The “new” Ketogenic Diet

• Published in: Journal of the American Dietetic Association 1995-09, Vol.95 (9), p.A59-A59
• Main Authors: Phillips, R.H., Bunnell, A.
• Format: Article
• Language: English
• ISSN: 0002-8223; 1878-3570
• DOI: 10.1016/S0002-8223(95)00553-6

A “long-lost” diet for controlling epilepsy has been the subject of renewed, consumer-driven interest due to publicity on a popular news feature TV program. The ketogenic diet, a medical nutrition therapy for epilepsy which essentially had fallen into disuse everywhere except Johns Hopkins Pediatric Epilepsy Center was resurrected at our facility in November 1994. This diet is one of the oldest forms of seizure control, however, the mechanism remains unknown. The diet is very high fat, moderate protein, very low carbohydrate. Calories and protein are calculated to allow for growth but no weight gain. Calories are typically supplied in a 4:1 ratio of grams of fat: grams of protein + grams of carbohydrate, with fluid restricted to ∼65cc/kg/d. The child fasts until 4+ ketosis is achieved, and then the diet is introduced slowly. The goal is to maintain 3-4+ ketosis, remaining on the diet 2-3 years. As initiation of the diet requires extensive nutrition education and close monitoring for hypoglycemia, a hospital stay of ∼ five days is required. Close outpatient follow-up by both the neurologist and the dietitian is essential. Johns Hopkins' statistics claim the diet improves seizure control in 70-75% of patients, and eliminates seizures in 50% of patients who stick to it rigidly. To date, 20 patients have been admitted to our facility for diet therapy. Of these, 100% are currently following the diet or followed the diet for greater than two months to determine responsiveness. All have maintained ketosis and most have reported a reduction in seizures. Though long term success measures will require two to three years to report, we have concluded that any opportunity for success is dependant on a cooperative multi-disciplinary effort with the dietitian playing a pivotal role in developing and implementing a care map that extends through pre-admit, hospitalization and long-term follow-up.