Ketosis and the Ketogenic Diet, 2010: Advances in Treating Epilepsy and Other Disorders

Abstract

Since the authors’ 1997 review of the ketogenic diet in Advances in Pediatrics, a remarkable increase has been seen in interest in its use, in reports of its effectiveness, and in studies of how the diet works. Although used primarily for treating seizures in children, the diet has also been shown to be useful in treating intractable seizures in adults, and possibly for treating other nonepileptic conditions, such as brain tumors, Alzheimer’s disease, and diabetes. The ketogenic diet is a high-fat, adequate protein, low-carbohydrate diet designed to produce ketosis through mimicking the metabolic changes of starvation. It is carefully calculated to be nutritionally adequate for each individual, providing 90% of needed calories as fat, a minimum of 1 g/kg of protein, and minimal carbohydrates. The ratio of fats to protein and carbohydrate is classically 4:1. The diet and its cousins—the modified Atkins diet, the medium chain triglyceride (MCT) diet, and the low glycemic index treatment—have provided substantial advances in the treatment of childhood seizures. However, because of myths and misunderstandings about the benefits and side effects of the diet, and because of the lack of trained physicians and dieticians to provide the diet, it is used too infrequently. This report summarizes progress made during the past decade and provides information about both the diet’s documented usefulness in childhood epilepsy and its potential uses in other conditions. A considerably fuller discussion of the classic ketogenic diet and its implementation are provided elsewhere [1–3]. The ketogenic diet only should be undertaken only under the medical supervision of a physician and a dietician knowledgeable in its management. Many myths and misconceptions exist about the ketogenic diet, such as: 1. The ketosis of starvation and of the ketogenic diet is dangerous and similar to the ketoacidosis of diabetes. 2. High-fat diets are unpalatable and difficult to calculate and prepare.