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Ketogenic Diet 101

You may have not heard of the ketogenic diet–then again, maybe you have, especially if you know a child who has seizures. I have asked registered dietitians and pediatric experts, Jennifer Gallagher and Britt Schuman-Humbert to help us understand this highly specialized nutrition approach. I hope you find this interesting…

The other day a colleague of mine said she heard that the ketogenic diet (KD) is recommended for weight loss in children. My eyebrows nearly pealed right off my forehead. Now, I have witnessed the life changing success from the KD for children with seizures but have some skepticism about its use for other conditions. Nonetheless, it got me curious.

Sure enough, a quick internet search revealed the KD popular for lots of health claims but a closer inspection reveals something a bit different.

First a Little Background.  The KD has been used as a seizure control therapy since the 1920’s but fell out of favor when drug therapy became available. It wasn’t until the mid 1990’s when the Abrahams family, after trying and failing several medications and brain surgery for their young son, Charlie, that they found success at John’s Hopkins pediatric epilepsy program.  The Abrahams family began The Charlie Foundation, a nonprofit organization dedicated to raise awareness of the KD for treatment, to facilitate research and to educate parents, clinicians and hospitals on its proper implementation. The Charlie Foundation is credited with pushing the KD back into medical mainstream as a tool to mitigate seizures.

So, What is the KD You Ask?

I’ll begin by telling you what it is not. Regardless of the variations of the KD, it is not natural, nutritious, holistic, healthy, or without side effects. It is not to be implemented without a trained clinician and fortunately it is not meant to be a forever way of eating.

The KD is food controlled, very high fat, very low carbohydrate with normal levels of protein and fluid.

 

 

Let’s compare.  A normal diet might contain half carbohydrate such as bread, pasta, fruit, dairy and sweets, 35% from fat and 15% from protein such as meats, fish and nuts.

A KD turns a normal diet on its head with 90% fat, 2% carbohydrate and about 8% protein.   That’s about 1 oz of chicken with melted butter, ½ c ranch dressing, a sliver slice of strawberry with whipped cream and a couple slices of cucumber.Is That It?

Fortunately, there are alternatives to traditional favorites such as pancakes, flatbread, pizza and even birthday cake made with specialty powders or nut flours.

How Does All That Fat Help Seizure Control?

The KD diet is so low in carbohydrates that it mimics “starvation” and forces the body to use fat for energy, which in turn produces ketones. Normally, carbohydrates are the fuel source for our brains but the brain will use ketones for energy when carbohydrate is limited. However, the person must stay in constant ketosis in order for the diet to continue to suppress seizures. Even the wrong toothpaste can knock a person out of ketosis. The mechanisms by which the KD reduces seizures are linked to shifts in brain energy metabolism. 

Is the Ketogenic Diet Used for Other Therapies?

The KD should not be used for weight loss for children and yes, KD is being studied in several other diseases. Most exciting is KD research in brain cancer therapy. Cancer cells rely primarily on carbohydrate to fuel their growth but cannot use ketones to do so. The thought is that a KD could starve tumor cells, and in combination with traditional therapy, has the potential to improve overall care. Research is ongoing in the areas of type 2 diabetes, obesity and neurological disorders such as Parkinson’s disease but despite internet claims, we are not there yet.

For children who are trying to grow their brain and learn the world around them, recurring seizures can set them back significantly. The KD has been just short of a miracle for many families and is close to my heart because I have seen so many children helped by this therapy. If it can be a treatment for other conditions, I’ll be right there singing its praises.

References

Kossoff EH, Nabbout R. Use of Dietary Therapy for Status Epilepticus.  J Child Neurol.  2013 May 1 (Epub ahead of print)

Seyfried TN, Marsh J, Shelton LM, Huysentruyt LC, Mukherjee P.  Is the restricted ketogenic diet a viable alternative to the standard of care for managing malignant brain cancer?  Epilepsy Res. 2012 Jul;100(3):310-26.

Stafstrom CE, Rho, JM. The ketogenic diet as a treatment paradigm for diverse neurological disorders.  Front Pharmacol. 2012;3:59

 

Jennifer Gallagher, MPPA, RD, LDN is a pediatric dietitian and public health nutrition consultant with 20 years of experience.  Britt Schuman-Humbert RD, CSP, LDN, CNSC is a pediatric dietitian and wellness nutrition consultant.  She has over 18 years of experience in clinical nutrition.  They are dedicated to making nutrition counseling readily available to everyone.  Both Jennifer and Britt direct Pediatric Nutrition Providers, an emerging private practice in North Carolina dedicated to outreach, education, and guidance to support families in their endeavors to nourish their children.

 

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