Kids First

Ketogenic Diet Program

What health benefits does it offer kids with epilepsy?

- BY MATTHEW SOLAN

Although the keto diet is the latest weight-loss trend, the special diet has helped children with epilepsy for decades. The diet emphasizes high amounts of fats, moderate intake of protein, and low, low, low carbohydra­tes. It affects the body like this: Without enough carbs for energy, the body breaks down stored fat for energy, which produces chemicals called ketone bodies that are released into the bloodstrea­m. This process, called ketosis, often begins after several days, or even a week, on the diet.

The keto diet is popular for weight loss because it forces the body to burn fat. However, it is a highly restricted diet, and many people cannot manage the low carb amounts needed to keep the body in ketosis.

Also, because fats make up such a large portion of the diet, people may overeat poor-quality fats from processed foods, and eat few nutrient-rich fruits and vegetables. It is also common to experience temporary side effects during the transition, like nausea, fatigue and sleep problems.

While the health benefits of a keto diet are still debated, one area it has shown helpful is: children with epilepsy.

Since the 1920s, keto diets have been an effective remedy for intractabl­e epilepsy (seizures that are not controlled with standard treatment). Keto diets are often prescribed to children older than age 2 when anti-seizure drugs have failed, or even earlier in the case of epilepsy syndromes.

“The ketogenic diet is used therapeuti­cally to manage the frequency and severity of seizures, or to reduce the dosage of anti-seizure medication­s,” says Laura Hatfield, clinical nutrition manager with Golisano Children’s Hospital of Southwest Florida.

More than half of children who follow a keto diet have at least a 50% reduction in the number

“The ketogenic diet is used therapeuti­cally to manage the frequency and severity of seizures, or to reduce the dosage of antiseizur­e medication­s.”

—Laura Hatfield, clinical nutrition manager with Golisano Children’s Hospital of Southwest Florida

of seizures, and about 10% to 15% become seizure-free, according to research from the Epilepsy Foundation.

No one is certain how the diet helps children with epilepsy, according to Hatfield. One theory is that high amounts of ketones affect brain neurotrans­mitters in a way that reduces seizure frequency.

A medical keto diet is prescribed by a registered dietitian, who can determine the exact calorie level based on a child’s age and activity level.

A keto diet is often calculated in ratios, such as 4:1, 3:1, 2:1 and 1:1. For example, in a 4:1 proportion, there is four times as much fat as protein and carbohydra­tes combined. “Yet, it is unclear whether certain ratios afford greater seizure protection,” says Hatfield.

Staple keto diet foods include plenty of meat, eggs, cheese, fish, nuts, butter, oils, seeds, and fibrous vegetables. The range of daily carbohydra­tes varies. A typical amount in a 1,000 calorie

diet would be 8 grams for a 4:1 ratio diet, 16 grams for 3:1, 30 grams for 2:1, and 40 to 60 grams for a 1:1 ratio.

A typical daily meal includes a fat, a proteinric­h food, and a small amount of fruit or vegetable. For instance, a 4:1 keto meal for a 7-year-old could be 50 grams heavy cream (maybe sweetened with erythritol, a type of sugar alcohol), 40 grams broccoli, 20 grams salmon, 10 grams butter, and 13 grams olive oil.

The keto diet can have an immediate effect or take several months, according to Hatfield. “There is usually an improvemen­t in seizure frequency within the first 10 weeks on a keto diet, although each child is unique and has varying seizure patterns,” she points out.

A keto diet is managed under close medical supervisio­n and evaluated every three and six months at first and then every year after that.

Parents also should be aware that a keto diet increases urination frequency and does not contain adequate amounts of vitamins and minerals for children. Proper fluid intake and extra supplement­ation are often needed.

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