When the body burns (metabolizes) fat, it creates substances called
ketones. The ketogenic diet tries to force the body to
use more fat for energy instead of sugar (glucose) by increasing fat and
restricting carbohydrates. It is not yet clear how or why the ketogenic diet
prevents or reduces seizures, but it has been shown to be effective in reducing
epileptic seizures in some children.1
One version of the ketogenic diet provides 4
grams of fat for every 1 gram of protein and carbohydrate together. People on a
ketogenic diet have to eat mostly fatty foods, such as butter, cream, and
peanut butter. Foods such as bread, pasta, fruits, and vegetables have to be
severely limited. And the person's total calories and fluids are also
restricted. At every meal, the food has to be measured carefully so that the
right amounts of each food are given. Even a slight departure from the diet can
cancel its effect.
A person usually has to fast the day
and night before starting the diet. The diet is gradually introduced over
several days, so that the body can get used to the dramatic change. The person
may feel tired and lack energy during the first few days.
are usually admitted to a hospital or epilepsy center when starting the diet so
that they can be monitored. The ketogenic diet should always be given under the
supervision of a doctor and a dietitian.
The ketogenic diet may sometimes be
used to treat children who have severe seizures and who have not responded to
antiepileptic medicines. It has worked especially well in treating seizures
Lennox-Gastaut syndrome. It may be a good choice for a
child when other treatments have failed to control seizures.
Doctors are not sure why the
ketogenic diet helps prevent seizures. But the diet has prevented epileptic
seizures in many children who did not respond to treatment with antiepileptic
medicines, including children with Lennox-Gastaut syndrome. Another benefit of
the ketogenic diet for some children is that it may reduce or end the need for
medicine and thus avoid the side effects that result from medicine.
A review of the results from many studies of the ketogenic diet found
that 4 out of 10 children on the ketogenic diet have one-half the number of
seizures they had before being on the diet.1 Some
children have an even greater reduction.
In one study, children on the ketogenic diet had about one-fourth as many seizures as kids who weren’t on the diet. So a child who wasn’t on the diet had 4 seizures for every 1 seizure that a child on the diet had.2
No one knows why the
ketogenic diet prevents seizures in some children and not in others or why it
has been more successful with children than with adults. If you have a child
with uncontrolled epilepsy, you may wish to discuss with your child's doctor
whether a ketogenic diet might be an option.
The ketogenic diet may cause side effects in
some people. These are not usually serious but may include:
People on the ketogenic diet may develop vitamin and
mineral deficiencies unless they take vitamin and mineral supplements. The diet
does not supply adequate amounts of the vitamins and minerals the body
Everyone on the diet needs close supervision by a doctor
and a dietitian.
Despite the success of the
ketogenic diet in some children, many doctors are skeptical of its use. It
may pose other health risks to your child, and it is extremely hard to follow.
Until more is known about how the ketogenic diet works and what its effects
are, some doctors may not recommend using it. If you are thinking about having
your child try the ketogenic diet, keep in mind that it has several
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Jarrar RG, Buchhalter JR (2003). Therapeutics in
pediatric epilepsy, part 1: The new antiepileptic drugs and the ketogenic diet.
Mayo Clinical Procedures, 78(3): 359–370.
Neal EG, et al. (2008). The ketogenic diet for the treatment of childhood epilepsy: A randomised controlled trial. Lancet Neurology, 7(796): 500–506.
August 26, 2011
Susan C. Kim, MD - Pediatrics
& Steven C. Schachter, MD - Neurology
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