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Keto diet
The document discusses the ketogenic diet, which is a high-fat, low-carbohydrate diet used to treat intractable epilepsy. It aims to decrease seizures by putting the body into a state of ketosis. The diet has shown to be effective in reducing seizures in 38% of patients after 3 months compared to 6% of control patients. It can be implemented as a classical 4:1 or 3:1 ratio diet, or as a medium chain triglyceride diet, with no difference in efficacy between the two. Strict monitoring of growth, blood tests, seizures and ketone levels is needed when a patient is on the ketogenic diet.
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Keto diet
- 1. Md. Nahian Rahman M.Sc(Nutrition andFood Science) INFS,University of Dhaka.
- 2. It isa high fat, low carbohydrate and adequate protein diet used in the treatment of intractable epilepsy It aims to decrease the number and severity of the patients’ seizures Therefore improving the quality of life and hopefully reducing medication use What is the ketogenic diet?
- 3. Intractable childhoodepilepsy* *incomplete seizure control despite > 2 AED GLUT 1 deficiency syndrome PDH deficiency Consider as early treatment for myoclonic astatic epilepsy Age not a barrier but works well in younger children, e.g. under 10years Indications for use
- 4. Randomised controlledtrial at GOS 2008 150 patients After 3 months 38% had >50% seizure reduction compared with 6% in the control phase 7% had >90% reduction in seizures Efficacy
- 5. Study alsocompared the Classical and MCT (Medium Chain Triglyceride) diets Results showed no difference in efficacy or tolerability between the 2 diets after 3,6, and 12 months Those on the MCT version had a little more nausea Efficacy
- 6. Family agreeto a 3 month commitment period on the diet as there is a huge investment of professional time 3 months is the best time scale to determine outcomes Diet usually advised for up to 2 years Expectations from medical team and families need to be discussed to assist future monitoring Once selected
- 7. To achieveketosis by providing fat for metabolism To ensure that growth is adequate To ensure nutritional well being is not compromised To implement a dietary regimen that is palatable and possible to comply with The dietetic aims
- 8. Energy distribution froma normal diet: Normal diet Protein Fat Carbohydrate
- 9. Energy distribution froma classical ketogenic diet: Ketogenic diet Protein Fat Carbohydrate
- 10. Classical 4:1and 3:1 ratio i.e. Calorie controlled with 4 or 3 parts fat to 1 part protein and carbohydrate combined MCT diet (medium chain triglycerides) Calorie controlled 40-60% energy from MCT allows a little more flexibility but high MCT intake can lead to nausea Types of Ketogenic Diet
- 11. Modified Ketogenicdiet 60% fat 30% protein 10% CHO The carbohydrate intake is limited to approximately 20g per day Less strict still needs good knowledge of foods to choose Energy intake monitored for weight control Low Glycaemic Index (GI) diet Energy distribution as above but choice of foods with GI less than 50 typically high fibre foods Total carbohydrate load 40-60g per day Types of Ketogenic Diet
- 12. Protein lean meats small amount oflentils fish eggs Cheddar cheese small amount of nuts
- 13. Fatcream cheese double cream mayonnaise oils (e.g.olive oil, sunflower oil) avocado butter or margarine Liquigen Calogen
- 14.
- 15. Carbohydrate Sources of carbohydrateto avoid bread peaches sweets cake rice pasta chocolate biscuits sugar
- 16. F Example ofFoods
- 17.
- 18. KetoCal 4:1Multifibre For enteral feeding 200ml carton 300kcal 6.2gP 1.2gCarb 29.6gFat KetoCal 3:1 powder For enteral feeding Suitable from birth Products for the Ketogenic diet
- 19. Calogen 50%LCT fat CarbZero 20% LCT fat Liquigen 50% MCT fat Betaquik 20% MCT fat Vitamin and Minerals e.g. Fruitivits Phlexy Vits Supplementation Products
- 20. Growth: weight,height, and well being Bloods, urine other tests e.g. ECG, renal USS Record of seizures Record of ketosis -Blood use Abbott meter Freestyle Optium Neo (need lancets & ketone strips) aim 2-5mmol/l -Urine use Ketostix aim for (+2 to +4) or 8-16mmol/l Monitoring
- 21. Nausea Vomiting Hypoglycaemia Acidosis Sleepiness Dehydration Diet refusal Short term problems
- 22. Constipation Renalstones Abnormal lipid profile Growth Bone demineralization and fractures Long term problems
- 23. Rapid pantingor breathing Facial flushing, vomiting Irritability and unexpected tiredness Acidosis Blood ketone reading 6mmol/l or “Hi” with symptoms Treat with 1-2 tablespoons of sweet drink If no improvement after 15 minutes repeat and contact Dr Excess ketosis
- 24. If IVfluids needed use 0.9% saline 4 hourly blood glucose Avoid sugar and carbohydrate containing drugs and IV solutions Illness
- 25. Carnitine It isa protein which is necessary to carry fat into the mitochondria to be broken down to energy (ATP) KD high in fat therefore ↑need KD low in lysine + methionine needed to synthesize carnitine ↑Excretion of acylcarnitine with ketosis Other considerations
- 26.