A ketogenic diet consists of high fat, sufficient protein and low carbohydrate. It mimics a majority of the biochemical changes related to a lengthy period of starvation. It was initially developed in the 1900s and used successfully to treat seizures in children. This diet was all but forgotten with the development of anticonvulsant medicines. This diet has since been ‘rediscovered’ and is being widely used.
Many clinical papers from the early 1900s highlighted that about a third of children on this ‘ketogenic diet’ were enabled to keep their seizures under control; a third were helped substantially to improve their siezure control, with a third hardly benefiting from the diet.
The biochemical effects of fasting can be replicated by being on a diet high in fat, however, containing insufficient carbohydrate to completely ‘burn’ the fats. The ‘ash’ from the incompletely burned fat is comprised of ketones in the blood.
When phenytoin was discovered in 1938, attention moved away from the ketogenic dietas new anticonvulsant drugs were developed. Thus the ketogenic diet was used less and less, as well as less successfully with fewer dieticians trained in the finesse of such a diet.
When a difficult-to-control child was treated successfully in 1994, the ketogenic diet gained a lot of good publicity and there was a re-ignition of interest in this diet particularly in America.
What does the ketogenic diet comprise of?
This diet is a high fat, enough protein, low carb diet, meticulously calculated for each child. Calorie intake is restricted and is dependent on the age as well as the level of activity of the child. Should the calorie intake have been calculated accurately, the child should not lose nor gain weight. The child ought to grow at a rate normal for his/her height and ideal weight. Should the child be overweight, the child is given limited calories until the ideal body weight is reached.
This diet provides about 90% of the child’s calories as fat, one gram per kilogram of body weight as protein, with little carbohydrate intake. This low carb diet has to be supplemented with calcium and vitamins.
How does the diet work?
This diet replicates various metabolic effects of starvation. In starvation, the body initially uses its glucose and glycogen store, then it starts to burn stored body fat. When insufficient glucose is available, body fats cannot be burned and ketone bodies are left as residue. The ketogenic diet offers the body exogenous fats (fat external to the body) to burn. However, it restricts available carbohydrates to ensure that ketone bodies build up. It appears it is this high level of ketones that suppresses seizures.
What do children eat on a ketogenic diet?
Children on such a diet are allowed to eat set, meticulously calculated meals. As portions are slight, ketosis quashes appetite and quenches thirst. Given a short period of time adjusting to this diet, children rarely get hungry.
Many people may think such diets are not appetising. However, meals on this dietcan be surprisingly tasty.
A normal breakfast could be a mushroom omelette, several bacon slices and hot chocolate with 36% cream. Lunch could be celery stalks with peanut butter, lettuce, mayonnaise, tomato, with a caffeine-free dietdrink to wash it all down. Dinner could be a specifically weighed portion of hot dog, ketchup, mustard, lettuce, mayonnaise, as well as a whipped cream sundae with strawberries and a diet drink.
Is this diet effective?
Older studies document the effectiveness of this diet. It remains as effective today with children who have difficult-to-control seizures as it did in yesteryear, despite the use of anticonvulsants.
The 1998 Johns Hopkins study (Source: Pediatrics December 1998) assessed the effectiveness and tolerability of this diet amongst 150 children.
The children studied had 400 plus seizures a month prior to going on the ketogenic diet. They had also tried six or more types of anticonvulsants. The following were the outcomes:
Daily Meal Plan
Fried egg with bacon and cup of decaff coffee with single cream.
Chicken breast with melted mozzarella with mixed lettuce leaves and olive oil.
8oz pan-fried rump steak with spinach and soured cream