Ketogenic Diet for Epilepsy and Sample Menu

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The ketogenic diet for epilepsy (KDE) is a specific diet that has helped many children and some adults achieve better (or even complete) seizure control . It is a first-line treatment for several specific epileptic syndromes such as epilepsy caused by GLUT-1 mutations or pyruvate dehydrogenase deficiency .

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The ketogenic diet for epilepsy was developed in the 1920s by a Michigan physician named Hugh Conklin. However, with the advent of effective drugs, the diet was used less and less.

It gained acceptance and became the standard contingency plan for children whose epilepsy symptoms are difficult to control with medication. In the United States, more than 470,000 children with seizures (according to statistics from the Centers for Disease Control and Prevention ) are a significant addition to the epilepsy treatment arsenal.

Researchers are also beginning to understand how this can help adults with epilepsy and people with various neurological disorders.

The ketogenic diet and epilepsy

Implying

The ketogenic diet for epilepsy is a very high-fat diet, with enough protein to support and grow the body, and very low in carbohydrates.

When fats are broken down into energy, the body enters what is called a ketogenic state , in which the body produces molecules called ketones. The goal of KDE is for the brain to make the most of ketones for energy, not glucose (sugar).

Ketones are (to a large extent) soluble in water, so they are easily transported to the brain. The brain cannot use fatty acids for energy, but it can use ketones to meet a significant portion of its energy needs .

KDE generally begins in a hospital setting and often begins with a one or two day fast, although there may be a tendency to move away from both requirements .

After determining the required amount of protein (depending on age, etc.), the diet is constructed as the ratio of grams of fat to a gram of protein plus grams of carbohydrates . It usually starts with a 4: 1 ratio and can be adjusted from there. The diet is usually limited in calories and fluids. Also , low carb packaged foods (shakes, bars, etc.) are prohibited for at least the first month.

Since a gram of fat contains more than twice as many calories as a gram of protein or carbohydrates, this equation means that at least 75% of the calories in the diet are fat. This is a very strict diet and it takes time to learn how to formulate meals that conform to this formula. All food must be weighed and recorded.

Often, the discontinuation of the diet is made after two years, although some children follow it for longer .

Get Medical Information / Emily Roberts

Why it works

Researchers are beginning to understand why a ketogenic diet reduces seizure rates. Based on a 2017 research review , it appears that several mechanisms may be working, including the following.

  • Diet appears to alter ketone metabolism in the brain in a way that enhances the brain's ability to produce the neurotransmitter GABA, which has a calming effect on the brain .
  • Diet has important anti-inflammatory and antioxidant effects that appear to alter the way in which some genes involved in epilepsy are expressed.
  • Some fatty acids in the diet are anticonvulsant and even potentiate the effects of valproic acid, a common anticonvulsant.
  • Polyunsaturated fatty acids in the diet can prevent brain cells from becoming overexcited.
  • Decanoic acid, which is also included in the diet, appears to have a direct inhibitory response to AMPA receptors in the brain. These receptors are believed to play a role in epilepsy and are the target of some epilepsy medications.
  • Targeting a key cellular energy sensor appears to help prevent brain cell overstimulation.
  • Diet can positively influence circadian activity and growth factor expression in the brain .

Efficiency

Research generally shows that about a third of children with epilepsy who follow a ketogenic diet have at least 90% fewer seizures , and another third have between 50% and 90% .

This is great considering that these patients tend to be those with poor control of their seizure medication.

In adults

There is a growing body of research on KDE and the modified Atkins diet in adults with seizure disorders, and the results are similar to those in children.

A 2014 study reported that 45% of adolescents and adults had a 50% or greater decrease in seizure frequency. Tolerability was better in patients with symptomatic generalized epilepsy.

Interestingly, keeping the adults on a diet was more difficult, as they apparently have better control over what they eat. Research in this area is still limited and more trials are needed .

During pregnancy

A 2017 report on the use of these diets during pregnancy suggests that they may be an effective way to control seizures and possibly allow pregnant women to use lower doses of epilepsy medications. However, the safety of this remains to be studied .

Work with your medical team

It is vital that anyone using this diet for a seizure disorder do so under the supervision of an experienced physician and nutritionist. Many individual variations can affect a person's exact dietary recommendations, and it can be difficult to reconcile this meal plan with medications. This is not something you should try to do on your own.

Typical menu of the day

The following is an abbreviated description of the menu that appeared in the 2015 Pediatric Annals article The Ketogenic Diet: A Practical Guide for Pediatricians . It is intended to give an idea of what children eat on the diet, not to serve as an accurate recipe. Remember that all of these foods are carefully weighed and measured.

  • Breakfast: boiled eggs with cream, cheese and butter; a small serving of strawberries, pineapple, or melon
  • Lunch: cheeseburger cutlet; cooked broccoli, green beans, or carrots with whipped cream ghee
  • Dinner: grilled chicken breast with cheese and mayonnaise; vegetables boiled in butter; whipped cream
  • Appetizers: Whipped cream, small portions of fruit, unsweetened gelatin.

In some variations, the heavy cream and butter are replaced with coconut oil or MCT oil.

School lunch

With a school-age child, keeping him on a diet during the school day is difficult, but necessary. Thinking and planning ahead can help you be successful. You can try the following strategies:

  • Talk to your child – Make sure your child understands the diet and why it is so important to follow it. Let them know that they should not exchange food with other children. As difficult as it is, they should not eat the food from the vending machines or the treats that are distributed in the classroom.
  • Talk to the school – The teacher, counselor, nurse, and administration should be aware of your child's special dietary needs (as well as other health concerns). You will want to interact with them regularly and you may also have a 504 plan or an individualized education plan (IEP).
  • Become a Planner – Collect multiple recipes to combine meals to create convenient, easy-to-pack meals. If possible, you can treat your child with treats at Christmas parties and other special events that you may know about in advance. The Charlie Foundation and Clara's Menu are good resources for keto recipes for kids.
  • Educate family members: It is important that family members and other caregivers know how to prepare meals for a child with epilepsy.
  • Establish a daily routine – Meal and snack times should be consistent to keep your child 's glucose levels as stable as possible. You may need to work with your child's teachers on this.
  • Invite a friend: Having a friend at school who understands the importance of your child's diet can help you feel less embarrassed about being 'different' and give you someone to lean on when needed. Make sure your child likes it and invite him to choose a friend.

You'll also want the parents of your child's friends to be aware of the special diet and that what some people might consider "a harmless little trick" may not be at all. It is a good idea to give your child food to take to parties and play parties.

Alternatives to the super strict ketogenic diet

The modified Atkins diet is a popular alternative that helps many people who find it too difficult to stick to a ketogenic diet. This diet is much less restrictive since calories, fluids, and protein are not measured .

The diet begins with 10 grams of carbohydrates per day for the first month, gradually increasing to 15-20 grams. This is similar to the very strict induction phase of the standard Atkins diet.

Research shows that the contributor has achieved better attack control in KDE. A 2016 study confirmed that this applies to children under the age of 2, but the diet gives similar results for older children. The modified Atkins diet has also been observed to have fewer serious side effects and better tolerance .

Get the word of drug information

Because a high-fat diet runs counter to general notions of healthy eating, you may face criticism for putting your child on it. These critics tend to be well-intentioned but uninformed. Ultimately, it is up to you and your child's healthcare team to determine the best course of action when it comes to protecting your child's health.

If you have questions or concerns about how the ketogenic diet might affect your child, speak with your doctor. Before starting KDE, make sure you understand all the nuances and that you can follow it as instructed. Our Doctor Discussion Guide will help you start a conversation with your healthcare provider about the best treatment options.

Epilepsy Physician Discussion Guide

Get our printed guide to your next doctor's appointment to help you ask the right questions.

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