dareNtiff: The Ketogenic Diet

Many of you are asking us what is this Ketogenic Diet that we are starting for Nathanael, so we have put some documentation together from a book and some internet websites.

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B R I E F S U M M A R Y

The Ketogenic diet is a special diet to help children treat epilepsy seizures/fits.

The name ketogenic means that it produces ketones in the body (keto = ketone, genic = producing). Ketones are formed when the body uses fat for its source of energy. Usually the body usually uses carbohydrates (such as sugar, bread, pasta) for its fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. Ketones are not dangerous. They can be detected in the urine, blood, and breath. Ketones are one of the more likely mechanisms of action of the diet; with higher ketone levels often leading to improved seizure control.

The typical ketogenic diet, called the "long-chain triglyceride diet," provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. It will be a tough diet to keep and maintain as we will have to be totally strict about what Nathanael eats, and we have to keep providing him the proper diet with a +/- 1 gram difference from what is calculated.

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FULL DETAILS
Excerpt from “The Ketogenic Diet – A Treatment for Epilepsy”

Every child and every family who embarks on the ketogenic diet dreams of a total cure. Sometimes their dream comes true. Unfortunately the ketogenic diet does not result in a success story for everyone. Almost half of all children who start the diet stop during the first year. Some stop because the seizures have not improved sufficiently to make their efforts worthwhile. Some discontinue because of illness, noncompliance, or because the diet is “just too hard”.

The diet is less likely to work in the presence of a structural lesion, but still can be given a try before surgery. Its role in the treatment of infantile spasm is not known.

Consideration on who would be a good candidate for Ketogenic Diet
- 70% of people who have a single seizure will never have another
- 70% of those who have a second seizure will have their seizures successfully controlled by medication
- The ketogenic diet begins to be an option worth considering when two or more medications fail to bring about seizure control, or when medications cause unacceptable side effects
- If a first medication fails, the chance that a second or third will also be ineffective rises
- For approximately 20% of children with epilepsy, even the newer medications are either ineffective in controlling seizures or have unacceptable side effects. There is little evidence but much hope that the next new medication will provide better seizure control

What is Ketogenic Diet?
It is a rigid, mathematically calculated, doctor supervised therapy. It is high in fat and low in carbohydrate and protein, containing three to five times as much fat as carbohydrate and protein combines. Calories and liquid intakes are strictly limited. This diet should not be attempted except under close supervision by a physician.

The ketogenic diet improves control of seizures in more than half of the children who try it. Only 10% of children with very difficult-to-control seizures have their seizures completely controlled, but one third have their seizures mostly controlled, most have medication reduced and some become free of medication.

Fats in the Body
The human body has been designed and modified over time to meet potential emergency conditions. Thus the normal person has stores of energy in reserve (glucose and glycogen) to use when food is not immediately available. If no new sources of glucose are available within 24 to 36 hours, these stores are used up and the body begins to burn energy that it has stored as fat.
Fasting has been recognized as the mans of controlling seizures since biblical times. But fasting as a treatment for seizures has one major drawback, namely people cannot fast indefinitely because they would starve to death! The body would run out of fat and then burn its own muscle (protein). Even if seizures were controlled by fasting, they often would return when a normal diet was resumed.

The ketogenic diet simulates the metabolism of fasting body. A fasting person burns stored body fat for energy; a person on the ketogenic diet derives energy principally by burning fat in the diet rather than from the more common energy source, carbohydrate (glucose). As the water content of a fasting body is lower than normal, so the ketogenic diet limits liquid intake and lowers the water content of the body.

But unlike fasting, the ketogenic diet allows a person to maintain this fat-burning, partially dehydrated metabolism over an extended period of time.

The ketogenic diet, unlike anticonvulsant medication, it does not appear to have any adverse cognitive side effects. Even children with structural brain disorders such as microcephaly, hypoxic brain damage, prior strokes and developmental abnormalities have had success with the diet.

The ketogenic diet has been most often prescribed for children over one year of age. Children under the age of one year have been thought to have trouble becoming ketotic and maintaining ketosis.

The ketogenic diet must be calculated with precision, prepared meticulously using a gram scale, and followed rigidly.

To optimize the chance of success, the diet must be undertaken with the supervision of a dietitian trained in its use and a physician familiar with tits many quirks. Even seemingly small mistakes such as calculating too many calories into the diet, drinking too much water or using medications that contain carbohydrates (even sunscreen!) can throw off the diet and perhaps bring on seizures.

Success of the ketogenic diet requires the commitment, determination and faith of the entire family.

The ketogenic diet is intended to control seizures. Decreasing and discontinuing medications is only a secondary goal. Improving intellect is a hope and desire, but that is not what the ketogenic diet is designed to do.

How does Ketogenic Diet Work?

The body burns three types of fuel to produce energy. These fuel types are :
- CARBOHYDRATES : Starches sugars, breads, cereal, grains, fruits, vegetables
- FATS: Butter, margarine, oil, mayonnaise
- PROTEINS : Meat, fish poultry, cheese, eggs, milk

When carbohydrates are digested the body converts them to glucose.

Glucose is the fuel source burned by the body to produce energy. When its supply of glucose is limited, the body first burns adipose (fatty) tissue for enegy. IF caloric needs are not met by boy fat, the body then draws from its protein stores (muscle), compromising good health.

The body cannot store large amounts of glucose; it maintains only about a 24-hour supply. Fasting for 24 hours depletes body glucose. Only glucose is depleted, the body automatically draws on its other energy source – stored body fat.

In the absence of glucose, fat is not burned completely, but leaves a residue of soot or ash in the form of ketone bodies (acetone and acetoacetic acid). These ketone bodies build up in the blood.

The ketogenic diet deliberately maintains this buildup of ketone bodies in the blood by forcing the body to burn fat, instead of glucose, as its primary source of energy.

The ketones that are left from the burning of fat are beta-hydroxubutyric acid and acetoacetate. Beta-hydroxybutyric acid can be used by the liver and by the brain as a source of energy. Acetoacetic acid is excreted in the urine and imparts a sweet smell to the breath that has been likened to pineapples.

When ketone body levels are large enough, as indicated by a simple urine test, it is said that the body is “keotic” (pronounced key-tah-tic) or in the state of “ketosis”. Ketosis is also evidenced as mentioned above by a fruity, sweet odor to the breath.

Fat energy is the basis of the ketogenic diet. In the presence of large levels of ketone bodies, seizures are frequently controlled.
[Unfortunately we do not know precisely why the diet works!]