Ketogenic diet

The ketogenic diet is a low carbohydrate Limited, protein and calorie balance sheet and therefore the form of dietary -fat diet that mimics the starvation metabolism in certain aspects. In this type of diet the body gets its energy requirement is less fat and glucose, but only from fat and from built-on in the body glucose replacement, the eponymous ketone bodies. A ketogenic diet is used as a method of therapy, especially in children with drug-resistant epilepsy, glucose transporter malfunction ( for example, GLUT1 deficiency syndrome) and Pyruvatdehydrogenasemangel. You must be calculated individually and monitored by a physician. A non- medically indicated special form of ketogenic diet are low-carb diets such as the Atkins diet.

Effect

Proteins such as the various carbohydrates are converted into glucose to maintain blood sugar levels and thus to supply the brain with energy, especially in the metabolism approximately 50% and fats only about 10% ( ie their glycerol content ). In the fasting state, the body starts by taking on its glycogen stores ( a storage form of carbohydrates ) back and then turns increasingly on a hunger metabolism to. This is characterized, inter alia, that fatty acids are broken down in the liver to ketone bodies, the energy needs, especially of the brain ( which is otherwise dependent on glucose as the sole energy source) then, to cover efficiently in an alternative way. The target state is called ketosis.

Indications

In addition to patients with glucose transporter malfunction or Pyruvatdehydrogenasemangel may be considered in patients with epilepsy, in which so far more than two anticonvulsant medications have not worked enough and where surgical intervention is not an option, the use of the ketogenic diet. They can be applied to different types of seizures, epilepsy causes and age ranges through adolescence, but seems to lose the other side of about 8 to 12 years of age on efficacy and to be more difficult feasible. In infants less than one year it is also applicable, such as in children beyond the first year of life. Good individual case experiences there in the treatment of Rett syndrome, Landau - Kleffner syndrome and Ohtahara syndrome.

After potassium bromide ( 1857), and phenobarbital ( 1910), the ketogenic diet was first introduced in 1921 specifically as then third anticonvulsant therapy option. It had been observed that starvation in many epilepsy patients favorable effect on seizure situation and tried to combine the condition of the carbohydrate defect in starvation with sufficient fat and protein intake.

Calculation, implementation

For a ketogenic diet, the energy requirement ( 20-80 kcal / kg depending on age and metabolic rate ) is calculated and the protein requirement ( 0.7-2 g / kg depending on age) and then the " ketogenic ratio " (typically 3 - 4, 5: 1) fixed. The ketogenic ratio determines the weight ratio of fat to carbohydrates proteins. A ketogenic ratio of 4:1, for example, that food to 80% by weight shall consist of fats. In the remaining 20 % by weight of the need for a comprehensive amount of protein must be accommodated. Accordingly, carbohydrates may be included only in minimal amounts to maintain an effective ketosis. A ketosis due to a random defect induced carbohydrate is broken by the addition of small amounts of excess carbohydrate in a short time, which can lead to increased seizures again. This strict diet regime requires careful indication, some detailed knowledge and a close cooperation between the treatment team and patients, their caregivers (eg parents) and their social environment. The diet prescription must be repeated adjusted by the doctor on the progress and identifiable needs. The proper implementation of the diet must be monitored via the urine and / or Blutketose ( as in the blood glucose monitoring in diabetic patients similar).

MCT -based ketogenic diet

In the 1960s it was discovered that medium-chain triglycerides (English: MCTs ) produce more ketone bodies and thus more energy per unit in the body as long-chain triglycerides predominantly normal food fats. MCTs are also absorbed more efficiently and quickly transported to the liver via the (liver) portal vein instead of the lymphatic system. Advantage for patients of a ketogenic diet is the way to increase the volume fraction of the carbs a bit to use better tasting and better accepted so dishes can. About Stomach and intestinal problems however will be reported. In some American clinics, the MCT diet replaced the classic ketogenic diet, with some also more likely to use a mixture of both.

Side effects

Temporary side effects are mainly digestive and bowel problems. Moreover sometimes comes increased fatigue, especially in the first two weeks of the metabolic conversion before, during, often followed by a better alertness. In addition, before coming: refusal of food or hunger and related psychological problems, hypercholesterolemia ( conclusive long-term studies of this side effect does not exist, a ketogenic diet is not but with a " fat fattening " as equal, as the calories are limited). Rare to very rare are frequent infections, platelet dysfunction with bleeding, hypocalcemia and cardiac arrhythmias ( demaskiertes long QT syndrome). Occasionally, kidney stones before (regular exam on the Urinstix on blood). Certain unrecognized rare metabolic disorders (mainly defects of the Ketolyse and ketogenesis, fat loss disorders, carnitine deficiency syndromes, etc.) can suddenly and may decompensate life-threatening, so here an informed preliminary diagnostics / medical history and (stationary ) monitoring of the beginning in the initial phase of the ketogenic diet is necessary. Overall, the adverse event profile is slightly cheaper than in an intensive pharmacological anticonvulsant therapy.

According to a long-term study of the Johns Hopkins Children's Center, a long-term ketogenic diet does not lead to negative health side effects such as cardiac, circulatory, liver or kidney problems.