The Ketogenic Diet
The Ketogenic Diet - A Brief Outline
Written by: Gail Hall – MF Regional Co-ordinator NW
Approved by: Gwyneth Magrath – Dietitian – BCH & MF Medical Board
The keto diet is more than its title suggests - it is NOT a fad diet like lots of others out there. It is a medical therapeutic diet that is high in fat, low in protein and carbohydrate with calorie control. It MUST be run under the care of a qualified dietitian in partnership with neurologists/medics. It has proven to be a highly effective diet in managing difficult to control epilepsies, as well as metabolic disorders e.g. GLUT1 deficiency.
The diet was initiated in the USA in the 1920's. With the advent of newer anti epileptic medication in the 1930's-70's interest in the diet waned. The 1990's, however, saw a resurgence of interest in the diet. In 1970 the MCT version of the diet was introduced.
Forms of the Diet
* Classical - where the diet uses "normal" foodstuff - lots of butter/oil/cream, meat/fish/eggs for protein and low carb type vegetables
* MCT - Uses a medium chain triglyceride oil e.g. refined coconut oil - which enhances ketosis and allows more carbs.
* Modified Atkins - not so restrictive on the protein allowance or calories, but with a set amount of carbs per day and pushing fatty foods.
* Low Glycemic Index Diet – once again this is not restrictive on calories but you still have to watch the carbohydrate intake and once again push the fatty foods.
The diet can be administered via bottle feed, normal food or gastrostomy/tube feed.
How the diet works
There is much debate in this area! The diet appears to "mimic starvation" by using fat as an alternative fuel source for the body, producing ketones. These ketones can then have an anti-convulsive effect on the body.
The "Holy Grail" of keto is for a child to be initiated on the diet, become seizure free, reduce/remove the anti-epileptic medication that is being taken, wean the diet and STAY seizure free. This DOES happen, but there are also other degrees of success on the diet:
* Reduction in number of/intensity of seizures
* Reduction in drugs and their subsequent side effects
* Increased alertness
* Improvement in behavioural problems
* Improvement in learning ability
* QUALITY OF LIFE!
The diet is perceived as challenging in the following areas:
* The diet is difficult - Depends what you mean by “difficult” – it’s difficult to watch your child seize. It’s difficult to watch your child in a drugged up haze. Compared to these, spending time in the kitchen, actively involved in your child’s care is a piece of cake! We don’t want to belittle the amount of effort needed to calculate or administer the diet – Initially you can feel like you’re never out of the kitchen – We just want to put this effort in context.
* It is unpalatable - This diet is high fat, adequate protein, low carbohydrate so doesn’t sound like it’s going to be very enjoyable for the child. Fortunately there’s loads of good keto recipes out there – our keto mums are very inventive – muffins, strawberry milkshakes, keto crackers, pizzas, pancakes, waffles and even Keto chocolate can all be made on this diet. It doesn’t take long to get to grips with the diet and you DON’T have to be a chef to do it – although Matthews Friends does have one available that could help you if you needed it!
* It may not work – That is true – the diet doesn’t work for everyone, but it has a substantially higher success rate for drug resistant epilepsies than anything else on offer and the drugs don’t work for everyone either – it IS worth trying though.
* The positive effects may not last – I recently read that “only rarely do the effects last more than 12 months” - myself and many others can testify that this is often not the case – the diet may need fine tuning as you go along, Breakthrough seizures can be treated by changing the ratio, the calories, the timing, size of meals, snacks and if required, changing the diet format from one to another.
If you have any further questions then please do not hesitate to contact the MF helpline on 0788 4054811.
The Ketogenic Diet should only be undertaken with strict medical supervision. Matthews Friends cannot be held responsible if this warning is ignored and you could put yourself and/or others at risk if you do not seek professional medical help with the administration and monitoring of a Ketogenic Diet treatment