A ketogenic diet is a high-fat, adequate-protein, and very-low-carbohydrate diet which has been found to help many children whose seizures are not well-controlled by anti-seizure medications.
In some children, the ketogenic diet is combined with standard anticonvulsant medications. While the actual mechanism of the ketogenic diet's effectiveness against seizures is unknown, many children on the diet are able to have their epilepsy medication dose lowered, decreasing unwanted medication side effects.
Because this is a medical treatment, the ketogenic diet must be supervised by a medical team, consisting of a neurologist and dietitian, who can anticipate and manage possible nutritional deficits or other medical side effects or complications. The team helps children and their families establish and maintain the diet, and learn how to incorporate the diet into daily living.
Children on the ketogenic diet are seen several times throughout the year for close monitoring, while they continue to follow with their primary neurologist for potential medication changes.
In addition, the team also implements the Modified Atkins Diet and Low-Glycemic Index Therapy, other dietary therapies for which there is increasing data about benefit in the treatment of difficult-to-treat epilepsy.
Conditions treated by the Ketogenic Diet Team include:
- Epilepsy such as Myoclonic Astatic Epilepsy and other epilepsies
- Glucose transporter type-1 deficiency
- Lennox Gastaut syndrome
- Pyruvate dehydrogenase deficiency
- Dravet syndrome
What is a ketogenic diet?
The ketogenic diet is sometimes offered to children who continue to have seizures while on seizure medication. When medications do not work, a ketogenic diet may be considered. No one knows exactly how the diet works, but some children do become seizure-free when put on the diet. However, the diet does not work for everyone.
What does the diet consist of?
The ketogenic diet is very high in fat (about 90 percent of the calories come from fat). Protein is given in amounts to help promote growth. A very small amount of carbohydrate is included in the diet. This very high-fat, low-carbohydrate diet causes the body to make ketones. Ketones are made by the body from protein. They are made for energy when the body does not get enough carbohydrates for energy. If your child eats too many carbohydrates, then his/her body may not make ketones. The presence of ketones is important to the success of the diet.
- Heavy cream
- Cream cheese
- Fruit and fruit juice
- Breads and cereals
- Vegetables (corn, peas, and potatoes)
- Snack foods (chips, snack cakes, crackers)
Your child's physician will determine if this diet is right for your child. When the ketogenic diet is started, your child will be admitted to the hospital. It may take four to five days in the hospital to get the diet started and for you to learn how to plan the diet.
While in the hospital, your child may not be able to eat for one to two days until ketones are measured in the urine. Once ketones are present in the urine, special high-fat, low-carbohydrate shakes may be started. These are sometimes called keto shakes. After several meals of keto shakes, your child will be started on solid foods.
You may also be taught how to check your child's urine for ketones. The dietitian will help determine how much fat, protein and carbohydrate your child is allowed to have, usually divided into three meals a day. The ketogenic diet can by very challenging to prepare and requires that all foods be weighed using a food scale. The ketogenic diet is not nutritionally balanced, therefore, vitamin and mineral supplements are needed.
Some medications and other products, such as toothpaste and mouthwash, contain carbohydrates. It is important to avoid these products if your child is on the ketogenic diet. Your child may not make ketones in their urine if too many carbohydrates are included in the diet. Your child's physician and dietitian can give you a list of medications, and other products, that are free of carbohydrates.
How long is the diet used?
Children usually stay on the diet about two years. The diet is then slowly changed back to a regular diet.
Sample ketogenic meal:
- 60g heavy cream
- 21g strawberries
- 53g eggs
- 10g cheddar cheese
- 10g bacon
- 21g butter
Sample ketogenic shake:
- 500g Ross Carbohydrate-free Formula (concentrate)
- 270g heavy cream
- 13g Egg Beaters®