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| Ketogenic diet: epilepsy
cure? |
| Created: Monday, November 12,
2007 |
| A recent Carte Blanche
programme featured the use of the controversial ketogenic
diet in the treatment of intractable epilepsy in children.
Intractable epilepsy – of which Lennox-Gastaut is a prime
example – refers to a type of epilepsy that doesn't respond
to anti-epilepsy medication. In children who suffer from
Lennox-Gastaut epilepsy, the use of the ketogenic diet is
often the last resort to keep the child from suffering
multiple seizures every day.
But the diet can be both dangerous and difficult to
maintain.
What does the diet entail?
The ketogenic diet involves inducing a state of ketosis in
the child by reducing carbohydrate intake drastically and
increasing the intake of fats and proteins to compensate for
the lack of carbohydrates.
The diet forces the body to burn fats for energy (nearly
80% of the diet's energy is derived from fat) – a process
which produces chemicals called ketones.
For some reason that is not yet fully understood, the
ketones that circulate in the body help to suppress
epileptic seizures (Krause, 2000; Epilepsy Foundation,
2007). It's possible that ketones act like inhibitors of
neurotransmission that prevents seizures (Krause, 2000).
However, the diet is not successful in all cases. About
30% of children with severe seizures will respond fully to
the ketogenic diet, while 30% will experience a decrease in
seizures, and 30% will not respond. We also don't yet know
why the diet works for some children and not for others
(Krause, 2000).
Initial ketosis is induced in children by starvation for
24 to 72 hours. During this period the child is usually
hospitalised. Once a satisfactory state of ketosis has been
achieved, the child is given the high-fat, high-protein
diet.
There are two versions of the ketogenic diet: the older
version, which reduces carbohydrate intake to a minimum, and
a more recent version that makes use of medium-chain
triglycerides (MCTs) to provide the high fat intake.
The latter diet is probably easier to apply because it
allows small quantities of fruit and vegetables and doesn't
require such strict attention to liquid intake. When the
older ketogenic diet is used, the child must be partially
dehydrated to ensure that the circulating ketones are not
diluted. With the MCT diet, liquid restriction is less
severe (Krause, 2000).
Important things to remember
The following vital points must be kept in mind when
considering or applying the ketogenic diet:
- Don't ever put your child or yourself on a ketogenic
diet without consulting a medical team that consists of
an epilepsy specialist and a dietician.
- Don't stop your child's anti-epileptic medication
without consulting the doctor who is treating him or
her.
- The ketogenic diet will not work in all cases of
intractable epilepsy.
- The ketogenic diet is difficult to apply and you're
going to need the guidance of a dietician to help you
work out how much food your child is going to eat.
Generally, the energy content of the diet is reduced to
compensate for the high fat levels. It's also important
for the child to take a multivitamin and mineral
supplement to ensure that he does not develop
nutritional deficiencies. All these aspects will be
addressed by your dietician. (Krause, 2000; Epilepsy
Foundation, 2007)
Side effects of the ketogenic diet
The ketogenic diet can have a variety of side effects,
including:
- Dehydration – this needs to be monitored very
carefully as a certain degree of dehydration is
necessary to make the diet effective, but excessive
dehydration can have serious consequences.
- Constipation – this is due to the lack of
dietary fibre in the diet caused by omitting fruit,
vegetables, grains and cereals. The epilepsy specialist
will have to prescribe a suitable, gentle laxative.
- Kidney or gallstones may develop because of
the high fat content of the diet. Children need to be
monitored regularly to check if they're developing
kidney or gallstones.
- Vitamin deficiencies induced by omitting
fruits, vegetables and grains. As mentioned before, the
child needs to take a vitamin and mineral supplement.
- Increased blood cholesterol levels,
particularly in children with an inborn defect in terms
of cholesterol metabolism. This can have serious
consequences and the medical team will monitor your
child throughout her use of the diet.
- Refusal by the child to follow such a diet.
The ketogenic diet is unpalatable and may make children
feel marginalised because they cannot eat 'normal'
foods. Behavioural counselling may be necessary to help
the child manage her diet.
- Difficulty in applying the diet. Foods for
each meal have to be carefully weighed and the volume of
liquid the child drinks each day must be carefully
controlled. Some parents may find it impossible to
adhere to such a strict regimen, particularly if they
work or are away from home often.
- Short duration. The ketogenic diet can
generally not be applied for longer than two years.
(Krause, 2000; Epilepsy Foundation, 2007)
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------------Important Read--------------- Autoimmune disorders rank number three but
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Introduction
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Dysautonomia
Dysautonomias include chronic fatigue syndrome (CFS,) vasovagal or
neurocardiogenic syncope, panic attacks, anxiety, inappropriate
sinus tachycardia (IST,) irritable bowel syndrome (IBS,) postural
orthostatic tachycardia syndrome (POTS,) or fibromyalgia. Sufferers
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the body, producing the rapid heart rates, increased breathing, and
increased blood flow to the muscles that are necessary when an
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rest. And in normal individuals, the parasympathetic and sympathetic
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from moment to moment, depending on the body’s instantaneous needs.
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sympathetic systems inappropriately predominate. Symptoms can
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