Overview KD BethZK

Ketogenic Seminars ©2014
Beth Zupec-Kania, RDN, CD
Ketogenic Therapies 2016

Evolution of the KD
460 BC
Hippocrates:
Fasting used to
cure an epileptic
1000 AD
Biblical reference; Jesus
heals a possessed child
by fasting and prayer
1920
Starvation with reduced
seizures noted. KD
developed at Mayo
clinic
1960s
Post WWII emergence of
antiepileptic drugs
1990s
Charlie Foundation
“First Do No Harm”

2. Carbohydrate
3. Protein
1. Fat
Biological fuels on ketogenic diets
October 30 2015

From food to ATP

Carbohydrate: sugars
Carbohydrate: complex
Protein
Fat
1 hour 2 hours 3 hours 4 hours 5 hours
70
100
150
60
Glucose Curves on a High Carb Diet
GLUCOSE
LEVEL
Normal 4.4-6.7 mmol/L
Keto 3.5 – 5 mmol/L

1 hour 2 hours 3 hours 4 hours 5 hours
70
100
150
60
Glucose Curve, Ketogenic Diet
GLUCOSE
LEVEL
Carbohydrate: sugars
Carbohydrate: complex
Protein
Fat

Ketone Production
FASTING STATE
Liver During Fasting Conditions (Ketosis)

Biological Fuels
Carbohydrate
Protein
FAT = Ketogenic
= Anti-ketogenic

= 40kcal / dietary unit
25 x 4 = 100gm Fat
1000kcal ÷ 40kcal / dietary unit = 25 dietary units
X 4kcal = 4
X 9kcal = 36
Ketogenic Ratio 4:1
Fat Fat Fat Fat
Carb +
Protein

Ketogenic 4:1 100 17 8
3:1 97 18 14
2:1 91 20 26
1:1 77 38-58 20-40
Mod Atkins 1:1 72 52-62 10-20
LGIT 1:1 70 40-60 40-60
MCT Diet 1:1 78 25 50
Regular diet 0.2:1 33 35 140
Ratio gm Fat gm Pro gm Carb g
Comparison of 1000 kcal

Comparison of fast food meal with 4:1 meal
42 gm Fat
7 gm Protein
3 gm Carb
18 gm Fat
20 gm Protein
45 gm Carb

18
14.4
12.
8
FAT
1.27 1.5
0.3
0.0
PROTEIN
CARBOHYDRATE
5.5
1.5
0.4
Dissection of a 4:1 Ketogenic Meal

Ketogenic Meal
KetoDietCalculator.org

Keto Mac-n-Cheese, celery, tomatoes, cream float
Ketogenic Meal
Mac & Cheese
Celery sticks
Tomato
Root beer Cream
4:1
October 30 2015

Pepperoni
Pizza
3:1
October 30 2015
Ketogenic Meal

Ketogenic Food

Breakfast
Calories controlled
Equal energy distribution
Carb: Low glycemic foods
Low glycemic load
Protein adequate
Fat: main source of kcals
Ketogenic Diet
Lunch Supper Snack

Blender shakes:
Cream or coconut milk
Oils
Berries or cocoa
Protein powders
Flaxseed (fiber and omega-3 fat)
Chia seeds (protein and omega-3 fat)
Hemp seeds (protein and omega-3 fat)
Liquid Meals

Formulas

1 gram carb
Liquid medicines
1 tsp = 3-5gm carb
Carbohydrate from meds can disrupt ketosis
October 30 2015

Non-compliance or diet error
What could happen if
someone received more
carbohydrate than their
diet allows?
Seizures; receiving too
much carbohydrate can
negate ketosis and result
in loss of seizure control.
October 30 2015

Invert syrup
Lactose
Levulose
Maltodextrin
Maltose
Carbohydrate Additives
Corn syrup solids
Cornstarch
Dextrin
Dextrose
Disaccharide
Fructose
Glucose
Glycerin
High-fructose corn syrup
Mannitol
Molasses
Monosaccharide
Polydextrose
Propylene glycol
Polysaccharide
Sorbitol
Sorghum
Starch
Sucrose
Sugarcane
Syrup
Xylitol
Xylose

4 .5
5 .0
5 .5
6 .0
6 .5
7 .0
7 .5
J a n 2 0 0 5 A p r J u l O c t J a n 2 0 0 6 A p r J u l O c t
K e t o g e n i c D i e t B e t a H y d r o x y b u t y r a t e
mmol/L
F R E D E R IC K , R Y A N
K e to g e n ic D ie t B e ta H y d r o x y b u ty r a te ( m m o l/L )
Serum Glucose and BHB
7 Year Old Male 3:1 Diet Seizure-Free

Adenosine: Masino & Rho
Biological Fuels and Epilepsy

Ketogenic Diet Review for Epilepsy
• The Cochrane Collaboration reviewed 7 RCTs involving 427 patients for
evidence of efficacy and tolerability of KD in the treatment of epilepsy in
children.
• Reported rates of seizure freedom reached as high as 55% in a 4:1 KD
group after 3 months and reported rates of seizure reduction reached as
high as 85% in a 4:1 KD group after 3 months.
• Studies assessing the efficacy of the MAD (~1:1) reported seizure freedom
rates of up to 19% and seizure reduction of 60%.
• Adverse effects were fairly consistent across different dietary
interventions. The most commonly reported adverse events were GI
gastrointestinal symptoms.
Martin K, et al. Cochrane Database Syst Rev 2016;2:No. CD001903.

Landau-Kleffner syndrome
Lafora body disease
Rett syndrome
Glyogenosis type V
Subacute sclerosing
panencephalitis (SSPE)
Published evidence KD therapies benefit:
Glut-1DS
Pyruvate Dehydrogenase Def.
Infantile spasms
Doose syndrome
Dravet syndrome
Tuberosclerosis
Rett Syndrome
Lennox Gasteau
Mitochondrial disorders

Beta-oxidation defects
Carnitine deficiency
Porphyria
Pyruvate carboxylase deficiency
Relative Contraindications
Inability to maintain adequate nutrition
Surgical focus
Contraindications to the Keto Diet

Poor
control
Good control
Timeline of therapy for pediatric epilepsy
Re-evaluate at
1 month
• Fine tune diet
• Re-evaluate
at 2-3 months
• Consider
discontinuing
diet if no
improvement
Diet initiated over 3 days or several weeks
Re-evaluate at
3 months
Gradually taper
diet 2nd-3rd year
October 30 2015

All of these are can be prevented or minimized
Long term adverse effects – not significant
Potential Adverse Effects During Therapy
Constipation
Acidosis
Elevated lipids

The therapeutic efficiency of a KD in a broad variety of
diseases is mainly based on its ability to alter metabolism,
improve cell signaling and reduce inflammation.
Vidali S, et al. Internat J Bioch Cell Biol 2015;63:55-59.

Charlie with Jamie, Joseph, Nancy &
Jim Abrahams
Charlie at 5 years
eating his ketogenic diet
CharlieFoundation.org

Thank you to the Abrahams family !

Overview KD BethZK

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