The Ketogenic Diet

1. The Ketogenic Diet Melissa McCollom NSCI 5373 November 14, 2002

2. Abnormal nerve cell firing Partial seizures Generalized seizures Types of seizures: Grand mal Petit mal Causes of epilepsy: Genetics Injury to the brain Brain tumor Alcohol/Drug Abuse Overview of Epilepsy

3. The ketogenic diet • A treatment option for epilepsy • A very strict diet that involves fluid restriction, high fat and low carbohydrate + protein intake. • The goal: alter the body’s fuel source from glucose to fat.

4. History of the diet • The basis of the diet – fasting • The encounter with a faith healer • Devised in the 1920’s at Johns Hopkins University School of Medicine. • Popularity faded in the 40’s and 50’s when new anticonvulsant drugs were discovered • Resurgence recently because of the TV movie based on Charlie Abrahams

5. Physiology behind the diet • Glucose → Fat (as the primary fuel source) • Ketone bodies – the acidic products formed from excessive breakdown of fat. • The brain uses the ketones as fuel. • No one knows why this works!

6. Calculations of the Diet: • The ketogenic ratio – 4:1 • Calculate the # of calories needed a day (based on RDAs) • The following calculation is for a 2 yr. old child weighing 18kg.

7. Calculations: • Divide the total # of grams for fat, protein and carbohydrate by the # of meals in a day. • Example: 135.0/3 = 45 g fat 16.87/3 = 5.62 g protein 16.87/3 = 5.62 g carbohydrate

8. Sample Meals: • Meal 1: • melted butter • heavy whipping cream • chicken • apple • sugar free Jell-O • Meal 2: • Hot dog slices w/ sugar-free catsup • Asparagus w/ butter • Chopped lettuce w/ mayo • Sugar-free vanilla cream popsicle

9. Who qualifies? • Children – usually 2-10 years of age • Most effective in kids with “drop” type seizures • Johns Hopkins – the children considered have at least 3 seizures/week • The antiepileptic medication is not working.

10. Beginning the Treatment: • Prep for parents • Hospitalization to induce ketosis • Blood sugar and ketone levels monitored • 1st meal: eggnog drink • Before discharge, the child must tolerate a full ketogenic meal

11. Maintenance of the Diet: • Medications are continued initially • Constant calculations! • BE VERY PRECISE! • Monitor ketone levels twice a day • Watch for cheating! • Special toothpaste • No added seasonings

12. Supplementation: • Calcium • Water-soluble B and C • Carnitine? *Supplements must be selected by the keto team to insure proper carbohydrate balance.

13. Variations of the Diet: • The classical diet • MTC oil diet: • Advantages • Laxative • Fast acting • More flexibility in the diet • Disadvantages • Is it as effective? • Not palatable • Can cause stomach cramps

14. The Ketogenic Team: • The neurologist • The dietician • Parents • Keto Kid

15. Effectiveness: • 20-25% – seizures were completely controlled • 30-40% - seizure frequency decreased by 50% • 25-30% - not effective

16. Low blood sugar Lethargy Nausea Vomiting Elevated cholesterol Kidney stones Constipation Weight loss or gain Dehydration Cheating Problems that may arise:

17. It works for many children! Frequently medications are greatly decreased or discontinued. VERY STRICT! Long duration Stunted Growth? Heart Problems? Advantages & Disadvantages

18. The dietician’s role: • Developing the calculated dietary requirements based on the ketogenic ratio • To communicate possible risks • To communicate the precision required for success • To aid in achieving the goal – freedom from epileptic seizures • Determine the appropriate supplements • Teach parents how to cook, calculate and watch for hidden carbohydrate in all foods and medications.

19. November is National Epilepsy Awareness Month

20. References Berryman, S., (October 1997). The ketogenic diet revisited. Journal of the American Dietetic Association, 97. Chauncey, K., Ph.D., R.D., The ketogenic diet in the Treatment of Pediatric Epilepsy. Retrieved November 7, 2002 from http://www.ttuhsc.edu/pages/fammed/ketogenic.html. Children’s Epilepsy Program: Ketogenic Diet Retrieved November 7, 2002 from http://www.rch.unimelb.edu.au/cep/Pages/ketogenic_diet.html Flamini, J., M.D., Treating epilepsy with the Ketogenic Diet. Retrieved November 7, 2002 from http://www.choa.org/library/conditions/ketogenic_history.shtml Hendricks, M., (April 1995) High fat and Seizure free. John Hopkins Magazine. Retrieved November 7, 2002 from http://www.jhu.edu/~jhumag/495 web/fat.html Ketogenic Diet for Epilepsy. Retrieved November 7, 2002 from http://137.172.248.46/epilepsy.html The John Hopkins Ketogenic Diet Fact Sheet. Retrieved November 7, 2002 from http://www.hopkinsmedicine.org/ketodiet.html The Ketogenic Diet. Retrieved November 7, 2002 from http://www.mynchen.demon.co.uk/The%20ketogenic%20diet

21. References (cont.) Scalisi, J., MacCracken, K., (December 1999). Development and evaluation of a ketogenic diet program. Journal of the American Dietetics Association, 99, 1554-1558. Schwarzman, F., Koenigsberger, D., Couch, S., Carroll, J., (December 1999). Growth and nutritional outcomes of children treated with the ketogenic diet. Journal of the American Dietetics Association, 99, 1573-1575. Vining, E., Pyzik, P., Pillas, D., Freeman, J., (1998). The efficacy of the ketogenic diet – 1998: A prospective evaluation of intervention in 150 children. Pediatrics, 102, 1358-1363. What is epilepsy all about? Retrieved November 7, 2002 from http://137.172.248.46/epilepsy.html Williams, S., Schuller, R., Curtis, R., Basualdo-Hammond, C., (March 2002) Growth retardation in children with epilepsy on the ketogenic diet: A retrospective chart review. Journal of the American Dietetics Association, 102, 405-407. Wyllie, E., Powaski, K., Chesney, D., Brouhard, B., (February 1999). Biochemical abnormalities of the ketogenic diet in children. Clinical Pediatrics, 38, 107-109.