The ketogenic diet, also known as the traditional ketogenic diet and modified Atkin’s diet, is an important and validated dietary approach to controlling intractable epilepsy that focuses on a high-fat, protein, and low-carb diet. Yet despite its success in cases of drug-resistant epilepsy, the mechanism behind its effectiveness is still not well understood.
In adults, the type of ketogenic diet typically used is the modified Atkins diet. Carbohydrates are limited to 20 grams per day and the intake of foods containing fat is required to get into the state of ketosis. For example, foods such as heavy cream, oils, avocado, eggs, butter and meats are encouraged; whereas conventional breads, pastas, cereals and cakes are restricted.
Mitochondria are the main power generators in our body’s cells and also play a prominent role in antioxidant activities and calcium buffering. The number of mitochondria present in any cell is directly related to its metabolic requirements, and can range from a solitary mitochondrion to thousands of them. In fact, mitochondria enable cells to generate up to 15 times more ATP than they could otherwise!
One review looked at how the KD and modified Atkins diet (MAD) helped with seizure control in adults. Across the 5 studies reviewed, 32% of KD-treated patients achieved ≥50% seizure reduction while a slightly lower 29% of MAD-treated patients hit that same target. Even more drastic was the 9% KD-treated and 5% MAD-treated patients that achieved >90% seizure frequency reduction.4
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On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell's mitochondria (the energy-producing parts of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this by using fatty acids. Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the blood–brain barrier. However, the liver can use long-chain fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy.
Like all the other treatments for epilepsy, the ketogenic diet has some side effects, which may or may not affect a particular child. Some side effects may go away if caught and managed early on. Knowing what to look for can make a big difference. Reported side effects include dehydration, constipation, and, sometimes, complications from kidney stones or gall stones.
I had some eggs and some meat and all this stuff. Then they tested me literally every 30-60 minutes for five hours. I got to see literally what was happening real time after a low carb meal. I think that’s where having the right nutrition really is the basis for knowing where you stand. The other thing for people that are worried about this morning reading, check your A1C. That’s the average of the last 3 months worth of all of your blood sugars, not just the ones in the morning that you’re testing and freaking out about. By the way, when you freak out that also raises your blood sugar.
I have been on keto for past 7 months. Triglycerides improved from 117 to 86 and HDL from 53 to 55, VLDL from 23 to 17 compared to last year. My problem is, LDL has been increasing by an average of 20 points every year for past 5 years, it was 130 in 2014, My metabolic panel is normal. Below is my lipid panel done a couple of days ago. Could you please advise me on how to improve my LDL level?
Since this is my full-time job, donations really help me keep afloat and allow me to post as much to the website as I do. I really appreciate any donation you want to give, but you can change the price yourself. I’ve added in $15 as the suggested price. I think that’s a very fair price considering other websites are charging in the hundreds of dollars, and I’ve seen what they are like on the inside.
Jimmy Moore: Yeah, this is such a discouraging topic and I’ve gotten pretty upset about it when I talk to people like you, in interviews, because imagine this. Grandma is turning 65, and she’s starting to see her cholesterol get a little bit higher, so she goes to see her doctor, “Oh my gosh, your cholesterol going high, we need to put you on Staten drug.” She starts taking the Staten drug and removes the very element that was keeping her faculties about her in her head, and over the next four or five, even ten years you start to see a mental decline. What do we call it?
Increasing numbers of people around the world are suffering from chronic diseases such as diabetes and obesity, and the main culprit is usually the food they eat. The standard American diet, for example, consists of excessive amounts of protein, processed grains and carbohydrates — particularly in the form of refined, added sugars — none of which is good for your health.
A computer program such as KetoCalculator may be used to help generate recipes. The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.
Another memorable patient written up for the book had been diagnosed with what was thought to be localized endometrial cancer in 1969. After a course of radiation to shrink her large tumor, she underwent hysterectomy, and was told they “got it all.” Over the next few years, however, her health began to deteriorate: she experienced persistent fatigue, malaise, pelvic pain, and weight loss.
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet. This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.
Other genetic disorders caused by mutations limit the availability of energy substrates but do not necessarily cause seizures. One such disease is phosphofructokinase (PFK) deficiency. PFK is the rate-limiting enzyme in glycolysis for the conversion of fructose-6-phosphate to fructose-1,6-bisphosphate. Patients with mutations in the muscle isoform of PFK demonstrate exercise intolerance with myalgias and stiffness. There also are rare infantile forms, such as a case reported by Swoboda et al. [21, Class III], with myopathy and arthrogryposis. This patient displayed marked gains in muscle strength and improvement in his developmental milestones after being placed on the ketogenic diet.
Artificial sweeteners such as saccharin (Sweet’N Low), aspartame (NutraSweet, Equal), and sucralose (Splenda) are quite popular among low-carb dieters. However, concerning new research indicates that artificial sweeteners have adverse metabolic effects and may work against your keto efforts by disrupting your gut microbiota and inducing insulin resistance and weight gain. (46, 47) If you want to use a non-caloric sweetener, I recommend either stevia or monk fruit sweetener.
Protein consumption can also stimulate a little protein present in the body called mTOR (short for mammalian target of rapamycin) which helps regulate cell growth, proliferation, survival, and protein synthesis (among other things). Something as simple as a big juicy steak will cause our body to upregulate (stimulate the increase of) mTOR — and when this happens, the cells can “forget” to do some very important things (like controlling and preventing cancer growth).
Once a child is considered a candidate for the diet, a screening evaluation by selected members of the team responsible for implementing the diet is initiated. This screening includes a comprehensive evaluation by the dietitians and nursing staff. The purpose of this evaluation is to educate the family and to assess their ability to maintain the diet. At the same time, the different types of meal plans and foods that the child can eat are discussed, along with their preparation. Children traditionally are fasted for 24 hours prior to the initiation of the diet, beginning after the dinner on the day prior to admission. Occasionally, medically complex children will not be fasted. There are many ketogenic diet centers now that do not fast children, and research indicates that there is no difference in efficacy between fasted and non-fasted children. However, a more rapid reduction of seizures often seen with earlier ketosis can lead to a quicker response . Evidence also suggests that fasting is not the same as the diet in terms of mechanism of action and so may be of additional help. The decision to fast should be individualized and also at the comfort level of the ketogenic diet team.
Dr. Kossoff is a Professor of Neurology and Pediatrics at Johns Hopkins University in Baltimore, MD. He received his medical degree from SUNY at Buffalo School of Medicine in New York, followed by a residency in pediatrics at Eastern Virginia Medical School in Norfolk, Virginia. He completed a fellowship in child neurology and then pediatric epilepsy and clinical neurophysiology at The Johns Hopkins Hospital in Baltimore. He has been at Johns Hopkins since 1998.
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.
A lot of people take their macros as a “set in stone” type of thing. You shouldn’t worry about hitting the mark every single day to the dot. If you’re a few calories over some days, a few calories under on others – it’s fine. Everything will even itself out in the end. It’s all about a long term plan that can work for you, and not the other way around.
Ketosis was a beneficial process the human body developed as an adaptation to times when food was unavailable (such as for these hunter-gatherers). However, you can effectively produce ketones too by limiting the carbohydrates in your diet to less than 80 grams daily and protein to no more than 1.2 grams of protein/per kg lean body mass. As the body adapts to the use of ketone metabolism over time, the hormone in the liver that is essential to ketone metabolism (known as FGF21) becomes more efficient.
According to a 2015 review of the literature on the ketogenic diet for human glioma patients (32 case studies), “Prolonged remissions ranging from more than 5 years to 4 months were reported in the case reports. Only one of these patients was treated using KD as monotherapy. The best responses reported in the more recent patient series were stable disease for approximately 6 weeks.”