A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital and followed-up by a report published in 2001. As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.
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When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks. The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness. The level of parental education and commitment required is higher than with medication.
“There is an ion channel in the membrane of neurons which makes membrane less excitable; a potassium channel which is activated specifically by adenosine triphosphate (ATP). The more ATP is generated, the more this channel is active and the less excitable the neuron becomes,” said Pavel Klein, MD, of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland. “It has also been shown that ketone bodies also act directly to reduce the release of glutamate, the main excitatory neurotransmitter. When less glutamate is released by a neuron, neighboring neurons are excited less and less prone to generate a seizure.”
The understanding of the mechanisms of action of KD is incomplete; however, some theories have been advanced about how it modifies the neuronal metabolism and excitability in order to reduce the seizure frequency. Possibly, the real mechanism of reduction of cortical hyperexcitability involves multiple factors. Some of the systems involved in seizure reduction are related to metabolic changes in the blood and cerebrospinal fluid (CSF), including a decrease in glucose levels and an increase in KB. The mitochondria function and energy reserve may also play a role in the KD mechanisms, resulting in synapse stabilization and excitatory decrease.
Importantly, cholesterol doesn’t travel around your bloodstream on its own. As a hydrophobic (water-repelling) substance, it must be packaged within lipoproteins to move around the bloodstream. So that means when we talk about blood cholesterol levels, we’re referring to the amount of cholesterol contained in different lipoprotein particles. In addition to cholesterol, these lipoprotein particles also contain special proteins called apolipoproteins, triglycerides and other compounds.
Now a report, appearing several weeks ago in the journal Neurology, reveals that in fact, a ketogenic diet is also profoundly helpful in adults as well in terms of treating epilepsy. This research, published by investigators in Maryland, found that there was at least a 50% reduction in seizures in 32% of patients treated with a ketogenic diet as well as in 29% of patients who went on a modified Atkins diet. In fact, 9% of those placed on the ketogenic diet and 5% of those placed on the modified Atkins diet had a greater than 90% reduction in the frequency of their epileptic seizures. These diets were designed such that the bulk of calories, between 67% and 75%, came from fat. The study revealed that “the anticonvulsant effect occurs quickly with both diets, within days to weeks.” Interestingly, the most common side effect was weight-loss which the office indicated “maybe advantageous inpatients with obesity.”
The vast majority of claims regarding the ketogenic diet and cancer are drawn from lab and animal studies. Findings from animal studies are revealing. A study published in July’s Nature found that in mice, the ketogenic diet enhanced the effects of a specific cancer treatment. The drugs in that treatment targeted a signaling network guided by an enzyme (abbreviated P13K), which is commonly mutated in cancers.
Leanne: Billion. Okay, let’s talk a little bit about Staten, I can’t remember what book it was but they were saying that cholesterol is really important for brain health. You mentioned that too, the cholesterol uses the nutrient and moves it up to your brain, it’s really important. What I was reading is that as we age our cholesterol actually increases slightly to help with that aging process. You often meet people that are in their 40s, 50s, I know a lot of people in my family are now on Staten because their cholesterol is increasing. I always say, “Maybe that’s your body’s way of protecting yourself against aging.”
How ketosis helps with epilepsy isn't known, but it does. Researchers at Johns Hopkins University studied 150 children with epilepsy in one important study. After a year on the ketogenic diet, half of children had 50% fewer seizures. One fourth of the children reduced their seizures by 90%. After a few years on the diet, many of these children no longer needed medications at all.
The authors defined a VLCKD as a diet lower in 50g of carbohydrates – lower than the daily recommended grams of carb consumption clinicians recommend to diabetics. They included 13 randomized controlled studies with a total of 1,415 subjects. All studies took place for at least a full year and all subjects included were over 18 years old and had a BMI of at least 27.5 kg/m2. In each of these studies, VLCKD diets were compared to low-fat diets.
These affect your brain and spine, as well as the nerves that link them together. Epilepsy is one, but others may be helped by a ketogenic diet as well, including Alzheimer’s disease, Parkinson’s disease, and sleep disorders. Scientists aren’t sure why, but it may be that the ketones your body makes when it breaks down fat for energy help protect your brain cells from damage.
A meta-analysis of 13 randomized controlled trials following overweight and obese participants for 1-2 years on either low-fat diets or very-low-carbohydrate ketogenic diets found that the ketogenic diet produced a small but significantly greater reduction in weight, triglycerides, and blood pressure, and a greater increase in HDL and LDL cholesterol compared with the low-fat diet at one year.  The authors acknowledged the small weight loss difference between the two diets of about 2 pounds, and that compliance to the ketogenic diet declined over time, which may have explained the more significant difference at one year but not at two years (the authors did not provide additional data on this).
As of the moment, there is no industry standard as to how many calories should be consumed in a restricted ketogenic diet, but there are published studies that provide estimates. In one example, a 65-year-old woman who was suffering from glioblastoma multiforme (GBM), an aggressive type of brain cancer, was put into a restricted ketogenic diet that started with water fasting and then proceeded to consuming 600 calories a day only.