Ketogenic diet – a boon for uncontrolled epilepsy

Epilepsy is a nervous system disorder caused by electrical disturbances in the brain leading to recurrent convulsions. Despite medical advances in the treatment of epilepsy, 20 to 30% of the cases fail to respond well to them. In these cases, a ketogenic diet has proved to be beneficial. A ketogenic diet, which mimics the fasting state of the body, is a high fat, low carbohydrate, and normal protein diet. This diet leads to a state of ketosis, a condition that results from excess accumulation of ketone bodies in the body.

The ketogenic diet has its origin in the observation that fasting reduces convulsions. Normally, the brain utilizes only glucose as a source of energy. However, during a ketogenic diet, carbohydrates are restricted and instead fat is used as the source of energy to the brain.

The liver has the ability to convert fatty acids to something known as ketone bodies. Ketones have the ability to pass through the blood brain barrier and serve as energy fuel to the brain. It is hypothesized that these ketone bodies are anticonvulsant in nature and thus help to control convulsions.

A patient goes on a typical Indian ketogenic diet in four phases. The first phase mainly involves a complete medical history that includes the personal information of the patient along with details about his or her diet. Anthropometric measurements are made and basic blood and urine tests are done.

The second phase, also known as carbohydrate “washout” phase, involves restricting carbohydrates so that the body switches from glucose to ketones as a source for energy. All cereals, pulses, dhals, fruits and fruit juices, sugar cane juice, cold drinks, sugar, jaggery, honey, sweets, chocolates, puddings, and cakes are omitted from the diet. Only high fat and high protein foods are allowed. There is no restriction on the quantity. Once the body attains ketosis (the person passes ketones in urine), the third phase is started.

The third phase involves the maintenance of ketosis with the help of ketogenic recipes. These are specialized recipes, which are calculated according to the ketogenic ratio and dietary unit quantity (DUQ). This is then followed by the fourth phase, which comprises regular follow-ups with the doctor and nutritionist so that fine tuning can be done wherever required. This diet may be continued till the convulsions stop completely and the EEG normalizes.

The ketogenic diet is advantageous because it uses simple foods that we eat in our day-to-day life. It is nominal in cost. Nothing needs to be imported, nor is there any danger of something being unavailable. Also, it is a better alternative then neurosurgery which is very expensive and at the same time involves a high risk. Ketone bodies produced naturally have anticonvulsant effects and control fits without many side-effects. Consequently, medications can be reduced or omitted.

Patients on this diet have been found to be more alert with better concentration and memory. If a person is not satisfied with this diet, he only needs to revert back to his original diet. However, there are few side-effects related to the metabolic changes that it induces. These include hypoglycemia, dehydration, constipation, and vitamin or mineral deficiencies. Hence, it is always advisable to drink plenty of water and take multivitamin tablets when on a ketogenic diet.

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