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Ketogenic Diet

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IS IT WORTHFUL

IS IT WORTHFUL


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  • 1. The Ketogenic Diet
  • 2. introduction
    • high-fat,
    • adequate protein,
    • lowcarbohydrate diet
    • used for the treatment of intractable childhood epilepsy since the 1920s.
  • 3. history
    • Jesus
    • Huge conklin -1921, water diet
    • Geyelin -1921,AMA convention
    • Phenytoin-1938
    • Charlie foundation-1992
  • 4. Conklin paper
  • 5. Mechanisms of action
  • 6. Mechanisms of action
    • Ketone bodies- GABA
    • Increased expression ofGlial fibrillary acidic protein( GFAP ) in dentate gyrus of hippocampus
    • Depressive effect on synoptic reorganisation
  • 7. Mechanisms of action
    • Calorie restriction alone has been demonstrated in mice to impair seizure susceptibility. this may activate ATP sensitive potassium channels that may critically be involved in the regulation of seizure activity.
  • 8. Indications
    • several epilepsy syndromes,
    • particularly in myoclonic astatic epilepsy, Dravets syndrome, and tuberous sclerosis
    • focal and generalised epilepsy
  • 9. s
  • 10. Calculation of the ketogenic diet
    • The ratio of fats to carbohydrates and protein is based on the age, size, weight and activity level of the patient.
    • A young child or infant often receives a 3 :1 diet to provide additional protein.
    • Older children will receive a 4:1 diet with the exception of obese children (3:1 ).
    • Adolescents will often be started on a 3 :1 diet
  • 11. Calculation of the ketogenic diet
    • Calories targeted at 75% of the recommended daily intake for age
    • overweight children may be given only 25-30% of the recommended calories until they approach their ideal body weight.
    • Fluids are targeted at 80% of daily needs
  • 12. Initiation of the ketogenic diet
  • 13. Maintaining ketosis
  • 14. Types of KD
    • Classic ,FAT:CHO+PRO-4:1
    • MCT oil ,3:1
    • Modified Atkins , 60% fat, 30% protein and 10% carbohydrate
  • 15. Ketogenic meals
  • 16. KD classic diet,1500 kcal
    • Breakfast : egg with bacon
    • 28 g egg, 11 g bacon, 37 g of 36% heavy whipping cream, 23 g butter, 9 g apple.
    • Snack : peanut butter ball
    • ,6 g peanut butter, 9 g butter.
    • Lunch : tuna salad ,
    • 28 g tuna fish, 30 g mayonnaise, 10 g celery, 36 g of 36% heavy whipping cream and 15 g lettuce.
    • Snack : keto yogurt
    • 18 g of 36% heavy whipping cream, 17 g sour cream, 4 g strawberries and artificial sweetener .
    • Dinner : cheeseburger
    • 22 g minced (ground) beef, 10 g American cheese , 26 g butter, 38 g cream, 10 g lettuce and 11 g green beans.
    • Snack : keto custard
    • 25 g of 36% heavy whipping cream, 9 g egg and pure vanilla flavouring
  • 17. KD LIQUID
  • 18. KD POWDER
  • 19.  
  • 20. Efficacy of the ketogenic diet at 3, 6 and 12 months, showing the percentage of children in each outcome category. From a prospective study of 150 children treated at Johns Hopkins Hospital
  • 21.   Seizure control at 6 months at 12 months Number initiating the diet: 150 over 90% 48 (31%) 41 (27%) 50-90% 29 (19%) 30 (20%) under 50% 29 (19%) 8 (5%) Number continuing the diet   106   (71%) 83 (55%)
  • 22. Cochrane review
    • In 2003, a Cochrane review of the published literature found there were no randomised controlled trials on the ketogenic diet.
    • The review concluded that there was "no reliable evidence from randomised controlled trials to support the use of ketogenic diets for people with epilepsy" and stated that the diet was merely " a possible option" in the treatment of intractable epilepsy
  • 23. Neurologists survey
    • A survey in 2005 of 88 paediatric neurologists in the US found that
    • 36% regularly prescribed the diet after three or more drugs had failed;
    • 24% occasionally prescribed the diet as a last resort ;
    • 24% had only prescribed the diet in a few rare cases ;
    • 16% had never prescribed the diet.
    • There are several possible explanations for this gap between the evidence and clinical practice
  • 24. efficacy
    • The first randomised controlled trial was published in 2008 , which had an intent-to-treat prospective design, but no blinding.
    • It studied 145 children , half of whom started the ketogenic diet immediately, and half after a three-month delay.
    • Of the children in the diet group , 38% had at least a 50% reduction in seizure frequency,
    • 7% had at least a 90% reduction ;
    • one child became seizure-free .
    • Only 6% of the control group saw a greater than 50% reduction in seizure frequency and no children had a 90% reduction .
    • The mean seizure frequency of the diet group fell by a third;
    • the control group's mean seizure frequency actually got worse
    • Neal EG, Chaffe HM, Schwartz RH et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol 2008;
  • 25. RCT contd
    • the ketogenic diet group were further randomised to receive either the MCT diet or the classical diet ; results showed there was no significant difference in the responder rates or mean reduction in seizure frequency between the two groups.
    • Neal EG, Chaffe HM, Schwartz RH et al. A randomised controlled trial of classical and medium chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2008;
  • 26. Side-effects
  • 27. nephrolithiasis
    • hypercalciuria occurs due to increased bone demineralisation with acidosis (bone phosphate acts as an acid buffer)
    • hypocitraturia, which normally helps to dissolve free calcium.
    • The urine has a low pH, which stops uric acid from dissolving, leading to crystals that act as a nidus for calcium stone formation.
    • Many institutions restrict fluids on the diet to 80% of normal daily needs
  • 28. Growth
    • growth velocity deviates more from the expected trajectory the longer an individual is on the diet, particularly in the young
    • Neal EG, Chaffe HM, Edwards N, Lawson M, Schwartz R, Cross JH. Growth of children on classical and medium chain triglyceride ketogenic diets. Pediatrics 2008 ;
  • 29. NON EPILEPTIC INDICATIONS
    • Case reports on two children indicate a possible use in treating astrocytomas ,
    • Autism, depression, migraine headaches, polycystic ovary syndrome , and type 2 diabetes mellitus have been shown to benefit in small case studies.
    • uncontrolled clinical trials and studies in animal models has shown that the ketogenic diet can provide symptomatic and disease-modifying activity in a broad range of neurodegenerative disorders including amyotrophic lateral sclerosis , Alzheimer’s disease and Parkinson’s disease , and may be protective in traumatic brain injury and stroke
    • As of 2008 [update] , there is not sufficient evidence to support the use of the ketogenic diet as a treatment for these conditions