Ketogenic Diet: A High-Fat Dietary Therapy for Managing Epilepsy and Beyond

The ketogenic diet is a specialized high-fat, moderate-protein, and very low-carbohydrate diet primarily used in conventional medicine to manage refractory epilepsy, especially in children. It works by shifting the body's primary fuel source from carbohydrates to fats.

How the Ketogenic Diet Works: Burning Fat for Fuel

When carbohydrate intake is drastically reduced, the liver converts fats into fatty acids and ketone bodies.

• Ketone Bodies: These replace glucose as the primary energy source for the brain.
• Ketosis: The resulting elevated level of ketone bodies in the blood can lead to reduced epileptic seizures.
• Benefits: About half of children and young adults with epilepsy who have tried the diet experience a 50% or greater reduction in seizures, even after discontinuing the diet.

The Classic Ketogenic Diet

The classic ketogenic diet is precisely formulated to provide adequate protein for growth and repair, along with sufficient calories to maintain a healthy weight. This diet has a 4:1 ratio of fat to combined protein and carbohydrates.

• Food Restrictions: High-carbohydrate foods like starchy fruits, vegetables, bread, pasta, grains, and sugar are excluded.
• Increased Fat Intake: Foods high in fat, such as nuts, cream, and butter, are emphasized.

The MCT Ketogenic Diet: A More Flexible Approach

The MCT (medium-chain triglyceride) ketogenic diet uses a form of coconut oil rich in MCTs to supply around half of the daily calories. MCTs are more ketogenic than the long-chain triglycerides found in most dietary fats. Benefits of this approach are:

• Greater Food Variety: This allows for a greater proportion of carbohydrate and protein, increasing food choices.
• Less Overall Fat: Since MCTs are readily converted into ketones, less overall fat is needed.

Caption: An example of a Ketogenic diet with MCT.

History of the Ketogenic Diet: From Fasting to a Mainstream Therapy

The ketogenic diet emerged from the practice of fasting as a treatment for epilepsy. While popular in the 1920s and 30s, its use declined with the advent of anticonvulsant drugs.

• Fasting's Revival: Despite the effectiveness of medication for many, 25–30% of individuals with epilepsy don't achieve seizure control with drugs alone. For this group, especially children, the ketogenic diet has regained prominence.
• Ancient Roots: Physicians in ancient Greece, including those associated with the Hippocratic Corpus, recognized the link between diet and epilepsy, advocating for dietary changes to manage the condition.
• Modern Fasting Studies: The first modern study of fasting as epilepsy treatment occurred in France in 1911, revealing potential cognitive benefits compared to traditional medications like potassium bromide.

Potential Therapeutic Uses Beyond Epilepsy

Research suggests the ketogenic diet may have therapeutic potential for other neurological disorders, including:

• Alzheimer's disease
• Amyotrophic lateral sclerosis (ALS)
• Headaches
• Neurotrauma
• Pain management
• Parkinson's disease
• Sleep disorders

Potential Side Effects of the Ketogenic Diet

While generally safe under medical supervision, the ketogenic diet can have side effects, including:

• Constipation
• High cholesterol
• Growth slowing in children
• Acidosis
• Kidney stones

It's crucial to consult with a healthcare professional before starting the ketogenic diet, especially for managing epilepsy or other medical conditions.