Certain types of regimens that require tight medical oversight may be a potential treatment for some infants and kids with epilepsy, referred to as ketogenic diets. With this eating plan, high amounts of fat are consumed and very few carbs. This will cause the body to burn fat rather than carbs and protein for fuel and create ketones. The brain is capable of using ketones as a substitute source of energy. The way of eating resembles the metabolic state of the body when one is fasting or ill. Certain instances of seizure activity can be decreased by a high ketone state (ketosis) although the exact modus operandi is still unknown. The diet purposely keeps a large amount of ketones in the body through a specifically tailored individual plan that has very precise meal plans.
At The Royal Children’s Hospital, there are two distinct forms of ketogenic diet treatment: the Classical Ketogenic Diet (CKD) with a focus on minimal carbohydrates, appropriate levels of protein, and elevated amounts of fat, and the Modified Atkins Diet (MAD) which incorporates minimal carbs, moderate protein, and substantial amounts of fat. This is not like the ‘keto’ diet that is regularly mentioned on social media.
A ketogenic diet is not a “natural therapy”. All forms of diet therapy for the treatment of epilepsy must be medically managed with frequent assessments to protect against potential adverse reactions that could involve nutritional deficiencies, stunted growth, kidney stones, high cholesterol, and other issues.
Who Is the Diet For?
Ketogenic diets are typically recommended for children who suffer from epilepsy that is not responding to medication or who have GLUT 1 deficiency syndrome. A pediatric neurologist who has knowledge in managing epilepsy is a must in order to perform the assessment. In general, it is believed that the ketogenic diet is the most successful form of treatment for children with myoclonic-atonic seizures, infantile spasms, Dravet syndrome and absence seizures.
What is involved before commencing the ketogenic diet?
A referral from a neurologist or pediatrician must be obtained by all kids before they are assessed to determine if they are eligible to receive dietary therapies for dealing with epilepsy at the Dietary Therapies for Epilepsy Clinic. A comprehensive evaluation is carried out which involves medical examination of the person, fundamental tests, collaborative orientations with the epilepsy nurse professional (ENS) and nutrition specialist, assignments, and independent education sessions. The process is outlined below.
Ketogenic Diet Therapy for Epilepsy
The ketogenic diet is one of the earliest known methods of treating epilepsy. Ketogenic diet clinics have usually been focused on taking care of children from 0 to 18 years of age. There is increasing proof that it can be of aid in curtailing convulsions among adults. This piece includes responses to common inquiries about the advantages and issues of this kind of diet therapy. It is important to point out that the ketogenic diet should not be tried without assistance. Only attempt this with the help of a qualified medical team.
What is the ketogenic diet for epilepsy?
One of the earliest treatment methods for epilepsy is the ketogenic diet. This type of diet consists of mostly fat, a moderate amount of protein, and minimal carbs, and is used in cases of severe epileptic seizures. Different forms of the ketogenic diet exist, but all are founded on the same principles. Ketogenic dieting can be altered to accommodate different cultures, any food allergies, as well as providing nutrition through tube feedings. It is a therapy for both children and adults.
It is essential to do your research before embarking on a ketogenic diet, as this type of dietary regimen has its potential risks. Do not try the ketogenic diet without being medically monitored by a team with experience in this area, particularly if you are using anti-seizure drugs. This team of people dedicated to the ketogenic diet includes a neurologist, a trained diet expert, a nurse, and sometimes a nurse practitioner, pharmacist, social worker, and other healthcare professionals.
A ketogenic diet may be a wise decision for families, both practically and emotionally. The initial few weeks of beginning a ketogenic diet regime can be very demanding, and your family needs to have a strong backing system.
Figuring out alternate ways to cook requires both effort and patience. Having trouble adjusting to the changed diet may be an issue. Despite any challenges that may arise, having a look at your meal plan from a different perspective, being aware of what your troubles are, and getting assistance from your ketogenic diet team can help you get past these issues. Eventually, you will get used to the substantial shifts in how you cook and eat, and it will become easier. A lot of households handle the struggles good, and concur that if the eating plan drastically cuts down on seizures, all their hard work is justified.
How does the ketogenic diet control seizures?
Fasting has long been associated with reduced seizure frequency. Ketones are produced during extended periods of fasting. When a period of abstinence from food ends with meals that include either carbohydrates or protein, the risk of epileptic fits increases. Of course, fasting is not sustainable.
The ketogenic diet is very restricted in carbohydrates, has a moderate amount of protein, and is low in fat. This basic structure of the diet imitates the physiological state of fasting and prompts the production of ketones. Ketones show a substantial shift in metabolic activity, but cannot be the only factor responsible for the inhibitory effect on seizures. Investigators are investigating other modes of action in order to more clearly explain why this particular diet is effective at curbing seizures.
If antiseizure medications successfully mitigate seizures and the person taking them experiences no problems, many individuals would not have a desire to try out a ketogenic diet. In cases where antiseizure drugs are inefficient, present adverse reactions, or cannot be used due to a particularity, the ketogenic diet may be suggested as an alternative.
Can adults with epilepsy try the ketogenic diet?
Yes. There is an increasing amount of proof which demonstrates the effectiveness of using it in managing seizures in adults who cannot be treated medically for epilepsy. For adults, they can either follow the traditional ketogenic diet, or become familiar with the modified version or the Atkins plan which gives them the liberty to make their own food decisions and continue going out to eateries while adhering to this dietary therapy. Through the right preparation and inspiration, adults can keep up this dietary approach and effectively oversee their seizures. In spite of there being slightly more freedom involved in a few of the ketogenic diets for adults, it is still classified as a healthcare approach and should be commenced and regulated by your health team.
Can the ketogenic diet be applied to other disorders?
A diet high in fat and low in carbohydrates is suggested for certain metabolic issues, such as an inability to source glucose and an inability to breakdown pyruvate.
It appears that more and more research is showing that a ketogenic diet may be beneficial to people with neurological conditions and even certain brain tumors.
The eating plan can be tailored for those with allergies, those utilizing tube nourishment, or those who have particular cultural food preferences.
Are there different types of diet therapy for epilepsy?
Yes, this is an evolving area. At present, a variety of ketogenic diet types are being employed across the globe, including classic ketogenic, MCT oil ketogenic, adjusted Atkins, low glycemic index, and modified ketogenic diets. The type and quantity of fat, carbohydrates, and proteins differentiate between these dietary plans. Not all centers that follow the ketogenic diet will use the same guidelines or instructions. Many centers offer more than one option. A medical team who are experienced in ketogenic diets will assist you in deciding which kind of diet is most suitable for you or your child. Every person who seeks medical care must be dealt with on a case-by-case basis and a personalized ketogenic diet must be prepared to suit their individual circumstances.
What type of seizures responds well to the ketogenic diet therapy?
It is not possible to determine who will gain advantages from a ketogenic diet regimen. The ketogenic diet has been shown to work to counter various seizures caused by various forms of epilepsy.
How effective is the ketogenic diet in controlling seizures?
The ketogenic diet has been found to be useful when it comes to treating epilepsy in those who have not responded to other medications, ranging in age from infancy to adulthood.
As many as 60% of youngsters who attempt a ketogenic diet with guidance see an appreciated decrease in the amount of seizures that occur, with a reduction of 50% or greater.
Approximately half of adults who undertake a diet regimen monitored by medical professionals see a notable decrease in seizure activity, with at least a 50% reduction in occurrence.
How Is a Ketogenic Diet Commenced?
One can start a ketogenic diet either in a medical institution or from the comfort of their own home. The place where the child will eat will be determined by the kind of food they eat, their age and physical condition.
Inpatient initiation: Classical Ketogenic Diet
Kids are permitted to enter the Cockatoo (neurology) ward on Mondays after going through fasting blood and urine tests and obtaining an electrocardiogram. The length of admission is 4-5 days. During the acceptance process, young ones shall be required to ingest a KetoCalTM formula for 48 hours before they are allowed to enjoy ketogenic meals which have been prepared in the hospital kitchen. While they admit the patient, they will watch the patient’s blood ketones and glucose levels carefully. The Ketogenic Diet Group will examine the kid each day while they are being hospitalized.
Outpatient initiation: Classical Ketogenic Diet (CKD) or Modified Atkins Diet (MAD)
The date that the patient starts their outpatient care is decided between the Ketogenic Diet Team and the family. It is suggested that starting the diet on a Monday is best, and it usually takes approximately 2 weeks to reach the ideal nutrition plan for chronic kidney disease and 5 days for MAD. Prior to now, evaluations like renal ultrasound, fasting blood and urine analysis, and growth assessments would be done at the hospital. During home initiation, food is commenced from day 1. A family member should measure the blood ketone and blood glucose levels three times daily for someone suffering from CKD. For the MAD, urine ketones are commenced twice daily. The epilepsy nurse and dietician will be in touch with you every day at first to evaluate the situation.
Your child will still take the same dosage of medications, but they will need to transition to taking tablets for both the CKD and the MAD. They are urged to keep up with their regular activities and should not stay in bed all day.
How Likely Is the Diet to Work?
It is essential to be realistic about the possibilities of diet being effective in managing your child’s epilepsy. Not all children find relief from seizures while on a ketogenic diet. A limited number of kids gain considerable advantages from using the ketogenic diet. If the entirety of epileptic types are taken into account, a little over one-third of children will experience a decrease of more than half in the recurrence of their seizures. Almost one-third of people will have a decrease in seizures of less than half, while the rest will not notice any difference in seizure frequency. Fewer than 10% of people will observe a larger than 90% lessening in convulsions and fewer than 5% of people will become free from seizures.
In spite of that, certain types of epilepsy may have more positive reactions, such as absence epilepsy, myoclonic-atonic epilepsy (Doose syndrome), Dravet syndrome, and infantile spasms. Studies that have been conducted on a small scale indicate that more than two-thirds of the kids will experience a reduction in the number of seizures they experience, while one-fifth to one-third of the children will not have any seizures at all.
It is difficult to judge if CKD is superior to MAD, however, CKD is usually seen as the most reliable option for dietary therapy.
What does it look like?
Classical ketogenic diet
The dietitian will figure out the amount of calories and protein that your child needs for healthy development and establish the suitable proportion of fat to carbohydrates and protein for successful ketosis. Parents are recommended to gain an understanding of how to make ketogenic recipes, and the dietitian will impart knowledge. Recipes that adhere to a ketogenic diet must be quite distinct from more traditional dishes as they will contain a much higher amount of fat and a much smaller amount of carbohydrates. Meals consisting of bread, pasta, rice, and potatoes are typically not permitted. The daily food intake is usually split into three main meals and two snacks. It is prohibited to consume food that is not part of the meal plan. The size of meals is usually reduced owing to their high fat content. Water is the main fluid allowed. A balanced diet is not providing all the necessary nutrients, so it is essential to take daily vitamin and mineral supplements.
Modified Atkins diet
The MAD is calculated differently from the CKD. Meals have carbohydrates strictly regulated and fats included, but the amount of protein or diet composition are not monitored. Grains such as bread, pasta, rice, and potatoes typically cannot be eaten, however meat, eggs, and cheese are acceptable as sources of protein. Parents are encouraged to become educated on how to figure out Modified Ad Libitum (MAD) recipes and a dietitian can supply this knowledge. Water is the main fluid allowed. It is important to take daily vitamin and mineral supplements because the diet does not have enough nutrition.