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The Ketogenic Diet

Melissa McCollom
NSCI 5373
November 14, 2002

Overview of Epilepsy

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

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 bodys fuel source from
glucose to fat.

History of the diet


The

basis of the diet fasting


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

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!

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.

Fat
Protein
Carbohydrate

0.1000 x 1,350 =
0.0125 x 1,350 =
0.0125 x 1,350 =

grams
135
16.87
16.87

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

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

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.

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

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

Supplementation:
Calcium
Water-soluble

B and C

Carnitine?

*Supplements must be selected by the keto


team to insure proper carbohydrate balance.

Variations of the Diet:

The classical diet


MTC oil diet:

Advantages
1.
2.
3.

Laxative
Fast acting
More flexibility in the diet

Disadvantages
1.
2.
3.

Is it as effective?
Not palatable
Can cause stomach cramps

The Ketogenic Team:

The neurologist
The dietician
Parents
Keto Kid

Effectiveness:
20-25%

seizures were completely


controlled
30-40% - seizure frequency decreased by
50%
25-30% - not effective

Problems that may arise:

Low blood sugar


Lethargy
Nausea
Vomiting
Elevated cholesterol

Kidney stones
Constipation
Weight loss or gain
Dehydration
Cheating

Advantages & Disadvantages

It works for many


children!
Frequently medications
are greatly decreased
or discontinued.

VERY STRICT!
Long duration
Stunted Growth?
Heart Problems?

The dieticians 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.

November is National
Epilepsy Awareness
Month

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.
Childrens 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

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.

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