Ketogenic Diet

The ketogenic diet is basically a high fat, low carb diet that also includes adequate amounts of protein. It is designed in such a way that it mimics the various biochemical changes that take place when the body undergoes a prolonged period of starvation. It was in the 1900s that it was first devised, and was used to treat epileptic seizures in children in the 20s and 30s. However, with new anticonvulsant drugs being developed, the ketogenic diet was forgotten gradually. But, of late, the ketogenic diet has drawn renewed attention and is being increasingly used.

Despite some amount of misgivings, the ketogenic diet is not a ‘quack diet’ or a ‘fad’, but is an alternative treatment, which is approved medically, for children with epilepsy that is difficult to control. However, it is only under the strict supervision of a dietician and a physician that the diet should be used.

The Background of the Ketogenic Diet

Fasting as a way of controlling epileptic seizures has been mentioned in the Bible and has been used in the Middle Ages. However, it was only in the early part of the 1920s that scientific papers describing the benefits that prolonged periods of fasting had for children with epilepsy, which could not be controlled with the limited medications that were available then, first started appearing. According to these papers, it was claimed that epileptic seizures could be kept under control for long periods of time by going on a starvation diet, and consuming only water for 10-20 days or more.

During this time, when studies were also being conducted about what the metabolic effects of diabetes were, it was observed that the effects of fasting could be simulated with a diet comprising of high fat along with low carbohydrates was consumed. This had the effect of burning the fats completely. The residual ‘ash’ that resulted from the fat that was not completely burned was made up of ketones in the blood. Several research papers that were published in the ‘20s and ‘30s stated that the epileptic seizures in about one-third of the children who had taken the ketogenic diet was kept largely under control, while there was marked improvement in the patterns of epileptic seizures in another third, while one-third of the children experienced no particular benefit. The exact mechanism by which the ketone bodies reduce or control epileptic seizures in children is still not understood very well to date.

In 1938, when the anticonvulsant drug phenytoin was discovered, the ketogenic diet lost its pre-eminence, with attention being turned towards developing new drugs. And with new drugs being developed, the ketogenic diet began to be used increasingly less. This resulted in fewer dieticians being trained in the methodologies of the diet, and hence it began dropping out of sight even further, and even when it was used, the results were not as successful.

However, in 1994, when a child afflicted with epileptic seizures that were difficult to control was treated successfully with the ketogenic diet, it resulted in great attention by the media, which kindled a renewed interest in the diet in the US.

So, What Exactly is the Ketogenic Diet?

As has been mentioned above, the ketogenic diet basically comprises of a high fat, extremely low carbohydrate diet, along with enough proteins, which are all carefully calculated according to each individual child. The calories in the diet are controlled, depending upon the activity and the age of the child. If the calories are calculated properly, it will result in the child neither gaining nor losing any significant amount of weight, with growth continuing normally. However, the calories are reduced in case the child is overweight, until he/she reaches the ideal weight. There is also a restriction of fluids, although it is not quite clear the reasons for doing so. The ketogenic diet provides about 90 percent of the caloric needs of the child as fat, which includes butter, cream and mayonnaise, about 1 gram per kilogram of the weight of the child’s body as protein, and an extremely low intake of carbohydrate. Calcium and vitamin supplements must be taken when this diet is followed.

So, How does the Ketogenic Diet work?

The ketogenic diet simulates the metabolic effects that occur during starvation. When the body gets into starvation mode, it first uses up the glucose and glycogen that is stored for energy, and after that is used up, it begins burning up the body fat that is stored. When glucose is not available in sufficient amounts, the body is unable to burn the fats completely, which results in ketone bodies being formed, which are the residual matter of fat that is incompletely burned. Exogenous fats, or dietary fat, are provided to the body to burn in a ketogenic diet, and carbohydrates are severely restricted in order to deprive the body of glucose, thereby helping it to build up high levels of ketone bodies. It is these ketone bodies that seem to help in suppressing epileptic seizures.