|
Ketogenic
Diet
The CEP is pleased to announce the first patient began ketogenic diet on June 6, 2006. The ketogenic diet is a special high-fat diet that is used to treat seizures. Whipping cream, fats and vegetable oils are used to provide the necessary fat. The diet eliminates foods such as bread, cereal, pasta, potatoes, rice, sweets and milk. All foods must be carefully prepared and weighed on a gram scale. Each meal must be eaten in its entirety for the diet to be the most effective. It is very important to be completely dedicated to following the meal plan precisely.
If you would like to discuss enrolling in the ketogenic diet program please contact our dietician Amy Helms at 706-721-5559 or our nurse Pam Culberson-Brown at 706-721-3371 for additional information.
Who
is a good candidate for the diet?
Your child's physician will determine if this diet is right for your child. The diet should be used in those who traditional therapies have not worked. The diet requires a strong commitment from the family to measure all foods eaten on a daily basis. No deviation in the diet plan is allowed.
Who
can be helped by the diet and how much?
Many
children with seizures can be helped by the diet. There is no way to predict
beforehand whether it will be successful, you simply have to try it to find
out. Traditionally the diet has been used in young children, between the age
of 1 and 6, with myoclonic, atonic and tonic-clonic seizures. Recent studies
are confirming its benefits in children under age 1 and older children
although older children may rebel at the food restriction. In every decade
since the 1920’s, studies consistently show that 50-75% of children will
be helped considerably by the diet.
How
does the diet work?
No
one is certain how the diet works. One theory attributes the anti-seizure
effect of the diet to the ketones that the ketogenic diet produces. Ketones
are the products of fat breakdown. Our body normally burns glucose (sugar)
for energy. The body can use these ketones as a source of energy rather than
glucose.
What
is the diet all about?
Ketosis
is produced by eating a balance of foods that provide just the right amount
of fat, protein and carbohydrates. A calorie level is determined for each
child based on their age and activity level and is about 80-90% of the
child’s Recommended Dietary Allowance. To achieve a desired level of
ketosis, the diet is calculated in terms of ratios such as 4:1, 3:1, 2:1. In
a 4:1 ratio, there is 4 times as much fat as there is protein and
carbohydrate combined. The dietitian devises meal plans that complete the
required fat, protein and carbohydrate components in each meal. Each meal
plan provides the exact number of grams of each food. All food is weighed on
a gram scale. The diet is most effective when consumed in its entirety. A
typical meal includes a small amount of fruit or vegetable, a protein rich
food, and a source of fat such as heavy cream, butter or vegetable oil.
Ketogenic formulas are available for infants and children with special
feeding tubes.
How
effective is the diet at controlling or eliminating seizures?
The
diet has never been evaluated in a controlled scientific study. Studies that
have followed children on the diet for long periods reveal that 1/3 of
children treated with the ketogenic diet have greater than 90% seizure
control with half of these children becoming seizure free. An additional 1/3
gain a 50% reduction in seizures. The remaining 1/3 discontinue the diet due
to its ineffectiveness or its difficulty.
How
is the diet initiated?
The
diet is initiated under close medical supervision in the hospital. The diet
is initiated gradually and increased to the full amount over a 3 to 4 day
period. On the first day,
children will drink special ketogenic shakes (eggnog).
During this period the dietitian works with the family to explain the
diet and answers all questions. The
parents prepare all ketogenic meals while learning to measure the foods on a
gram scale. During this time
blood sugar and ketone levels are monitored. A fasting period is not
necessary to start the diet although it is used at some medical centers.
During the second and third day, the diet will be advanced to a
larger amount of eggnog, ketogenic formula or the ketogenic food.
How
soon does it take for the diet to reduce or eliminate seizures?
The
diet can become effective immediately or can take several months. Each child
is unique and has different seizure patterns and frequency. There is usually
improvement within the first 10 weeks on the ketogenic diet.
Will
anti-seizure medications be stopped after my child goes on the diet?
If
the child is on more than one anti-seizure medication, one may be reduced as
the child starts the ketogenic diet. The reduction of remaining seizure
medication may be made if the child’s seizures improve over time.
Is
the diet healthy for my child?
The
diet alone is inadequate in many vitamins and minerals.
Supplements will be prescribed for your child while on the ketogenic
diet. The diet is usually used for up to 3 years. A regular diet is then
resumed.
Are
there any adverse effects of the ketogenic diet?
The
most common adverse effect of the diet is constipation. There are options
available to prevent this problem including eating high fiber vegetables
that are allowed on the diet and drinking enough water. A less common
adverse effect is kidney stones. This problem can be prevented by making
sure that the child drinks enough water. Two anti-seizure medications which
can cause kidney stones should
be avoided with the ketogenic diet (Zonegran and Topamax). Other less common
adverse effects include elevated lipids and decreased growth rate.
Laboratory studies are necessary during the course of ketogenic diet therapy
to ensure that the child is receiving proper nutrition and to minimize any
adverse effects.
