The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain function. However, if little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures. Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet. Some evidence indicates that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.Potential side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones.
The original therapeutic diet
for paediatric epilepsy provides just enough protein for body growth and
repair, and sufficient calories to
maintain the correct weight for age and height. The classic therapeutic
ketogenic diet was developed for treatment of paediatric epilepsy in
the 1920s and was widely used into the next decade, but its popularity
waned with the introduction of effective anticonvulsant medications.
This classic ketogenic diet contains a 4:1 ratio by weight of fat to
combined protein and carbohydrate. This is achieved by excluding
high-carbohydrate foods such as starchy fruits and vegetables, bread,
pasta, grains, and sugar, while increasing the consumption of foods high
in fat such as nuts, cream, and butter. Most dietary fat is made of
molecules called long-chain triglycerides (LCTs). However, medium-chain
triglycerides (MCTs)—made from fatty acids with shorter carbon
chains than LCTs—are more ketogenic. A variant of the classic diet known
as the MCT ketogenic diet uses a form of coconut oil,
which is rich in MCTs, to provide around half the calories. As less
overall fat is needed in this variant of the diet, a greater proportion
of carbohydrate and protein can be consumed, allowing a greater variety
of food choices.
In the mid-1990s, Hollywood producer Jim Abrahams,
whose son's severe epilepsy was effectively controlled by the diet,
created the Charlie Foundation to promote it. Publicity included an
appearance on NBC's Datelineprogramme and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep.
The foundation sponsored a multicentre research study, the results of
which—announced in 1996—marked the beginning of renewed scientific
interest in the diet.
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