It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients. It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.
In 1921, Rollin Turner Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate, and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet. Dr. Russell Morse Wilder, at the Mayo Clinic, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.
"It was extremely difficult," he recalls. "You spend your entire life hearing that fat makes you fat and causes heart attacks and strokes. Now, all of a sudden, you're eating 200 grams of fat per day. There is a huge psychological component to conquer before you can become successful with the keto diet. In the beginning, it's like trying to convince people 1,000 years ago that the world is in fact round, not flat."
Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed. Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula. Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet. KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding. Other formula products include KetoVolve and Ketonia. Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.
Frederick F. Samaha, M.D., Nayyar Iqbal, M.D., Prakash Seshadri, M.D., Kathryn L. Chicano, C.R.N.P., Denise A. Daily, R.D., Joyce McGrory, C.R.N.P., Terrence Williams, B.S., Monica Williams, B.S., Edward J. Gracely, Ph.D., and Linda Stern, M.D., “A Low-Carbohydrate as Compared with a Low-Fat Diet in Severe Obesity,” N Engl J Med 2003; 348:2074-2081. http://www.nejm.org/doi/full/10.1056/NEJMoa022637.
But beyond that, experts aren't convinced that the keto diet has any other scientifically proven health benefits. In fact, it may have some distinct downsides. If you follow the keto diet incorrectly, for example (like by eating lots of saturated fats, versus healthy unsaturated fats), you're at risk of raising your cholesterol levels. “The best strategy to keep your heart healthy is to get as much fat as possible from unsaturated sources such as olive, avocado and canola oils, nuts, seeds, avocados, and olives," says Ansel. For some people, it's possible to actually improve cholesterol if the fats in their diet are from varied and healthy sources, says Harvey.
The ketogenic diet may seem like the Jekyll to the Hyde-like low-fat craze of the 1990s. The bulk of current research finds that the middle ground between the two extremes is more beneficial for overall health. Make it easy for yourself: Eat at least two servings a week of fatty fish (salmon, sardines, mackerel) and cook with a variety of quality fats (olive oil, canola oil, avocado oil) throughout the week.
The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients. Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective. Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug. Some evidence indicates that adolescents and adults may also benefit from the diet.
In 1994, Hollywood producer Jim Abrahams, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation for Ketogenic Therapies to further promote diet therapy. Publicity included an appearance on NBC's Dateline program and ...First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.
Instead of thinking about the total carbs you’re eating, assess what those carbs provide to you. Do the majority of your carbs come from fruit and vegetables, with a payload of fiber and disease-fighting antioxidants? Fantastic. Or are you consuming them in the form of added sugars (cookies, candy, soda) or refined flour? If you are, you know what to do.
Check the nutrition labels on all your products to see if they’re high in carbs. There are hidden carbs in the unlikeliest of places (like ketchup and canned soups). Try to avoid buying products with dozens of incomprehensible ingredients. Less is usually healthier.Always check the serving sizes against the carb counts. Manufacturers can sometimes recommend inconceivably small serving sizes to seemingly reduce calorie and carb numbers.
Because people with type 2 diabetes are at an increased risk for cardiovascular disease, there’s a specific concern that the saturated fat in the diet may drive up LDL, or “bad,” cholesterol levels, and further increase the odds of heart problems. If you have type 2 diabetes, talk to your doctor before attempting a ketogenic diet. They may recommend a different weight-loss diet for you, like a reduced-calorie diet, to manage diabetes. Those with epilepsy should also consult their doctor before using this as part of their treatment plan.
Bonnie J. Brehm, Randy J. Seeley, Stephen R. Daniels, and David A. D’Alessio, “A Randomized Trial Comparing a Very Low Carbohydrate Diet and a Calorie-Restricted Low Fat Diet on Body Weight and Cardiovascular Risk Factors in Healthy Women,” The Journal of Clinical Endocrinology & Metabolism: Vol 88, No 4; January 14, 2009. http://press.endocrine.org/doi/full/10.1210/jc.2002-021480.
It can take many weeks for someone to notice differences. If you’re weight training and doing the diet you may not notice weight loss immediately because you are growing muscle and muscle is heavier than fat. Elsewise, for me I went really strict starting out. I did under 30 carbs a day for the first week and measured my ketone levels with the piss sticks you can buy at cvs and was entering ketosis after 3 days. I went up to 40 carbs a day for the next 3 months and lost 60lbs of fat. I was 287 lbs and weighed in at 227 when I finished. Mind you I exercised daily doing heavy weight training and intermediate cardio. The diet does work though. I did put on lean muscle while getting down to a healthy weight for my height. It helped with my panic disorder as well as giving me a lot of energy.
Cognitive Enhancement: Ketones may be the preferred fuel source for the brain. Due to the brain’s preference to uptake and utilize ketones as fuel it is very common for individuals to report an increase in cognitive performance. This is even more common in individuals with some degree of insulin resistance, as their brain is likely unable to effectively utilize glucose as a sole fuel source due to the resistance.
Fasting ketosis: Fasting ketosis, also referred to as starvation ketosis, played a major role in the development of the keto diet for beginners. The concept of fasting has been around for centuries and can be traced back to biblical times. By definition, fasting is the absence of caloric consumption for a period of time. This can range from several hours to several days and can have profound effects on the degree of ketosis. As the duration of the fasting increases, so does the production of ketones, and thus a deeper ketogenic state is obtained. As such, the mechanisms of ketone production are similar between fasting and dietary applications similar to keto diet for beginners, both of which result in lower and more stable levels of insulin and blood glucose accompanied by fat metabolism.
A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures. Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable. In the largest trial of the ketogenic diet with a non-diet control, nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.
The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with drug-resistant epilepsy. It is approved by national clinical guidelines in Scotland, England, and Wales and reimbursed by nearly all US insurance companies. Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet. About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults. A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.
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.
Alcoholic ketoacidosis (AKA): AKA is a ketone-producing state that may occur following excessive alcohol consumption for long periods of time. When alcohol is metabolized in the liver, ketones are produced. Furthermore, as with other ketogenic states, certain biological changes, specifically at the hormonal level, occur to promote fat metabolism and ketone production. It is critical to note that AKA will not occur if the alcohol consumption is coupled with sugar.
If you’ve decided to move forward in trying the keto diet, you will want to stick to the parameters of the eating plan. Roughly 60 to 80 percent of your calories will come from fats. That means you’ll eat meats, fats, and oils, and a very limited amount of nonstarchy vegetables, she says. (This is different from a traditional low-carb diet, as even fewer carbs are allowed on the keto diet.)
The first modern study of fasting as a treatment for epilepsy was in France in 1911. Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.
Electrolytes: Due to the increased water expulsion by the kidneys, many electrolytes are simultaneously lost. Electrolyte imbalances are heavily responsible for feeling the “keto-flu.” Important electrolytes one must consider replacing: sodium, potassium, and magnesium. These electrolytes can be replenished by increasing your intake of certain foods and/or supplementation.
You’re transitioning. Your body is equipped to process a high intake of carbs and a lower intake of fat. Your body needs to create enzymes to be able to do this. In the transitional period, the brain may run low on energy which can lead to grogginess, nausea, and headaches. If you’re having a large problem with this, you can choose to reduce carb intake gradually.
I have the same calories limit and macro. I easily stay within the limit but I completely stopped eating any type of bread, pasta, rice, potatoes and starchy food. I started using butter or coconut oil to cook and put mayo EVERYWHERE. It’s my new favourite topping for lettuce even XD. Then I eat plenty of eggs/meat/fatty fish and cheese. Olives are great as a snack. I cut out completely milk and use whipping cream instead. If you get into this completely counter intuitive way of thinking of food it’s super easy to get enough fat within the calorie limit.
^ Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, saccharin and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1). The eggnog may also be cooked to make a custard, or frozen to make ice cream.
^ Jump up to: a b c d e f g h i j k l m n o p q r s Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009 Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
You’ll quickly find that eggs are a staple for breakfast in low carb diets. Eggies are a simple solution for days of healthy breakfasts. Simply beat 8 eggs in a bowl, add in cheese and vegetables, and pour into muffin tins that have been lined with a strip of bacon. Cook at 350 for 30 minutes, or until a toothpick stuck in the middle comes out clean. Store in baggies for breakfast for up to 5 days.
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.
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.