about 80% to 90% of calories come from fat. So your child's meals are loaded with fats while portions of protein and especially carbs are small. In the typical ketogenic diet, kids get three to four times as much Continue reading >>
This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see Low-carbohydrate diet and No-carbohydrate diet. The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures. Almost half of children, and young people, with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet. There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective. The most common adverse effect is constipation, affecting about 30% of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones, and is no longer considered beneficial. The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was develope Continue reading >>
Enteral Feeding Of Ketogenic Therapy
Use of an enteral feeding tube to provide all or part of a prescribed ketogenic therapy is indicated in situations where oral intake is not possible due to medical conditions. It may also be used to supplement an inadequate oral intake resulting from physical or behavioural eating problems. A ketogenic enteral feed can be used for existing tube fed patients who are to be initiated on ketogenic therapy, or for patients already established on ketogenic therapy who subsequently require tube feeding. The most common feeding route is directly to the stomach via a naso-gastric tube (short term use only) or a gastrostomy, through the abdominal wall (for longer term use), however it is also possible to feed directly into the duodenum or jejunum. Prior to commencement of enteral feeding a full nutritional evaluation must be carried out by the dietitian; this will include assessment of current and past growth, current nutritional intake and route of feeding, bowel function, scope for inclusion of oral feeds and whether swallow has been adequately assessed by a speech and language therapist, and review of baseline ketogenic blood biochemistry results. Consideration of nutritional requirements will then enable the dietitian to calculate and advise on an appropriate ketogenic feeding regime. At present there is one complete product available for ketogenic enteral feeding regimes. Ketocal (Nutricia) is available as a 4:1 or 3:1 ratio powder, or as a 4:1 ratio liquid. These formulations are based on the ratio system used in the classical ketogenic diet (fat: carbohydrate and protein) and are designed for use in children over 1 year. There are no ketogenic formulae designed for older children and adults available currently. The formulae readily require adjustment of the protein, fat or Continue reading >>
What Is Ketogenic Therapy?
An Introduction to Ketogenic Therapy The history of the ketogenic diet begins in biblical times, when fasting was used to cure what were known as "fits". Later, in the early 1900's abstaining from food for several days was found to result in cessation of seizing activity. However, while fasting did have temporary benefits, it could not be used to treat seizures indefinitely. Since then, many researchers have studied the effects of fasting on seizures, but the development of the Ketogenic Diet can be credited to Dr. R.M. Wilder at the Mayo Clinic in Minnesota. His idea for the diet stemmed from the knowledge that during starvation, the body undergoes a state of ketosis. Ketosis is the result of fat being burned in the presence of little carbohydrate. Examples of ketones are beta-hydroxybutyric acid, acetone, and acetoacetic acid. Therefore in 1921, Dr. Wilder proposed a diet that was high in fat and low in carbohydrate to produce ketosis in the body that could be maintained on a long term basis1. Ketogenic Therapy: An In-Depth Look Although this therapy has been in existence for a long time, its popularity has both waxed and waned and the mechanism of how ketone bodies function to reduce epileptic activity is still unknown. Currently, the way in which the therapy is administered is by prescribing a diet to a patient to be followed as rigidly as one would follow a prescription for a drug. The diet prescription is made up of several components including an allotment of adequate calories, protein, and nutrients for each individual. Supplementation is commonly employed to meet nutrient needs. The strength of the diet prescription (what would be comprable to a dosage amount in medication) is gauged by the ratio of fat in grams to grams of proteins summed with grams of carbohy Continue reading >>
Your Brain On Ketones
The modern prescription of high carbohydrate, low fat diets and eating snacks between meals has coincided with an increase in obesity, diabetes, and and increase in the incidence of many mental health disorders, including depression, anxiety, and eating disorders. In addition, many of these disorders are striking the population at younger ages. While most people would agree that diet has a lot to do with the development of obesity and diabetes, many would disagree that what we eat has much to do with our mental health and outlook. I believe that what we eat has a lot to do with the health of our brains, though of course mental illness (like physical illness) has multifactorial causes, and by no means should we diminish the importance of addressing all the causes in each individual. But let's examine the opposite of the modern high carbohydrate, low fat, constant snacking lifestyle and how that might affect the brain. The opposite of a low fat, snacking lifestyle would be the lifestyle our ancestors lived for tens of thousands of generations, the lifestyle for which our brains are primarily evolved. It seems reasonable that we would have had extended periods without food, either because there was none available, or we were busy doing something else. Then we would follow that period with a filling meal of gathered plant and animal products, preferentially selecting the fat. During the day we might have eaten a piece of fruit, or greens, or a grub we dug up, but anything filling or high in calories (such as a starchy tuber) would have to be killed, butchered, and/or carefully prepared before eating. Fortunately, we have a terrific system of fuel for periods of fasting or low carbohydrate eating, our body (and brain) can readily shift from burning glucose to burning what ar Continue reading >>
Using A Ketogenic Diet To Fight Cancer
(Chris Woollams) This article goes in depth into the Ketogenic diet - a diet of low or no glucose, high ´good fat´ and lowish protein, which is claimed to have the potential to manage even advanced cancer cases. Preliminary research shows it can stop cancer progression, inhibit metastases and kill off cancer cells. However, research to date is restricted mainly to animal studies. One cancer of particular interest is Brain cancer. Limited research on two specific cases and 30 others concluded that it did have merit. But then brain cells do seem to be more prone to glucose effects anyway, high glucose levels being linked to some cases of Dementia; and a ketogenic diet has been used with success in cases of Epilepsy. A product (high fat, lowish protein, very low carbs) called KetoCal was developed a number of years ago for just such cases. And healthy brain cells seem more ready to adapt to ketosis (See: Colorectal cancer has also been shown to be better treated with a low sugar diet by Johns Hopkins. Professor Thomas Seyfried of Boston is a biologist and, after years of extensive research, he fervently believes cancer is a metabolic disease, not a genetic one. Dr. Dominic D´Agostino Assistant Professor at South Florida University concurs. Both have been involved with treating patients with advanced cancer using a ketogenic diet. However, before we get carried away by the euphoria, there is cautionary evidence that this effect may depend on the cancer type (see ´Caveats´ below), and nothing has been firmly established as yet. In the UK, a Charity called Mathew´s Friends offers expert advice on the diet. ** ** ** ** ** ** The Ketogenic Diet has received great interest since we first wrote about it in 2006. The Simple Theory of the Ketogenic Diet Cancer cells love gluc Continue reading >>
Ketogenic Diet Benefits For Weight Loss, Fighting Disease & More
Unlike many fad diets that come and go with very limited rates of long-term success, the ketogenic diet (or keto diet) has been practiced for more than nine decades (since the 1920s) and is based upon a solid understanding of physiology and nutrition science. Rather than relying on counting calories, limiting portion sizes, resorting to extreme exercise or requiring lots of willpower (even in the face of drastically low energy levels), the ketogenic diet takes an entirely different approach to weight loss and health improvement. It works because it changes the very “fuel source” that the body uses to stay energized — namely, from burning glucose (or sugar) for energy to dietary fat and, critically, your own body fat after the stage of “ketosis” is reached. Meanwhile, beyond its outstanding potential to help people lose weight and burn off fat stores, research shows that the ketogenic diet helps to fight serious diseases, including cancer and Alzheimer’s. Table of Contents 1. What Is the Keto Diet? What Is Ketosis? How to Get Into Ketosis What Are the Stages of Ketosis? Does the Keto Diet Work for Women? 2. Benefits of the Ketogenic Diet 3. What Is the Ketogenic Diet Plan? 5. Keto Side Effects and the Keto Flu What Is the Keto Diet? The ketogenic diet is a very low-carb diet plan that was originally designed in the 1920s for patients with epilepsy by researchers working at Johns Hopkins Medical Center. (1) Researchers found that fasting — avoiding consumption of all foods for a brief period of time, including those that provide carbohydrates — helped reduce the amount of seizures patients suffered, in addition to having other positive effects on body fat, blood sugar, cholesterol and hunger levels. (4) Unfortunately, long-term fasting is not a feasible op Continue reading >>
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Ketogenic Therapy Effects On Electrical And Metabolic Abnormalities In Epilepsy
Approximately a fourth of children with seizures do not respond adequately to available therapy. Ketogenic therapy has a long history as treatment for intractable epilepsy, but there is no agreement concerning how it works and what is the best way to administer it. This natural history study will collect data pertaining to both questions. The basis of Ketogenic Therapy is an altered macronutrient intake. It is based on a ratio of fat: protein+carbohydrate in which protein intake is adequate and carbohydrate is minimal. On Ketogenic Therapy, the body metabolizes fat, producing ketones as an energy source for the brain. Induction of ketosis has been shown to correlate with the reduction of seizures observed with Ketogenic Therapy. A major challenge of Ketogenic Therapy in children is that the compounds provided to stop seizure activity are the same compounds provided for growth and development. The altered macronutrient ratio that is the basis of Ketogenic Therapy is also a potential risk factor for dyslipidemia and may adversely affect growth. The investigators will evaluate efficacy of Ketogenic Therapy by assessing seizures and requirements for antiepileptic drugs. The investigators will evaluate adverse effects of Ketogenic Therapy by assessing dyslipidemia and growth. The investigators will foster optimal daily administration of therapy with structured training programs for caregivers. Study Type : Interventional (Clinical Trial) Estimated Enrollment : 200 participants Intervention Model: Single Group Assignment Masking: None (Open Label) Primary Purpose: Treatment Official Title: Ketogenic Therapy Effects on Electrical and Metabolic Abnormalities in Epilepsy Study Start Date : September 2006 Estimated Primary Completion Date : September 2018 Estimated Study Completi Continue reading >>
Who Is Ketogenic Therapy Suitable For?
Ketogenic therapy should be considered as a treatment for epilepsy after two appropriate anticonvulsant medications have failed to be effective or produced unacceptable side effects. This treatment has been shown to be successful in treating a wide range of seizure types and syndromes (references 1, 2, 3) although may be particularly beneficial in myoclonic epilepsies, infantile spasms and tuberous sclerosis complex (reference 4). Guidelines from the UK National Institute for Health and Care Excellence (NICE), updated in 2012, recommend ‘Refer children and young people with epilepsy whose seizures have not responded to appropriate anti-epileptic drugs to a tertiary paediatric epilepsy specialist for consideration of the use of a ketogenic diet.’ (The ketogenic diet is a first-line treatment for the neurometabolic diseases glucose transporter type 1 (GLUT1) deficiency syndrome and pyruvate dehydrogenase (PDH) deficiency. Although clinical evidence is more limited, ketogenic therapy is also increasingly being explored as a treatment option for other disorders such as neurological cancers. The traditional or modified ketogenic diets should not be used in individuals who have fatty acid oxidation defects, pyruvate carboxylase deficiency, primary carnitine deficiencies, organic acidurias, defects in ketone metabolism, disorders that require high dietary carbohydrates as part of their treatment, severe liver disease or hypoglycaemia under investigation (4). They should be used with caution in those with a history of renal stones, hyperlipidemia, severe gastro-oesophageal reflux, diabetes mellitus and parent or care-giver non-compliance. Concomitant steroid use will limit ketosis. Although possible, they will be more difficult to implement if there are pre-existing dietary Continue reading >>
Hospital Guidance For Those On Ketogenic Therapy
The ketogenic patient in hospital: How to support children and adults already established on the ketogenic diet presenting with incurrent illness or for elective procedures. ADMISSION On admission, the patient or their carers will be able to supply: Information about their specific ketogenic regime. Contact details for their ketogenic dietitian / hospital team. Blood glucose and ketone testing equipment (if they use this at home). If you are unable to obtain individual guidance, the following background basics may be of help. MONITORING If the patient is unwell, it is recommended that the following biochemical indices are checked: Full blood count, renal function, liver function, ammonia, bicarbonate, lactate, beta-hydroxybutyrate, urinalysis, capillary blood gases. Please check weight on admission. Test urine for ketones each time passed. Check blood glucose and ketones 4 hourly if unwell or nil by mouth, otherwise please follow the individuals normal testing routine. BLOOD GLUCOSE and BLOOD KETONE LEVELS; when to take action? Ketogenic therapy tends to produce a very stable blood glucose profile at the mid/ low end of the normal range and patients may not show symptoms of hypoglycaemia at 2.5-3mmol/l. PLEASE TAKE ACTION IF: Blood glucose is 2.5mmol/l or below. Treat with 5g Maxijul* dissolved in either 30-50ml water or sugar free squash orally or via PEG, and retest the blood glucose in 15 minutes. Repeat as required. Patient is symptomatic of low blood glucose: Sweating Clammy Excessive Vomiting Increased sleepiness or confusion Fast Heart Rate Fast Breathing Blood ketones are 6mmol/l or above. Treat with 5g Maxijul* dissolved in either 30-50ml water or sugar free squash orally or via PEG, and retest the blood ketones in 30 minutes. Repeat as required. Patient is sym Continue reading >>
What Is The Ketogenic Diet?
The ketogenic diet has been in existence for 90 years The ketogenic diet was designed in 1924 by Dr. Russell Wilder at the Mayo Clinic. Despite being highly effective in treating epilepsy, it fell out of fashion due to the surge in new anti-seizure medications in the 1940s. In 1994 Charlie Abraham’s family started The Charlie Foundation after his complete recovery from daily seizures despite trying all available anti-seizure medications and enduring a futile brain surgery. Charlie started the diet as a toddler and remained on it for 5 years. He is now a college student and remains seizure-free. Ketosis is the unique feature The diet is high in fat, supplies adequate protein and is low in carbohydrates. This combination changes the way energy is used in the body. Fat is converted in the liver into fatty acids and ketone bodies. Another effect of the diet is that it lowers glucose levels and improves insulin resistance. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the occurrence of epileptic seizures. The Charlie Foundation is a global leader in promoting ketogenic therapies In 2006, The Charlie Foundation commissioned a panel comprised of neurologists and dietitians with particular expertise in using the ketogenic diet to create a consensus statement in support of the clinical management of the ketogenic diet and when it should be considered. Children are especially good candidates for the diet owing to their reliance on adults for nourishment and to the nature of a young developing brain. Comparison of diet therapies There are five levels of diet which have been published in medical literture as effective treatments for epilepsy: the classic ketogenic diet, the modified ketogenic diet, medium-chain triglyceride (MC Continue reading >>
Ketosis: What Is Ketosis?
Ketosis is a normal metabolic process. When the body does not have enough glucose for energy, it burns stored fats instead; this results in a build-up of acids called ketones within the body. Some people encourage ketosis by following a diet called the ketogenic or low-carb diet. The aim of the diet is to try and burn unwanted fat by forcing the body to rely on fat for energy, rather than carbohydrates. Ketosis is also commonly observed in patients with diabetes, as the process can occur if the body does not have enough insulin or is not using insulin correctly. Problems associated with extreme levels of ketosis are more likely to develop in patients with type 1 diabetes compared with type 2 diabetes patients. Ketosis occurs when the body does not have sufficient access to its primary fuel source, glucose. Ketosis describes a condition where fat stores are broken down to produce energy, which also produces ketones, a type of acid. As ketone levels rise, the acidity of the blood also increases, leading to ketoacidosis, a serious condition that can prove fatal. People with type 1 diabetes are more likely to develop ketoacidosis, for which emergency medical treatment is required to avoid or treat diabetic coma. Some people follow a ketogenic (low-carb) diet to try to lose weight by forcing the body to burn fat stores. What is ketosis? In normal circumstances, the body's cells use glucose as their primary form of energy. Glucose is typically derived from dietary carbohydrates, including: sugar - such as fruits and milk or yogurt starchy foods - such as bread and pasta The body breaks these down into simple sugars. Glucose can either be used to fuel the body or be stored in the liver and muscles as glycogen. If there is not enough glucose available to meet energy demands, th Continue reading >>
Review Article Ketogenic Diets As An Adjuvant Cancer Therapy: History And Potential Mechanism
Introduction Numerous dietary components and supplements have been evaluated as possible cancer prevention agents; however, until recently few studies have investigated diet as a possible adjuvant to cancer treatment. One of the most prominent and universal metabolic alterations seen in cancer cells is an increase in the rate of glycolytic metabolism even in the presence of oxygen . Although increased glucose uptake by tumor cells was thought to support increased cancer cell proliferation and energy demands, recent studies suggest that increased tumor cell glycolytic metabolism may represent an adaptive response to escape metabolic oxidative stress caused by altered mitochondrial oxygen metabolism [2–4]. These data support the hypothesis that cancer cells are reliant on increased glucose consumption to maintain redox homeostasis due to increased one electron reductions of O2 to form O2•− and H2O2 in mitochondria. This divergence from normal cell metabolism has sparked a growing interest in targeting mitochondrial oxygen metabolism as a means of selectively sensitizing cancer cells to therapy [5–17]. In this regard, dietary modifications, such as high-fat, low-carbohydrate ketogenic diets that enhance mitochondrial oxidative metabolism while limiting glucose consumption could represent a safe, inexpensive, easily implementable, and effective approach to selectively enhance metabolic stress in cancer cells versus normal cells. What is a ketogenic diet? A ketogenic diet consists of high fat, with moderate to low protein content, and very low carbohydrates, which forces the body to burn fat instead of glucose for adenosine triphosphate (ATP) synthesis. Generally, the ratio by weight is 3:1 or 4:1 fat to carbohydrate+protein, yielding a diet that has an energy dis Continue reading >>
Prescribing Dietary Fat: Therapeutic Uses Of Ketogenic Diets
February 2016 The high-fat, adequate-protein, and very-low-carbohydrate way of eating known as the ketogenic diet (KD) has been used to treat epilepsy for almost 100 years. The therapeutic effects of KDs have been investigated in a number of diseases and disorders, including diabetes, obesity, cancer, cardiovascular disease, and neurological conditions such as Alzheimer's and Parkinson's disease. This article provides an overview of where the research stands. One of the victims of the war against dietary fat has been the ketogenic (ketone-producing) diet. This high-fat, adequate-protein, and very-low-carbohydrate way of eating has been known for more than 100 years as an effective treatment for a number of disorders. William Banting published a monograph in 1863 titled Letter on Corpulence, which detailed the successful treatment of his own obesity with a low-carbohydrate diet. Severe childhood epilepsy has been treated since the 1920s with the ketogenic diet (KD), and some type 2 diabetics have achieved normal blood glucose levels without medication by following a high-fat, low-carbohydrate diet. Despite an abundant anecdotal and scientific history, many modern-day physicians-often underschooled in nutrition and over-reliant on pharmacotherapy-have written off KDs as being unsustainable and unsafe, thanks in large part to the demonization of dietary fat. Now, however, after a significant increase in research on KDs and a shift in opinion regarding dietary fat, ketogenic diets are experiencing a comeback. A recent review article co-written by Jeffrey S. Volek neatly summarizes a number of the conditions in which KDs appear to play a therapeutic role. These include a wide variety of neurological conditions such as epilepsy and Alzheimer's disease, diabetes, and certain c Continue reading >>