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The '''ketogenic diet''' is a treatment for ] that relies on inducing a state of ]. The diet prescribes foods high in fat, and heavily restricts ] intake. As fats become the body's primary source of metabolic energy, ] accumulate in the brain, which can alleviate epileptic symptoms. The diet is more effective in children than adults, particularly when anticonvulsant drug therapy is ineffective (20%-30% of patients) or contraindicated.
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The '''Ketogenic Diet''' is a treatment for ] that relies on inducing a state of ].


The diet provides 3-4 grams of fat for every 1 gram of carbohydrate, calling for such foods as high-triglceride dairy products (butter, cream, mayonnaise), peanut butter, etc. Carbohydrates, found in breads and starches, are eliminated from the diet, and liquid intake is often restricted as well in order to aid ketone accumulation. Though superficially similar, this is not the same as the ]. Possible long-term side effects of the diet include:
The medical profession does not widely prescribe
*kidney stones
the use of the Ketogenic Diet, preferring instead
*abnormal liver function
to use a variety of Anticonvulsant Drugs and surgery. However some of the anticonvulsent drugs are themselves quite toxic and approximately 20%-30% of patients do not respond to available drugs. Among the possible reasons
*high cholesterol
⚫ the diet was not widely adopted by doctors:
*weight gain
*dehydration
*bone thinning

The diet is typically supplemented with calcium, vitamin D, iron, and folic acid.
⚫ Among the possible reasons the diet was not widely adopted by doctors:
*Lack of ] studies. (see below) *Lack of ] studies. (see below)
*The method of causality is not known.
*Lack of promotion by pharmaceutical companies. No one stands to make a lot of money off the diet, so doctors are bombarded with info on pharmaceutical solutions rather than simple solutions.
*Money corrupts science. It can influence which studies are undertaken and which are not, which conclusions are drawn, and which are published.
*Doctors own financial self interest. A doctors own income can depend on sick patients who are reliant on doctors for pills and surgery.
*Concerns about patient compliance with diet *Concerns about patient compliance with diet
*Concerns about potential nutritional deficiency *Concerns about potential nutritional deficiency
*An obsession with the products of science rather than the ].
*It is possible that early anti-convulsants were statistically more effective than diets as treatment for new patients but that they worked on separate population groups. *It is possible that early anti-convulsants were statistically more effective than diets as treatment for new patients but that they worked on separate population groups.


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study conducted by Johns Hopkins] study conducted by Johns Hopkins]
reported that 50% of those patients starting the ketogenic diet reported a decrease in seizures of 50% or more, with 29% of patients reporting a 90% reduction in symptoms; these patients had previously tried an average of six anticonvulsant drugs. The success rate on patients who responded to anticonvulsants was not measured in that study (and appears to be lacking reported that 50% of those patients starting the ketogenic diet reported a decrease in seizures of 50% or more, with 29% of patients reporting a 90% reduction in symptoms; these patients had previously tried an average of six anticonvulsant drugs. The success rate on patients who responded to anticonvulsants was not measured in that study (and appears to be lacking
in other recent studies as well - there appears to be reluctance to try the diet on subjects except as a last resort). The success rate of the diet on those who are successfully treated with anti-convulsants may be higher, lower, or the same as those who do not respond. It may be that the diet and anti-convulsants are effective in other recent studies as well - there appears to be reluctance to try the diet on subjects except as a last resort). The success rate of the diet on those who are successfully treated with anti-convulsants may be higher, lower, or the same as those who do not respond. It may be that the diet and anti-convulsants are effective on different segments of the population.
on different segments of the population.


The ketogenic diet has been reported to work in cases were multiple epilepsy drugs have failed. There may also be cases where the ketogenic diet has failed and epilepsy drugs succeeded. When one epilepsy drug fails, there is a high likelihood that other drugs will also fail. When the diet works, the response is often rapid and dramatic.
The Ketogenic Diet has been reported to work in cases
were multiple Epilepsy drugs have failed. There may also be cases where the Ketogenic Diet has failed and Epilepsy drugs succeeded. When one Epilepsy drug
fails, there is a high likelihood that other drugs
will also fail. When the diet works, the response is
often rapid and dramatic.

⚫ Links to more studies
⚫ *Abstract: [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10584968&dopt=Abstract
⚫ Clinical efficacy of the ketogenic diet.]
⚫ *Abstract: [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11904241&dopt=Abstract
⚫ The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience.]


==Double Blind Studies== ==Double Blind Studies==
Lack of ] studies is an issue preventing wider acceptance by the medical profession. Reliance on proper studies rather than anecdotal evidence or flawed studies is Lack of ] studies is an issue preventing wider acceptance by the medical profession. Reliance on proper studies rather than anecdotal evidence or flawed studies is important. Double blind studies help eliminate:
important. There will always be some people who are spontaneously cured, there will be
Double blind studies help eliminate:
*] *]
*] *]
*Researchers expectations may prejudice their observations *Researchers expectations may prejudice their observations
*Researchers inadvertently prejudicing patients through body language, tone of voice, etc. There was a case of a horse that could answer math problems by tapping its hoof the appropriate number of times; it turns out it had simply learned to tap its hoof until there was a noticeable change in body language of the observers. *Researchers inadvertently prejudicing patients through body language, tone of voice, etc.


However, doctors who oppose the Ketogenic Diet on the basis of lack of double blind studies are being somewhat hypocritical: combinations of anti-convulsants commonly prescribed also lack double blind studies on their interactions and it is not possible to do double blind studies on surgery, either. However, doctors who oppose the ketogenic diet on the basis of lack of double blind studies are being somewhat hypocritical: combinations of anti-convulsants commonly prescribed also lack double blind studies on their interactions and it is not possible to do double blind studies on surgery, either.


It is difficult to conduct truly double blind studies on a diet. Unlike pills, the constituents of a diet are often It is difficult to conduct truly double blind studies on a diet. Unlike pills, the constituents of a diet are often
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A A
is underway. is underway.



==External links== ==External links==
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*NICUS: [http://webhost.sun.ac.za/nicus/Factsheets/ketogenic.htm *NICUS: [http://webhost.sun.ac.za/nicus/Factsheets/ketogenic.htm
Ketogenic Diet: Fact or Fiction?] Ketogenic Diet: Fact or Fiction?]

⚫ '''Links to more studies'''
⚫ *Abstract: [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10584968&dopt=Abstract
⚫ Clinical efficacy of the ketogenic diet.]
⚫ *Abstract: [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11904241&dopt=Abstract
⚫ The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience.]

Revision as of 16:50, 17 October 2004

The ketogenic diet is a treatment for epilepsy that relies on inducing a state of ketosis. The diet prescribes foods high in fat, and heavily restricts carbohydrate intake. As fats become the body's primary source of metabolic energy, ketones accumulate in the brain, which can alleviate epileptic symptoms. The diet is more effective in children than adults, particularly when anticonvulsant drug therapy is ineffective (20%-30% of patients) or contraindicated.

The diet provides 3-4 grams of fat for every 1 gram of carbohydrate, calling for such foods as high-triglceride dairy products (butter, cream, mayonnaise), peanut butter, etc. Carbohydrates, found in breads and starches, are eliminated from the diet, and liquid intake is often restricted as well in order to aid ketone accumulation. Though superficially similar, this is not the same as the Atkins diet. Possible long-term side effects of the diet include:

  • kidney stones
  • abnormal liver function
  • high cholesterol
  • weight gain
  • dehydration
  • bone thinning

The diet is typically supplemented with calcium, vitamin D, iron, and folic acid. Among the possible reasons the diet was not widely adopted by doctors:

  • Lack of double blind studies. (see below)
  • Concerns about patient compliance with diet
  • Concerns about potential nutritional deficiency
  • It is possible that early anti-convulsants were statistically more effective than diets as treatment for new patients but that they worked on separate population groups.

The TV movie First Do No Harm recently increased awareness of the Ketogenic Diet, though a curative link between fasting and Epilepsy was even mentioned in the bible.

Scientific Studies

A [http://www.hopkinsmedicine.org/press/1998/DECEMBER/981207.HTM study conducted by Johns Hopkins] reported that 50% of those patients starting the ketogenic diet reported a decrease in seizures of 50% or more, with 29% of patients reporting a 90% reduction in symptoms; these patients had previously tried an average of six anticonvulsant drugs. The success rate on patients who responded to anticonvulsants was not measured in that study (and appears to be lacking in other recent studies as well - there appears to be reluctance to try the diet on subjects except as a last resort). The success rate of the diet on those who are successfully treated with anti-convulsants may be higher, lower, or the same as those who do not respond. It may be that the diet and anti-convulsants are effective on different segments of the population.

The ketogenic diet has been reported to work in cases were multiple epilepsy drugs have failed. There may also be cases where the ketogenic diet has failed and epilepsy drugs succeeded. When one epilepsy drug fails, there is a high likelihood that other drugs will also fail. When the diet works, the response is often rapid and dramatic.

Double Blind Studies

Lack of double blind studies is an issue preventing wider acceptance by the medical profession. Reliance on proper studies rather than anecdotal evidence or flawed studies is important. Double blind studies help eliminate:

  • Placebo effect
  • Spontaneous Remission
  • Researchers expectations may prejudice their observations
  • Researchers inadvertently prejudicing patients through body language, tone of voice, etc.

However, doctors who oppose the ketogenic diet on the basis of lack of double blind studies are being somewhat hypocritical: combinations of anti-convulsants commonly prescribed also lack double blind studies on their interactions and it is not possible to do double blind studies on surgery, either.

It is difficult to conduct truly double blind studies on a diet. Unlike pills, the constituents of a diet are often rather obvious. One could argue that the placebo effect is not a factor since in one of the studies the patents have already tried six different "placebos" in the form of ineffective prescription drugs and the diet studies deal with a population group that has a low spontaneous remission rate. Also, in the patients previous clinical experience, they experienced a negative outcome when a positive outcome was expected by their doctors.

A double blind study of the Ketogenic Diet is underway.

External links

Ketogenic Diet: Fact or Fiction?]

Links to more studies

Clinical efficacy of the ketogenic diet.]

The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience.]