The Ketogenic Diet Melissa McCollomNSCI 5373November 14, 2002

Overview of EpilepsyAbnormal nerve cell firingPartial seizuresGeneralized seizuresTypes of seizures:Grand malPetit mal

Causes of epilepsy:GeneticsInjury to the brainBrain tumorAlcohol/Drug Abuse

The ketogenic dietA treatment option for epilepsyA very strict diet that involves fluid restriction, high fat and low carbohydrate + protein intake. The goal: alter the bodys fuel source from glucose to fat.

History of the dietThe basis of the diet fastingThe encounter with a faith healerDevised in the 1920s at Johns Hopkins University School of Medicine.Popularity faded in the 40s and 50s when new anticonvulsant drugs were discoveredResurgence recently because of the TV movie based on Charlie Abrahams

Physiology behind the dietGlucose 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!

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

Calculations:Divide the total # of grams for fat, protein and carbohydrate by the # of meals in a day.Example:135.0/3 = 45 g fat16.87/3 =5.62 g protein16.87/3 = 5.62 g carbohydrate

Sample Meals:Meal 1:melted butterheavy whipping creamchickenapplesugar free Jell-OMeal 2:Hot dog slices w/ sugar-free catsupAsparagus w/ butterChopped lettuce w/ mayoSugar-free vanilla cream popsicle

Who qualifies?Children usually 2-10 years of ageMost effective in kids with drop type seizuresJohns Hopkins the children considered have at least 3 seizures/weekThe antiepileptic medication is not working.

Beginning the Treatment:Prep for parentsHospitalization to induce ketosisBlood sugar and ketone levels monitored1st meal: eggnog drinkBefore discharge, the child must tolerate a full ketogenic meal

Maintenance of the Diet:Medications are continued initiallyConstant calculations!BE VERY PRECISE!Monitor ketone levels twice a dayWatch for cheating!Special toothpasteNo added seasonings

Supplementation:CalciumWater-soluble B and CCarnitine?*Supplements must be selected by the keto team to insure proper carbohydrate balance.

Variations of the Diet:The classical dietMTC oil diet:AdvantagesLaxativeFast actingMore flexibility in the dietDisadvantagesIs it as effective?Not palatableCan cause stomach cramps

The Ketogenic Team:The neurologistThe dieticianParentsKeto Kid

Effectiveness:20-25% seizures were completely controlled30-40% - seizure frequency decreased by 50%25-30% - not effective

Problems that may arise:Low blood sugarLethargyNauseaVomitingElevated cholesterol

Kidney stonesConstipation Weight loss or gainDehydrationCheating

Advantages & DisadvantagesIt works for many children!Frequently medications are greatly decreased or discontinued.

VERY STRICT!Long durationStunted Growth?Heart Problems?

The dieticians role:Developing the calculated dietary requirements based on the ketogenic ratioTo communicate possible risksTo communicate the precision required for successTo aid in achieving the goal freedom from epileptic seizuresDetermine the appropriate supplementsTeach parents how to cook, calculate and watch for hidden carbohydrate in all foods and medications.

November is National Epilepsy Awareness Month

ReferencesBerryman, 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.Childrens Epilepsy Program: Ketogenic Diet Retrieved November 7, 2002 from http://www.rch.unimelb.edu.au/cep/Pages/ketogenic_diet.htmlFlamini, J., M.D., Treating epilepsy with the Ketogenic Diet. Retrieved November 7, 2002 from http://www.choa.org/library/conditions/ketogenic_history.shtmlHendricks, M., (April 1995) High fat and Seizure free. John Hopkins Magazine. Retrieved November 7, 2002 from http://www.jhu.edu/~jhumag/495 web/fat.htmlKetogenic Diet for Epilepsy. Retrieved November 7, 2002 from http://137.172.248.46/epilepsy.htmlThe John Hopkins Ketogenic Diet Fact Sheet. Retrieved November 7, 2002 from http://www.hopkinsmedicine.org/ketodiet.htmlThe Ketogenic Diet. Retrieved November 7, 2002 from http://www.mynchen.demon.co.uk/The%20ketogenic%20diet

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.htmlWilliams, 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.

Brain is made up of millions of nerve cells. Each nerve cell is electrically charged. Nerve cells receive electrical signals from other nerve cells and passes them on to others. All movements and functions of the brain depend on this smooth electrical signal chain. In epilepsy, this chain is disrupted by nerve cells that are discharging signals inappropriately.

Partial occurs in a part of the brainGeneralized involves the whole brainThe encounter 1900s in NYC

NOT ONLY DOES THE CALORIC INTAKE FOR THE DAY HAVE TO BE IN A 4:1 RATIO, BUT EACH MEAL MUST BE 4:1EKGs are also performed to ensure no heart problemsClassical diet Johns Hopkins University begin on a 4:1 ratioJohn Hopkins meets the RDA requirement for protein which means there is little room for any carbs. MORE RESTRICTIVE!

MTC oil:Fast actiing most fats must be absorbed in the lymphatic system, but MTC oil is fast acting by absorbing directly into the portal blood.Flexibility because the oil is so ketogenic there is a little more room for carbsNeurologist must believe in the diet!

Statistics from Johns Hopkins University School of MedLethargy does it compare to the lethargy they experience everyday with seizures?Ex. MarkElevated cholesterol the levels resume after the diet is concludednot much research about whether there are long term effectsKidney stones due to the increase of uric acid excreted in the urineConstipation easily treatable w/ MTC oilWeight loss or gain depends on the variation of the diet and the clinic administering the dietJohns Hopkins weight loss during initial ketosis the weight is gained back, but carefully maintained in the first year. Protein RDA is met to insure proper growth