Ketogenic diet

The ketogenic diet is a type of eating plan in which a person consumes foods that are high in fat while limiting carbohydrates, proteins, and sugars. This diet helps people lose weight, but it also has other health benefits. It has been found to be beneficial in controlling epileptic seizures in some people when drugs do not help. The word ketogenic means "ketone producing." The ketogenic diet helps the body produce ketones when it uses fat stores instead of carbohydrates for energy. This process, known as ketosis, mimics starvation. The increased levels of ketones in the body help with weight loss and controlling seizures.

Background

The ketogenic diet was developed as a way to treat epilepsy in the early twentieth century. Epilepsy is a medical condition in which nerve cells in the brain are interrupted and cause seizures. Seizures can be mild or severe and cause behavior changes. Many people outgrow seizures during their lives.

Fasting (abstaining from food for certain periods) had been used successfully as an epilepsy therapy. This method was tested in France, where patients followed a low-calorie, plant-rich diet combined with fasting to counter the negative side effects of potassium bromide, which was prescribed to treat epilepsy at the time. Patients who took the drug and followed the diet had less impairment to their mental abilities than those who took the drug but did not adhere to the diet.

Around the same time, fasting became a popular way to control epileptic seizures in the United States. It was discovered that a toxin secreted in the intestine was responsible for causing seizures. Fasting for about twenty or so days helped the body rid itself of the toxin. In addition to fasting, a diet low in starchy and sugary foods was found to help epileptic patients.

Further research determined that the liver produced ketones when the body was in starvation mode due to fasting or from following a diet high in fat and low in carbohydrates. Mayo Clinic physician Russel Wilder named the ketogenic diet as a treatment for epileptic patients in 1921. It became a popular way to treat the condition, but it was soon replaced by drug therapy. New anticonvulsant drugs emerged that helped to control epileptic seizures, but these medicines were not effective in about 30 percent of people—especially children. For this group, physicians began to prescribe the ketogenic diet to manage epilepsy.

Scientists do not know exactly how the diet works to control—but not cure—epileptic seizures. They do know that ketones protect brain cells from being damaged. Scientists continued to research how ketones work and why they are important in controlling epilepsy into the twenty-first century.

How the Diet Works

When a person follows a regular diet (one that does not restrict or omit certain food groups), carbohydrates are converted into the sugar glucose. Cells in the body use glucose as an energy source, and the brain needs it to function properly. When the body has too little glucose in the bloodstream, the liver converts fats to a form of energy known as ketones and fatty acids. The body then uses the ketones as an energy source.

People who follow the ketogenic diet, also known as the long-chain triglyceride diet, eat a diet that is 70 to 90 percent fat. They eat three to four times as many fats as carbohydrates and proteins combined. A four-to-one ratio is normally used, but individuals who require more carbohydrates and proteins in their diets may use a three-to-one ratio. The body requires proteins for growth and repair, so a person should ensure that they are enough to maintain proper body function. Epileptics who follow the diet and do not wish to lose weight should ensure they eat enough calories to maintain a healthy weight. While the diet has yielded promising results in controlling both weight and seizures, it is very restrictive, which makes it difficult to follow.

The diet is usually started after a fast in which only water is consumed for about twenty-four hours. While fasting is not necessary, it does speed up ketosis. High-fat foods are then introduced slowly; unsaturated fats from plants and fish are considered better for long-term health than saturated fats like those from meat and dairy. Some of the foods allowed on the ketogenic diet include butter, cream, oils, nuts, seeds, meat, poultry, fish, eggs, and avocado. Dairy in the form of hard cheeses, full-fat milk, and yogurt can be consumed in limited amounts. Vegetables are restricted to leafy greens such as spinach and kale. High-carbohydrate vegetables, such as beets, carrots, corn, and potatoes, are not allowed. Neither are starches, grains, and any foods with added sugar, such as bread, legumes, pasta, rice, and cookies. Fruits and alcohol, which both contain high amounts of sugar, are to be avoided as well.

The ketogenic diet can cause several side effects, such as diminished appetite, constipation, dehydration, fractures, high cholesterol, kidney stones, nutrient deficiencies, stalled growth, and diabetic ketoacidosis. Initial symptoms of transition, known as "keto flu," may include fatigue, insomnia, digestive upset, achiness, and lightheadedness. People who menstruate may experience heavier or more painful periods while adjusting to a ketogenic diet, and those using hormonal birth control may have breakthrough bleeding. These initial symptoms usually disappear after several weeks or months of continuing to follow a ketogenic diet. People on a ketogenic diet usually need to supplement their diet with vitamins, calcium, and other minerals to ensure they are getting needed nutrients. They must also drink lots of water to stay properly hydrated. Without proper nutrition, the ketogenic diet can cause tooth and hair loss, fragile bones, and stunted growth. Pregnant people, those seeking to become pregnant, and those with a pancreatic or liver condition are cautioned against adopting the ketogenic diet. Physicians and dietitians typically monitor people who follow this diet, conducting blood and urine tests and measuring weight (and height for growing children) every few months. Dietitians adjust the diet as necessary.

People who use the ketogenic diet to control seizures usually follow this plan for about two years of being seizure-free. They may stop the diet sooner if they outgrow the seizures (common in about 60 percent of cases) or if the diet is too rigid and difficult to follow. A person must taper off the ketogenic diet gradually or risk seizures and other health effects.

Popularized by celebrities, the ketogenic diet has been touted as having a number of additional health benefits. Among these are greater mental clarity and recall, clearer skin, improved blood glucose control among diabetics, and reduced inflammation. However, weight loss and reduction of seizures are the only benefits of which there is substantial proof, in part because there have been few studies done on humans involving ketogenic diets outside of the context of epilepsy.

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