What is the ketogenic diet?

It’s Friday and I want to have some fun- so I’m going to post about the ketogenic diet. I’ll introduce the concept of dietary treatment of epilepsy now. I’ll discuss how these diets might be working in a later post. Of course, I’m no doctor and most of this info has come from research I’ve done on the web so please feel free to correct me if you don’t agree with anything. 

What is the Ketogenic Diet?
The ketogenic diet is a high fat, low carbohydrate and adequate-protein diet used to treat drug-resistant seizures. The most commonly used “classic” ketogenic diet has a 4:1 ratio. This means that there are 4 parts of fat to every 1 part of combined carbohydrate and protein (by weight). Translation: about 90% of your caloric intake is in the form of fat. Normally our body uses carbohydrate (sugars) as the main energy source. When dietary carbohydrates are severely limited (ie, almost no potatoes, rice, noodles, fruit, or candy) the body goes looking elsewhere for energy. Our bodies have a “backup system” that uses fat for energy. The KD provides a lot of fat for this back-up system to use.

Who Goes on the Ketogenic Diet?
Approximately 20-30% of people with epilepsy will not see a significant seizure reduction with the anticonvulsant drugs. These people are said to have “drug resistant”, “medically refractory” or “intractable” seizures. One of the alternative treatment options for these individuals is the ketogenic diet. Aside from neurosurgery, the KD is one of the only alternative treatments that could “cure” epilepsy. I use quotes to qualify the word “cure”. There’s a small percentage of patients that will achieve seizure freedom on the KD and when taken off the diet (after a few years), their seizures never come back. It’s hard to say whether the diet has cured their epilepsy or whether they simply out-grew their epilepsy while on the diet.

Is the Ketogenic Diet “Natural”?
The short answer is a definite, resounding NO! There is nothing natural about having fat represent 90% of your daily caloric intake. That said, there is nothing natural about the drugs either. My opinion is to eliminate “naturalness” as a factor when making a therapeutic decision for epilepsy treatment. Rather, weigh the pros-and-cons of “severity of treatment” and “severity of seizures” with the “possible benefit of the treatment”.

Strengths of the Ketogenic Diet

Anticonvulsant Effect
The main strength of the ketogenic diet is that it is very good at suppressing seizures. Clinical data suggest that about 60% of patients will see a >50% reduction in seizures with 10-15% of this group seeing a >90% reduction in their seizures. About 40% will see a less than 50% reduction in their seizures. This is remarkable given that these are individuals that have already failed to see a significant improvement on two or more anticonvulsant drugs.

Cognitive and Behavioral Effect
There is a growing body of evidence (although most of it remains anecdotal) that the KD is associated with beneficial cognitive and behavioral effects. There are anecdotes of parents putting their kids on the KD and seeing no change in seizure frequency. However, they saw such good changes in mood and cognition that they kept their child on the diet anyway.

Will I Gain Weight on the Ketogenic Diet?
Many people think you’ll get fat on this diet, but the opposite is true- you could actually lose some weight as the diet turbo-charges the fat burning machinery of the body. Carbohydrates and protein, nutrients limited by the KD, are both important in growth.

Adherence
Perhaps the largest issue facing the use of the KD is adherence. A large proportion of those that start the diet tend to quit due to the fact that it’s too restrictive and rigorous. For example, you need to weigh all of your food to the 100th of a gram and know all of the food’s nutritional content. The diet works in both kids and adults. Many neurologists say the diet works less well in adults, but this is simply because adults are more likely to say “forget this nonsense, I’m going to enjoy a chocolate bar” whereas children can have their diets imposed on them by their parents (it’s an autonomy issue, really).

Autonomy on the Ketogenic Diet
The autonomy (or freedom) of an individual on the KD is significantly affected by the dietary limits imposed by the KD. Kids can’t trade lunches or enjoy a fresh-baked chocolate chip cookie. This really cramps the style of a grade-schooler. Sometimes locks need to be put on the fridge/cupboards to prevent the sneaking of a sugary snack. This is a significant factor to consider when deciding whether or not to try the ketogenic diet.

So there’s a brief introduction to the ketogenic diet and its friends.

As always, Please feel free to post any comments/questions you may have.