Inspiration for this article developed from a recent dietetic training period at a French hospital. The opinions shared in this post are solely my own. The name of this hospital will remain anonymous, but I can attest in my professional and opinion that the health standards in this hospital (including hygiene, meals, nutritional care, patient satisfaction) were average to exemplary.
My first week on the training was going well. Day three would be another eye-opener, this time about children who suffer from epilepsy.
You can read other articles inspired from this training experience here:
Ketogenic Diet as a recognized treatment for epilepsy
One of my areas of empathy and passion in the nutrition field is working with and helping children. When the pediatric dietitian on my training turned to me and asked me what I knew about régime cétogène (ketogenic diet) to treat pediatric epilepsy, I had to admit,
(uhm…rien?) I knew nothing.
I did recognize the word keto or ketones, which translates from céto in French. Ketones are a type of energy that the brain uses when glucose is not available. (Our brain normally uses glucose to work and as a back-up can use ketones if glucose is not available. In diabetic persons there is a medical complication of high levels of ketones in the bloodstream in a state of insufficient insulin).
What I learned is that in some pediatric epileptic patients, diet alone (no medicines) can control epilepsy symptoms.
This diet is called a ketogenic diet or in French a régime cétogène.
At that moment in my training there was a 10-year-old boy with epilepsy being treated in the hospital with this ketogenic diet. The diet was working by allowing children to live symptoms free (or reduced symptoms) without the need for epileptic medicines.
I was intrigued. A disease controlled by strict diet alone?
Tell me more.
What are the facts about a ketogenic diet in children with epilepsy?
- First, and most important, this diet is not for every pediatric epileptic patient. Only a neurologist and/or pediatrician can correctly decide if your child’s epilepsy could benefit from a ketogenic diet.
- A pediatrician or neurologist plus a dietitian should monitor this strict high-fat diet for support, compliance and side-effects.
- A ketogenic diet is usually administered to children who are less than 12 years old.
- It is difficult diet to follow because the child must strictly abide by the diet food list.
What are the basic medical and diet guidelines for a ketogenic diet for children with epilepsy?
- Normally, at the hospital, the pediatric patient is admitted and is put on a two-day fast. The diet then begins under close medical supervision.
- The calories are set at 80-90% of the recommended daily allowance for the patient’s age. (see note about calories below)
- The diet is very high in fat: weight of fat to weight of protein and carbohydrate is 4:1
- Diet is very low in carbohydrate to prevent the brain from using glucose.
- The brain will use ketones for energy and the patient must check urine for ketones to be sure the diet is working.
- Dietary protein requirements are set at 1 gram/each kilogram of body weight.
- There are potential side effects such as kidney stones and weight loss which is why this diet should be administered via a doctor’s supervision.
- A dietitian role is very critical for the success of this diet because certain foods, medicines and creams can contain sugar-free ingredients which actually inhibit ketone production.
Why are calories for ketogenic diets set lower than the recommended daily guidelines?
Note from #2 above:
The calories for the diet are set to 80-90% of the recommended daily allowance for the patient’s age.
This diet is high in fat. Calories are based lower than the average daily allowance for a child their age to prevent weight gain from this high-fat diet. Calories are adjusted if the dietitian and doctor note that the child is losing weight (or excessively gaining weight). Fat in foods contain more energy (calories) than protein and carbohydrate (more than double calories per weight).
Call to action on using ketogenic diets for epilepsy
A ketogenic diets to control epilepsy is a well-established medical therapy. This diet allows the child’s epilepsy to be controlled without medication.
On the other side, a ketogenic diet requires a dedicated child and their family and a medical team that works together. A child following a ketogenic diet must be regularly monitored for weight, epileptic symptoms, medical side effects (such as kidney stones) and dietary compliance.
After twelve years old, the child can begin a modified Atkins Diet. More on that in a future article.
What do you think? Do you have experience with ketogenic or modified Atkins Diet? If you have a story please share it with us.
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