For children whose seizures are not well controlled with medication, Dell Children’s Comprehensive Epilepsy Center offers ketogenic diet therapy as an alternative treatment. Research shows that approximately half of those on ketogenic diet therapy will experience some improvement in seizures.
Our dietitians, nurse practitioners and epileptologists are trained in the intricacies of these specialized diets to help children with epilepsy. Our dietitians closely monitor, counsel and educate kids and their families. The diet therapies offered include:
- Ketogenic Diet (KD)
- Modified Atkins Diet (MAD) – aka Modified Ketogenic
- Medium Chain Triglyceride (MCT)
- Low Glycemic Index Therapy (LGIT)
What Is the Ketogenic Diet?
The ketogenic diet is a special high fat diet that is used for difficult-to-treat seizures. The diet can provide up to 90 percent of total calories from fat, adequate protein to support growth and a very small amount from carbohydrates. Heavy cream, butter and vegetable oils provide the necessary fat. Foods high in carbohydrates such as bread, potatoes, rice, cereals and pasta are not allowed on the strictest form of the diet, but are allowed on more liberal forms of the diet. Food must be carefully prepared and weighed on a gram scale. The classic ketogenic diet is described by using a ratio of fat to non-fat (protein and carbohydrates combined) of 4:1 to 3:1. The modified ketogenic diets consist of 2:1 and 1:1 ratios.
How Can Ketogenic Diet Therapy Help My Child’s Seizures?
Infants with seizures through young adults in their teenage years can use diet therapy to help control seizures. Unfortunately, there is no way to predict if the diet will be successful. Research supports that 50 to 75 percent of children with difficult to control seizures of all types benefit from the diet. In some cases, positive behavior changes have been observed in those children who follow the ketogenic diet.
How Does the Diet Work?
Scientists and medical teams have not been able to determine how the diet works. A metabolic change occurs in the body that alters the brain chemistry. Ketone bodies are produced in fat metabolism. One theory is that ketones may have a neuro-protective effect on the brain. Even though much research is in place to explain the function of the ketogenic diet, it remains a mystery.
How Do I Know If My Child Is a Candidate for Diet Therapy?
You and your pediatric neurologist will discuss the diet and if agreed that diet is an option, a referral to the ketogenic diet clinic will be made for an evaluation with the ketogenic diet team. At the appointment, the ketogenic diet team, including an epileptologist, nurse practitioner, and registered pediatric dietitian, will evaluate your child. Once completed, further plans may be made for a potential admission to the EMU for diet initiation.
What Does My Child Eat on the Diet?
Your dietitian will determine how many calories your child needs to continue to support growth. Once calories are figured, about 90 percent of the total calories will be provided from fats sources in the diet, protein needs will be met and a very small amount of calories will be provided from carbohydrates. Each child has their own set of recipes specifically prepared by the ketogenic dietitian. Some foods that are used in the diet are: heavy whipping cream, butter, oils, bacon, hot dogs and eggs. Fruits and vegetables are allowed but in very small quantities. Your child will require supplementation since many vitamins and minerals are absent from the diet.
Are There Side Effects from the Diet?
The most common side effect of the diet is constipation, which can be managed with daily laxatives. Labs are closely monitored for signs of acidosis that may lead to the development of kidney stones. This complication can be minimized with good fluid intake.
Why Is a Hospitalization Required to Begin the Ketogenic Diet?
An admission to the hospital is necessary for the safety of your child as the ketogenic diet is initiated. Hospitalization also allows for intensive 1:1 training with the ketogenic dietitians to train caregivers how to prepare meals and further educate how to implement the diet. In addition, the nursing staff will be checking your child’s blood glucose levels before meals. They will also check urine ketone levels with every void to monitor for ketone production. Prior to discharge, your child will need to tolerate three meals at their goal ratio, have stable blood sugars and not experience vomiting. The majority of children tolerate the transition to the ketogenic diet without complications.
How Long Is the Diet Used for?
The diet is typically used for two to three years if helpful in reducing or stopping seizure activity. To ensure that the diet has had an opportunity to work, it is suggested to allow up to three to four months to trial the diet before discontinuing. Your child will follow up in the keto clinic one month after discharge and then every three months. Lab work will need to be completed prior to each clinic visit.