You hear a lot about fad diets and why you shouldn’t use them and all of them have unusual pseudo-scientific sounding names. You’d be forgiven then for thinking that perhaps the ketogenic diet was just another such fad, but you would be off the mark. The ketogenic diet rather than being used for weight loss or muscle building is a diet used to control refractory epilepsy (particularly in children) and is thus a vital tool for many sufferers and their parents (and no, not suitable for dieting… ).
Here we will look in a bit more detail at what the ketogenic diet entails, how it works to help treat epilepsy and how to go about following it.
The diet consists of a lower (but adequate) intake of both dietary protein and carbohydrates along with a higher intake of fat. The ketogenic diet contains a 4:1 ratio of fat to combined protein and carbohydrate giving you an idea of just how much to reduce protein and carbs and how much to increase fat. This then simulates to some extent the results of fasting in which the body ends up burning fat as its major source of energy – except in that case there is normally no new fat being added to the body. When an individual fasts then their body will burn stored fat leading to weight loss and this will provide the energy the body needs while leading to weight loss and there will be no new fat coming in. In the ketogenic diet the body is still forced to turn to fat as its main fuel source as it is there in the highest quantities, except here that fat is also being replenished in the diet leading to less weight loss.
It is highly important for the diet to still contain adequate amounts of protein and carbohydrates however as these provide some energy that is more readily accessible and at the same time provide the amino acids that the body uses to create tissues and enzymes (such as digestive enzymes). If you completely cut your carbohydrates or proteins (as is the case in some instances of the aforementioned ‘fad diets’) then this would result in tiredness and lethargy along with muscle wasting and slow healing wounds along with other more long-term issues. Protein is particularly important in young children who are still growing and so required to build new tissue.
When used correctly the ketogenic diet has been shown to help produce the incidence of epileptic seizures in patients who cannot be treated with medication or surgery. It is successful on average in half to a third of patients.
How it Works: Ketosis
The question is then, how does this help epilepsy? Well while the exact method isn’t entirely understood there are some basic mechanisms through which it might work. One is called ‘ketosis’ which is a condition in which there are more ‘ketones’ in the bloodstream.
This occurs because the body is forced to rely on fat as the main source of energy and that causes the liver to convert the fat into fatty acids and ketone bodies as a by-product. Ketone bodies are useable as an energy source for the brain and the heart, and thus for those who are not getting as many carbohydrates or proteins, this can then replace glucose as the primary energy source in those areas. The change from glucose to ketones as the main energy source for the brain then seems to prevent as many seizures from taking place. Ketones have a sedative effect which may also help.
There’s another benefit of ketones too – and that’s that they help to promote acidosis (as ketones themselves are acids) – which is a more acidic pH level in the blood. This is useful as acidosis can be used to increase the threshold for seizures and this is why some acids can be used to temporarily prevent individual seizures.
There are some other benefits of the ketogenic diet too. One is that it means the body is presented with a lot of fatty acids which aid brain function and neurotransmission. Likewise, the ketones also work to suppress normal appetite and this makes the diet easier to stick too and helps prevent cravings.
However the ketogenic diet is not without its faults and there are some complications associated with it (though these may be less severe than some medication or surgery). Side effects will regularly include:
• Higher cholesterol
• Kidney stones
• Weakened bones
• Growth retardation
• Weakened immune system
• Weight loss
• Menstrual irregularities
• Liver damage
These are the common side effects but are relatively easily treated and preferable of course to seizures. They can be treated through further adjustments to the diet and the addition of further minerals. For instance vitamins and minerals can help to prevent weakened immune systems and growth retardation by ensuring minimal malnutrition. Meanwhile an increase in fiber can help to combat high cholesterol as can choosing the correct fats to consume. This is important as high cholesterol can lead to many more negative side effects, preventing the body from getting minerals and nutrients around the system while at the same time increasing the likelihood of heart attack and stroke. Fiber intake and laxatives may help to treat constipation.
Bones weaken as a result of excess acid causing demineralization along with lowered protein intake and this also leads to kidney stones as the amount of calcium in the urine is increased. This is difficult to treat, as adding calcium to the diet may increase the likelihood of kidney stones developing. 1 in 20 people on a ketogenic diet will develop kidney stones – significantly higher than the general population.
The ketones themselves are also toxic in their own right and this can cause to damage to both the liver and kidneys. Further symptoms of ketosis that need to be monitored are difficulty sleeping, nausea, muscle pain, thirst, headaches and dizziness – and the best treatment for this is to add carbohydrates back to the diet. Finally a ketogenic diet might have interactions with some drugs and medications and with other existing medical conditions. For instance someone with high cholesterol would be ill advised to go on a ketogenic diet.
Should You Consider a Ketogenic Diet?
Of course the doctor’s are aware of these complications and will go to lengths to avoid the problem. As mentioned, supplementation and fine-tuning of the diet can be used in order to treat any side effects. At the same time the patients will go through an ‘initiation’ period where they will discuss their current diet, the problems and their medical history. They will be screened for conditions that could contraindicate the diet and they will then go through a process that will involve lowering the carbohydrate intake drastically before adopting the normal ketogenic diet after three full days. During the first three days the patients will remain in the hospital and will be carefully monitored. They will also attend classes on how to manage their new diet, and how to prepare meals. Subsequently patients will be monitored by visiting an outpatient clinic and undergoing various tests. Adjustments will be made to the diet to compensate for any problems as they arise and this should minimize complications. If the side effects become unmanageable and long-term damage is being wrought then the patient can return to a regular diet.
Even with these safety measures however there are risks inherent in the ketogenic diet. It comes down to personal choice whether you think these risks are worth taking and it will likely depend on the severity and intensity of your seizures. Consult with your doctor and discuss the pros and cons.