All about Diet

Mankind fills no container worse than he fills his stomach.

In the past most illness was mostly the result of a lack, such as warmth, food etc. Now it is mostly due to excess and in particular excess of the wrong food or food in general.

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Ketogenic Diets

Ketogenic diets are a group of high-fat, moderate-protein, and very low-carbohydrate diets given to treat some children and adolescents with epilepsy, and some adults with epilepsy and other diseases. The name ketogenic refers to the increased production of ketone bodies as a result of this special diet. Ketone bodies are three compounds that are formed during the metabolism of fats and are ordinarily excreted in the urine. An abnormally high level of ketone bodies is called keto-sis, and this condition is the goal of the ketogenic diet. It is thought that ketosis helps to control the frequency and severity of epileptic seizures, even though the reasons for this effect are not fully understood as of 2007.

Classic ketogenic diet (Johns Hopkins protocol)

The ketogenic diet used at the Johns Hopkins Pediatric Epilepsy Center is commonly considered the standard or classic form of this diet. Its usual protocol for children between the ages of 3 and 12 years provides a ratio of 4 parts fats to 1 part protein and carbohydrates combined. Infants, toddlers, and adolescents are usually started on a 3:1 ratio. Individual patients may require ratios ranging from 2.5:1 to 5:1; these ratios are worked out by fine-tuning the diet once the child has been started on it.

PREPARATION. The most important aspect of preparation for the ketogenic diet is deciding whether it will benefit the child. Most doctors prefer not to use it if the child is taking medications that are effective in controlling seizures without producing severe side effects. If, however, the child has tried two or more anticonvulsants without success, or is having serious side effects from the drugs, the ketogenic diet offers a chance to have a more normal life. It helps if the child is not a fussy eater and is willing to try foods that he or she might not ordinarily choose. The child also must be capable of self-control, as eating only a few cookie crumbs or anything else containing sugar (including toothpaste and other oral care products), will break the effect of the diet and possibly bring on a seizure.

Another important aspect of preparation is commitment on the part of the entire family. It takes considerable time and care to measure food portions, test the child's urine at home, watch for possible side effects, and keep a balance between the needs of the epileptic child and the food preferences of other family members. Parties and holiday meals may require some advice from the dietitian so that the child can have a treat that won't break the diet and will allow him or her to enjoy the meal or party with other friends or family members.

INITIAL FAST. The classic ketogenic diet begins with placing the child on a 24- to 48-hour fast followed by a stay of several days as a hospital inpatient, so that his or her body fluids can be measured and possible side effects monitored. The reason for the fast is to force the body to exhaust its glucose supply and begin burning stored fat for energy. The foods that are given after the fast are intended to keep the process of fat burning going by providing slightly fewer calories than the body needs and providing 80% of those calories in the form of fat.

Prior to coming to the hospital, the child's food records are kept over a three-day period so that the doctors will know the average daily calorie intake in order to tailor the special diet to the child's need for growth. The goal is to maintain the child's body mass index at the 50th percentile. The amount of protein in the diet is based on the child's age, kidney function, and stress factors. While the child is in the hospital, the parents are given a four-day educational program to help them understand the diet and give them practice in preparing meals as well as monitoring the child.

The Johns Hopkins schedule for the child's hospital stay is as follows:.

  • Sunday (night before admission): Child begins fasting at home in the evening.
  • Day 1 (Monday): Child is admitted to the hospital; fasting continues; fluid intake is restricted; and blood glucose is monitored every 6 hours
  • Day 2 (Tuesday): Child is given "eggnog" for dinner (1/3 of the maintenance calorie allotment for dinner); blood glucose checks are discontinued. The parents are asked to start checking the child's urine ketone levels. Ketone levels should be between 80 and 160 mg/dL when the diet is working properly.
  • Day 3 (Wednesday): Breakfast and lunch are given as eggnog (1/3 of the maintenance calorie allotment for those meals); dinner (more eggnog) is increased to 2/3 maintenance level.
  • Day 4 (Thursday): Breakfast and lunch are given at 2/3 maintenance level; dinner is the child's first full ketogenic meal (not eggnog).
  • Day 5 (Friday): After a full ketogenic breakfast, the child's prescriptions are reviewed, follow-up is arranged, and the child is discharged from the hospital.

Some hospital programs do not require fasting to initiate the child's diet. Follow-ups for most children take place at three-month intervals, although infants may be seen monthly. Children must take multivitamins and mineral supplements (particularly calcium) while on the ketogenic diet. Anticonvulsant medications are usually continued for the first few months of the diet, but may be given in lower dosages if the child responds well to the diet, or even discontinued altogether.

SAMPLE MENUS. A typical day's menu for a child on the standard 4:1 ratio diet, allowing 1500 calories per day:

  • Breakfast: egg with bacon, made with heavy whipping cream and butter, plus an apple
  • Snack: peanut butter mixed with butter
  • Lunch: tuna salad made with celery, mayonnaise, and heavy whipping cream, served with lettuce
  • Snack: keto yogurt (made with heavy whipping cream, sour cream, strawberries, and artificial sweetener)
  • Dinner: cheeseburger with lettuce and green beans
  • Snack: keto custard (heavy whipping cream, egg, and pure unsweetened vanilla flavoring)

A computer program is available (listed in the resources below) to help parents and dietitians devise menus that will take the individual child's food preferences into account as well as keep the meal selections within the correct nutritional ratio.

TAPERING AND TERMINATION. The ketogenic diet is a long-term diet but is not intended for indefinite use in children. Most children who respond favorably to it remain on it about two years. The diet must not be stopped abruptly, however; most doctors recommend that parents slowly start to add regular foods to the child's menu to see whether the seizures are still controlled.

Sanggye Paik Hospital diet

The Sanggye Paik Hospital diet is a version of the ketogenic diet developed in Korea for the treatment of Asian children, whose diets typically contain much less fat than the diets of Western children. The Sanggye Paik protocol does not require an introductory fast and introduces high-fat foods to the patient's diet gradually, although it uses the same 4:1 ratio of fats to protein and carbohydrates as the Johns Hopkins protocol. It is reported to have the same proportion of successes in patients as the Johns Hopkins ketogenic diet.

Modified Atkins diet

In 2003 the Johns Hopkins treatment center initiated a case series of six children and adults who used a modified version of the Atkins diet to control seizures rather than the classic 4:1 ketogenic diet. These patients were not admitted to the hospital; did not have to fast at the beginning of the diet; did not have calories, protein, or fluid intake restricted; were limited to 10-grams of carbohydrates per day; and were encouraged to eat foods rich in fats. Half the patients showed a marked reduction in seizures.

Based on this initial success, the Johns Hopkins doctors drew up a modified Atkins diet protocol for a group of 20 children, as follows:

  • A carbohydrate counting guide is given to the patient's family
  • Carbohydrate intake is limited to 10g per day for the first month
  • A generous intake of fats in the form of mayonnaise, butter, oils, heavy cream, etc. is encouraged, although precise amounts are not defined
  • Clear carbohydrate-free fluids and calories are unrestricted
  • The patient is given a low-carbohydrate multivitamin and a calcium supplement
  • Ketones in the urine are checked twice a week and weight once a week
  • Low-carbohydrate store-bought products (shakes, snack bars, etc.) are discouraged for at least the first month
  • The patient is given a complete blood test and metabolic workup every three months

Of the 20 patients, two-thirds had a significant reduction in seizures, 9 were able to reduce medication dosages, and none developed kidney stones.


The function of ketogenic diets is therapeutic- improved control of seizures in children, adolescents, and some adults with epilepsy; treatment of some other rare metabolic disorders; and slowing the progression of such other diseases as amyotrophic lateral sclerosis.


The benefits of the ketogenic diet are improved seizure control without the need for large doses of anticonvulsant drugs with their associated side effects. Patients who respond well to the diet are able to lead more nearly normal lives. Patients with amyotrophic lateral sclerosis or other disorders being treated experimentally with a ketogenic diet may benefit by having their disease progress at a slower rate even when a cure is not possible.


The most important precaution to note is that the ketogenic diet is not a do-it-yourself nutritional regimen. It is a serious form of therapy and requires careful medical supervision as well as parental monitoring. Patients on the diet must be followed by an experienced treatment team, usually based in a specialized epilepsy treatment center. Even though the diet may seem like a more "natural" way to control seizures than taking medications, it is based on a highly unnatural selection of foods and forces the body to obtain its necessary energy in an unusual way.

Another important precaution is preventing the child from accidentally ingesting sugar in over-the-counter medications, toothpastes, mouthwashes, or similar products. A list of sugar-free products can be found in PDF format on the Charlie Foundation website.



Success rate

Not all patients respond to the ketogenic diet. According to the Johns Hopkins treatment center, about half the children who begin the classic ketogenic diet will have at least a 50-percent reduction in seizures within 6 months. Half of that group will show greater than 90-percent improvement, with about 15% completely seizure-free. Many families are able to taper or completely eliminate the use of anticonvulsant medications.

As of the early 2000s, there is no way to predict ahead of time whether a child will respond to the diet. It is recommended that the child follow the diet for a period of 2-6 months before deciding that it isn't working. Ineffectiveness is the single most common reason for children's discontinuing the diet, although some discontinue it because they cannot tolerate the foods allowed even after fine-tuning, or because of side effects. The Johns Hopkins program reports that about half the children who begin the ketogenic diet in their treatment center are still using it a year later.

Side effects

Because the 4:1 ketogenic diet is an unnatural way to obtain nutrition, it has some potential side effects. Reported adverse effects in patients using the classic ketogenic diet include:

  • Growth retardation caused by protein deficiency
  • Vitamin and mineral deficiencies
  • Nausea, vomiting, or constipation
  • Abnormally high levels of blood lipids after discontinuation of the diet
  • Kidney stones or gallstones. Parents are taught to monitor the child's urine for blood as well as ketone levels, because blood in the urine is often an early sign of kidney stone formation
  • More frequent infections due to a weakened immune system
  • Inflammation of the pancreas
  • Dehydration
  • Decreased bone density
  • Menstrual irregularities (in adolescent and adult females)

Research and general acceptance

Another area of recent research is the use of the ketogenic diet in the treatment of other disorders. It appears to be beneficial in the treatment of patients with glucose transporter defects (genetically transmitted disorders in which glucose in the blood cannot cross the blood-brain barrier) and a few other inborn metabolic disorders. In 2006 a group of researchers at Mount Sinai School of Medicine in New York reported that the diet shows promise in slowing the progression of amyotrophic lateral sclerosis, a progressive and fatal disease of the nerve cells that control movement.


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