The ketogenic diet is a very high fat diet that relies on inducing a state of ketosis. The diet typically provides 3-4 grams of fat for every 1 gram of carbohydrate and protein combined. It is most commonly used for the treatment of epilepsy. The diet is essentially comprised of 88% fat,10% protein, and 2% cabohydrates. Ketosis (IPA pronunciation: ) is a stage in metabolism occurring when the liver has been depleted of stored glycogen and switches to a fasting mode such as occurs during sleep, during dieting, and during the bodys response to starvation. ...

Description

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 often perceived as more effective in children than adults, particularly when anticonvulsant drug therapy is ineffective (20%-30% of patients) or contraindicated, however, data from the 1920s and 1930s, as well as recently, shows similar results. However, the ketogenic diet is more restrictive for adults. For other uses, see Fat (disambiguation). ... Lactose is a disaccharide found in milk. ... Ketone group A ketone is either the functional group characterized by a carbonyl group linked to two other carbon atoms or a chemical compound that contains this functional group. ... In animals, the brain, or encephalon (Greek for in the head), is the control center of the central nervous system. ... Contraindicated is a medical term to indicate a situation in which a medication or treatment should not be administered. ...

Foods used in the diet include high-triglyceride dairy products (butter, cream, mayonnaise) and peanut butter. Carbohydrates, found in breads and starches, are eliminated in the diet, and liquid and calorie intake are often restricted as well in order to aid ketone accumulation. Though superficially similar, this is not the same as the Atkins diet. This has been used as well for some patients with epilepsy, as well as a low-glycemic index diet. [1] Possible long-term side effects of the diet include: It has been suggested that Medium Chain Triglycerides be merged into this article or section. ... Butter is commonly sold in sticks (pictured) or small blocks, and frequently served with the use of a butter knife. ... Cream is a dairy product that is composed of the higher-fat layer skimmed from the top of raw milk before homogenization. ... Mayonnaise made in a food processor with an assortment of standard ingredients Mayonnaise is a stable emulsion of vegetable oil and egg yolk, flavored with vinegar or lemon juice and frequently mustard (all of which help the emulsion). ... Peanut Butter in a jar Peanut butter is a food made of roasted and ground peanuts, usually salted and sweetened. ... Percentages are relative to US RDI values for adults. ... A calorie is a unit of measurement for energy. ... book The Atkins Nutritional Approach, popularly known as the Atkins Diet or just Atkins, is a popular but controversial high-protein, high-fat, low-carbohydrate diet. ...

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

The diet is typically supplemented with calcium, vitamin D, iron, and folic acid. Bladder stone redirects here. ... Low-density lipoprotein (LDL) refers to a class and range of lipoprotein particles, varying in their size and contents, which carry cholesterol in the blood and around the body, for use by cells. ... To meet Wikipedias quality standards, this article or section may require cleanup. ... Dehydration (hypohydration) is the removal of water (hydor in ancient Greek) from an object. ... General Name, Symbol, Number calcium, Ca, 20 Chemical series alkaline earth metals Group, Period, Block 2, 4, s Appearance silvery white Atomic mass 40. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... General Name, Symbol, Number iron, Fe, 26 Chemical series transition metals Group, Period, Block 8, 4, d Appearance lustrous metallic with a grayish tinge Atomic mass 55. ... Folic acid and folate (the anion form) are forms of a water-soluble B vitamin. ...

Among the possible reasons the diet has not been 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.
• Lack of knowledge and a dietitian to help manage children on the diet

The Double blind method is an important part of the scientific method, used to prevent research outcomes from being influenced by the placebo effect or observer bias. ...

Scientific studies

A 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. This has continued to be the statistics today, with approximately half of patients having at least half of their seizures improve.

The ketogenic diet has been reported to work in cases where 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: The Double blind method is an important part of the scientific method, used to prevent research outcomes from being influenced by the placebo effect or observer bias. ...

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

A double blind study of the Ketogenic Diet has been completed and is being analyzed. It has been suggested that this article or section be merged into Placebo. ... Spontaneous remission is a catch-all expression by the medical faculty for any healing with no obvious conventional explanation. ...

Research and variants

The diet usually referred to in the context of epilepsy treatment is the classic 4:1 fat to protein plus carbohydrate ratio John Hopkins Hospital protocol,^[2],[3] but there is more than one type of ketogenic diet. There's also the Sanggye Paik Hospital protocol (also 4:1) developed by Drs Kim and Park, the medium chain triglyceride diet,^[4] the Atkins diet,^[5] and supplementation with polyunsaturated fats.^[6] For other uses, see Fat (disambiguation). ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Lactose is a disaccharide found in milk. ... It has been suggested that Medium Chain Triglycerides be merged into this article or section. ... book The Atkins Nutritional Approach, popularly known as the Atkins Diet or just Atkins, is a popular but controversial high-protein, high-fat, low-carbohydrate diet. ... An unsaturated fat is a fat or fatty acid in which there is one or more double bonds between carbon atoms of the fatty acid chain. ...

Kim Dong Wook and colleagues at the Inje University Sanggye Paik Hospital Epilepsy Center found that patients treated with the nonfasting, introduce high-fat foods to existing diet gradually protocol (August 1999-February 2001) achieved urinary ketosis just as fast, with just as much improvement in seizures, as patients using the initial fasting John Hopkins protocol (July 1995-July 1999), with 1/6 the dehydration and a shorter average hospital stay.^[7] A team led by Dr. Inna I. Vaisleib reported that same year that the 4:1 diet could also be done outpatient and with no caloric restrictions.^[8] According to Freeman et al, the ketogenic diet reduces atonic and myoclonic seizures by over 50% immediately.^[9] Dehydration (hypohydration) is the removal of water (hydor in ancient Greek) from an object. ... Atonic seizures (also called drop seizures, drop attacks, or akinetic seizures), are a minor type of seizure. ... Myoclonic seizures are brief twitches or jerks of muscles or groups of muscles. ...

Like any other therapeutic intervention, the ketogenic diet is not without adverse effects. In 2004, Drs Hoon Chul Kang, Da Eun Chung, Dong Wook Kim, and Heung Dong Kim reported that out of 129 patients who were on the diet at the Epilepsy Center at Inje University Sanggye Paik Hospital between July 1995 and October 2001, 46.5% experienced—in the 4-week trial period—dehydration, 38.8% experienced gastrointestinal symptoms (diarrhea (32.6%), nausea/vomiting (27.9%), and constipation (2.3%)), hypertriglyceridemia in 27.1%, hyperuricemia in 26.4%, hypercholesterolemia (14.7%), infections (pneumonia, cystitis, etc) in 9.3%, symptomatic hypoglycemia (7.0%), hypoproteinemia (5.4%), hypomagnesemia (4.7%), repetitive hyponatremia (4.7%), HDL hypocholesterolemia (3.9%), lipoid pneumonia due to aspiration (2.3%), hepatitis (2.3%), acute pancreatitis and persistent metabolic acidosis.^[10] After those first four weeks, the side effects, in descending order of prevalence, were gastrointestinal discomfort (27.9%), infectious disease (20.9%), hypertriglyceridemia (20.2%), hypercholesterolemia (19.4%), osteopenia (14.7%), hypomagnesemia (10.9%), hyperuricemia (7.8%), hepatitis (5.4%), lipoid pneumonia due to aspiration (4.7%), hypoproteinemia (3.9%), kidney stone(s) (3.1%), iron-defiency anemia (1.6%), secondary hypocarnitinemia (1.6%), HDL hypocholesterolemia (0.8%), symptomatic hypoglycemia (0.8%), hydronephrosis (0.8%), and cardiomyopathy (0.8%).^[11] The person who had cardiomyopathy died, along with three other people, one with lipoid pneumonia and the other two with sepsis.^[12] Dehydration (hypohydration) is the removal of water (hydor in ancient Greek) from an object. ... In medicine, hypertriglyceridemia denotes high (hyper-) blood levels (-emia) of triglycerides, the most abundant fatty molecule in most organisms. ... Hyperuricemia is the presence of high levels of uric acid in the blood. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ... Hypoglycemia (hypoglycæmia in the UK) is a medical term referring to a pathologic state produced by a lower than normal amount of sugar (glucose) in the blood. ... Hypoproteinemia (or Hypoproteinaemia) is a condition where there is an abnormally low level of protein in the blood. ... Hypomagnesemia is an electrolyte disturbance in which there is an abnormally low level of magnesium in the blood. ... The electrolyte disturbance hyponatremia or hyponatraemia exists in humans when the sodium level in the plasma falls below 135 mmol/l. ... HDL is an initialism that may refer to any of the following: High density lipoprotein Hardware description language german: Hab Dich Lieb This page concerning a three-letter acronym or abbreviation is a disambiguation page — a navigational aid which lists other pages that might otherwise share the same title. ... Hypocholesterolemia is the presence of abnormally low (hypo-) levels of cholesterol in the blood (-emia). ... See: Aspiration (phonetics) Aspiration (medicine) Aspiration (long-term hope) - see for example, Robert Goddards response to the ridicule by the New York Times, 1920: Every vision is a joke until the first man accomplishes it; once realized, it becomes commonplace. ... Hepatitis is a gastroenterological disease, featuring inflammation of the liver. ... Pancreatitis is inflammation of the pancreas. ... In medicine, metabolic acidosis is a state in which the blood pH is low (under 7. ... Bladder stone redirects here. ... Hydronephrosis is distention and dilation of the renal pelvis, usually caused by obstruction of the free flow of urine from the kidney. ...

The majority of side effects of the diet are transient and can be addressed without diet discontinuation. Kidney stones can be treated with extra hydration and oral citrates. Hypercholesterolemia is improved with lowering the diet ratio and substituting higher amounts of polyunsaturated fats. Weight loss can be corrected with extra calories. Kidney stones are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... Chemical structure of citric acid. ... Hypercholesterolemia (literally: high blood cholesterol) is the presence of high levels of cholesterol in the blood. ... A calorie refers to a unit of energy. ...

Recent work on the mechansim of action for ketogenic diet as a treatment for epilepsy have investigated the role of glycolysis in the disease [13]. The glycolytic inhibitor 2-Deoxy-D-glucose has been proposed as a mimic for the ketogenic diet, and shows great promise as a new anti-epileptic drug. Glycolysis is a biochemical pathway by which a molecule of glucose (Glc) is oxidized to two molecules of pyruvic acid (Pyr). ... 2-Deoxy-D-glucose is a molecule which has the 2-hydroxyl group replaced by hydrogen, so that it cannot undergo further glycolysis. ...

The diet of the Inuit is similar to the Ketogenic diet. Typically Inuit diets contain 15-18% protein with the remainder being fat. Interestingly, despite the lack of numerous vitamins in this diet, Inuit do not appear to suffer deficiency diseases. In particualr vitamin C deficiency or Scurvy, is referred to as the white mans disease^{[citation needed]}. For other uses, see Inuit (disambiguation). ...

Footnotes

1. ↑  James Wheless (1996). A Practical Approach. Special Meeting: Controversies in Epilepsy - The Ketogenic Diet. Retrieved on 22 February 2006.
2. ↑  Vining, Eileen P. G., John M. Freeman, MD; Karen Ballaban-Gil, MD; Carol S. Camfield, MD; Peter R. Camfield, MD; Gregory L. Holmes, MD; Shlomo Shinnar, MD, PhD; Robert Shuman, MD; Edwin Trevathan, MD; James W. Wheless, MD; and The Ketogenic Diet Multi-Center Study Group (November 1998). "A Multicenter Study of the Efficacy of the Ketogenic Diet". Archives of Neurology 55 (11): 1433-7. PubMed.
3. ↑  P. R. Huttenlocher, A. J. Wilbourn and J. M. Signore (November 1971). "Medium-chain triglycerides as a therapy for intractable childhood epilepsy". Neurology 21 (11): 1097-103. PubMed.
4. ↑  Kossoff, Eric H., Gregory L. Krauss, Jane R. McGrogan and John M. Freeman (23 December, 2003). "Efficacy of the Atkins diet as therapy for intractable epilepsy". Neurology 61 (12): 1789-91. PubMed.
5. ↑  Yuen, Alan W.C., Josemir W. Sander, Dominique Fluegel, Philip N. Patsalos, Gail S. Bell, Tony Johnson and Matthias J. Koepp (September 2005). "Omega-3 fatty acid supplementation in patients with chronic epilepsy: A randomized trial". Epilepsy & Behavior 7 (2): 253-8. DOI:10.1016/j.yebeh.2005.04.014.
6. ↑  Dong Wook, Kim, Hoon Chul Kang, Jung Chae Park, and Heung Dong Kim. "Benefits of the Nonfasting Ketogenic Diet Compared With the Initial Fasting Ketogenic Diet". Pediatrics 114 (6): 1627-30. DOI:10.1542/peds.2004-1001.
7. ↑  Vaisleib, Inna I., Jeffrey R. Buchhalter and Mary L. Zupanc (September 2004). "Ketogenic diet: Outpatient initiation, without fluid, or caloric restrictions". Pediatric Neurology 31 (3): 198-202. DOI:10.1016/j.pediatrneurol.2004.03.007.
8. ↑  Freeman JM, Vining EP (1999). "Seizures decrease rapidly after fasting: preliminary studies of the ketogenic diet". Archives of Pediatrics & Adolescent Medicine 153 (9): 946-9. PubMed.
9. ↑  Kang HC, Chung da E, Kim DW, Kim HD (2004). "Early- and late-onset complications of the ketogenic diet for intractable epilepsy". Epilepsia 45 (9): 1116-23. PMID 15329077. Fulltext options
10. ↑  see Kang et al., 2004.
11. ↑  see Kang et al., 2004.

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External links

• Epilepsy Action: The Ketogenic Diet
• Johns Hopkins
• Ketogenic Diet for people with ALS - A recent study (April 4th, 2006) by Mount Sinai School of Medicine shows KD diet may prevent progression of ALS
• NICUS: Ketogenic Diet: Fact or Fiction?

Studies

• Abstract: Clinical efficacy of the ketogenic diet.
• Abstract: The ketogenic diet in children, adolescents and young adults with refractory epilepsy: an Italian multicentric experience.