Children’s Epilepsy: the Ketogenic Diet. Some parents of children with epilepsy are skeptical of the ketogenic diet when they first hear about it. A diet that can control epilepsy and stop seizures without any medication? It almost sounds like a scam. But the ketogenic diet is real and legitimate. It works very well in many people. The catch is that it's extremely demanding and difficult to follow. A common misconception is that a ketogenic diet is expensive. People see low-carb and automatically start calculating the high prices of meat. This app is designed for use by people familiar with the ketogenic diet (please go to flexibleketogenic.com to learn more). It complements other nutrition or fitness. Learn how to follow the Vegan Ketogenic Diet! Burn fat in ketosis while eating ethically. Get the best of both worlds and put an end to animal cruelty. Specifically, What Is The Ketogenic Diet? There are variations, but in a typical keto diet, 5% of daily calorie intake is derived from carbohydrates, 20% from protein. Low-carbohydrate diets or low-carb diets are dietary programs that restrict carbohydrate consumption, often for the treatment of obesity or diabetes. In fact, it is so difficult to follow that most doctors recommend it only for people who haven't been able to control their seizures with medicine. What Is the Ketogenic Diet for Epilepsy? The ketogenic diet is an extremely high- fat diet that requires a child to eat four times as many fat calories as calories from protein or carbohydrates. A meal might include a small portion of chicken, a little bit of fruit, and a lot of fat, typically butter or cream. Frankly, it's a difficult diet to swallow. ![]() Your child may start the diet in the hospital, so nurses and doctors can observe the first few days. Your child will probably need to go without any food for 3. After that, food is gradually increased over a few days. This diet does not provide all the vitamins a body needs, so your child will probably have to take sugar- free vitamin supplements. Why Does the Ketogenic Diet Work? No one knows why the ketogenic diet - - which was developed in the 1. But we do know something about how it affects the body. The key to success on a ketogenic diet or high-fat diet is to eliminate processed food items, and eat high-quality healthy fats. ![]() By reducing the number of carbohydrates a person eats, the body is forced to burn fat for energy, a process called ketosis. This ketosis is the same process that kicks in when someone is fasting - - on purpose or because of starvation. Fasting has been a traditional seizure treatment for centuries. How ketosis helps with epilepsy isn't known, but it does. Researchers at Johns Hopkins University studied 1. After a year on the ketogenic diet, half of children had 5. One fourth of the children reduced their seizures by 9. After a few years on the diet, many of these children no longer needed medications at all. ![]() Nicholas Gonzalez discusses the long history and failure of the ketogenic diet for cancer treatment. His expertise and perspective is unmatched. The Recommended Daily Allowances (RDA) for different nutrients were developed on Western diets, and therefore, high-carb diets. Given that a ketogenic metabolism uses. Steve: Thank you for the kind words! I'm glad to have an informed reader like yourself. Why did you switch from a ketogenic diet to a diet of 50 to 100 grams of. Continued. The Drawbacks of the Ketogenic Diet. There are many difficulties following the ketogenic diet: Weighing food precisely is important. Even little lapses - - like sneaking the crumbs of a cookie or swallowing a nasal decongestant - - can result in a seizure. Turk, MD, Chief of the Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida. As you might imagine, it's a challenge for most parents to keep their children on this diet. Children may accept foods from other kids at school, or over at a friend's house. Older children may already have strong opinions about what they want to eat. The ketogenic diet works best in young children who haven't yet developed strong tastes in food. Children on the ketogenic diet also often feel very hungry, at least at first. You need to monitor all of the food in the house, including food in the dog's bowl. You may also be concerned about the effects of eating all that butter and cream. After all, isn't fat supposed to be bad for you? A recent study confirmed that children on the ketogenic diet do have significantly higher levels of cholesterol than most kids. But damage from a high- fat diet generally comes only after many years. Children usually follow the ketogenic diet for just a few years. Starting the Ketogenic Diet. This high- fat/low- carb diet may sound like any number of protein diets you've read about. In fact, some popular protein diets also claim to cause the process of ketosis. But the ketogenic diet is not like a typical protein diet and you can't do it on your own. Moshe, MD, director of Clinical Neurophysiology and Child Neurology at the Albert Einstein College of Medicine in New York. Talk it over together. Your child probably wants the seizures to stop, too, and may cooperate willingly. Sources. SOURCES: Solomon L. Professor of Neurology, Neuroscience and Pediatrics, Director of Clinical Neurophysiology and Child Neurology at Albert Einstein College of Medicine, Bronx, New York; past president of the American Epilepsy Society. Division Chief, Department of Pediatrics, Division of Neurology, The Nemours Children's Clinic, Jacksonville, Florida. Freeman, J. Seizures and Epilepsy in Childhood: A Guide. National Information Center for Children and Youth with Disabilities web site. Nemours Foundation web site. Epilepsy Foundation web site. American Epilepsy Society web site. ![]() National Institute of Neurological Disorders and Stroke web site. Epilepsy Foundation Entitled 2 Respect web site. Medscape Epilepsy Resource Center web site. Web. MD Medical News: . All rights reserved. Ketogenic Diet . It is prescribed by a physician and carefully monitored by a dietitian. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. 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 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. However, there are many other theories for why the diet will work. Who will it help? Doctors usually recommend the ketogenic diet for children whose seizures have not responded to several different seizure medicines. It is particularly recommended for children with the Lennox- Gastaut syndrome. The diet is usually not recommended for adults, mostly because the restricted food choices make it hard to follow. Yet, studies done on the use of the diet in adults show that it seems to work just as well. The ketogenic diet has been shown in small studies (case reports and case series) to be particularly helpful for some epilepsy conditions. These include infantile spasms, Rett syndrome, tuberous sclerosis complex, Dravet syndrome, Doose syndrome, and GLUT- 1 deficiency. Using a formula- only ketogenic diet for infants and gastrostomy- tube fed children may lead to better compliance and possibly even improved efficacy. ![]() ![]() The Ketogenic Diet by Lyle McDonald is a complete reference manual for low-carbohydrate/ketogenic diets such as Atkins, South Beach, the Anabolic Diet, Bodyopus, etc. The diet works well for children with focal seizures, but may be less likely to lead to an immediate seizure- free result. In general, the diet can always be considered as long as there are no clear metabolic or mitochondrial reasons not to use it. What is it like? The typical ketogenic diet, called the . For example if a child is eating a 1. For very young children only, the diet may be prescribed based on weight, for example 7. If it sounds complicated, it is! That’s why people need a dietician’s help when using this diet. A ketogenic diet “ratio” is the ratio of fat to carbohydrate and protein grams combined. A 4: 1 ratio is more strict than a 3: 1 ratio and is typically used for most children. A 3: 1 ratio is typically used for infants, adolescents, and children who require higher amounts of protein or carbohydrate for some other reason. The kinds of foods that provide fat for the ketogenic diet are butter, heavy whipping cream, mayonnaise, and oils (e. Because the amount of carbohydrate and protein in the diet have to be restricted, it is very important to prepare meals carefully. No other sources of carbohydrates can be eaten. The child usually begins by fasting (except for water) under close medical supervision for 2. For instance, the child might go into the hospital on Monday, start fasting at 6 p. The diet is then started, either by slowly increasing the calories or the ratio. This is the typical Hopkins protocol. There is growing evidence that fasting is probably not necessary for long- term efficacy, although it does lead to a quicker onset of ketosis. The primary reason for admission in most centers is to monitor for any increase in seizures on the diet, ensure all medications are carbohydrate- free, and educate the families. Does it work? Several studies have shown that the ketogenic diet does reduce or prevent seizures in many children whose seizures could not be controlled by medications. Over half of children who go on the diet have at least a 5. Some children, usually 1. Tell me more. Children who are on the ketogenic diet continue to take seizure medicines. Some are able to take smaller doses or fewer medicines than before they started the diet. When medications can be lowered depends on the child and the comfort level of the neurologist. Evidence suggests it can be done safely in come children - as soon as the diet is started. If the person goes off the diet for even one meal, it may lose its good effect. So it is very important to stick with the diet as prescribed. It can be hard to follow the diet 1. Small children who have free access to the refrigerator are tempted by . Parents need to work as closely as possible with a dietician. Are there any side effects? A person starting the ketogenic diet may feel sluggish for a few days after the diet is started. This can worsen if a child is sick at the same time as the diet is started. Make sure to encourage carbohydrate- free fluids during illnesses. Other side effects that might occur if the person stays on the diet for a long time are. Kidney stones. High cholesterol levels in the blood. Dehydration. Constipation. Slowed growth or weight gain. Bone fractures. Are any other medicine changes needed? Because the diet does not provide all the vitamins and minerals found in a balanced diet, the dietician will recommend vitamin and mineral supplements. The most important of these are calcium and vitamin D (to prevent thinning of the bones), iron, and folic acid. There are no anticonvulsants that should be stopped while on the diet. Topamax (topiramate) and Zonegran (zonisamide) do not have a higher risk of acidosis or kidney stones while on the diet. Depakote (valproic acid) does not lead to carnitine deficiency or other difficulties while on the diet either. Medication levels do not change while on the diet according to recent studies. How is the patient monitored over time? Early on, the doctor will usually see the child every 1- 3 months. Blood and urine tests are performed to make sure there are no medical problems. The height and weight are measured to see if growth has slowed down. As the child gains weight, the diet may need to be adjusted by the dietician. Can the diet ever be stopped? If seizures have been well controlled for some time, usually 2 years, the doctor might suggest going off the diet. Usually, the patient is gradually taken off the diet over several months or even longer. Seizures may worsen if the ketogenic diet is stopped all at once. Children usually continue to take seizure medicines after they go off the diet. In many situations, the diet has led to significant, but not total, seizure control. Families may choose to remain on the ketogenic diet for many years in these situations. Where can I find out more information about the diet? Other than the internet, there are several books about the ketogenic diet available. One is The Ketogenic Diet: A Treatment for Children and Others with Epilepsy, by Drs. Freeman and Kossoff, which discusses the Johns Hopkins approach and experience. The Charlie Foundation and Matthew’s Friends are parent- run organizations for support.
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