The ketogenic diet is used to treat drug-resistant epilepsy. But it has nothing to do with the keto diet that makes celebrities lose weight. You can’t just turn it on at home and see if it works. Its rules are strict to the point that it checks whether there is no sugar in toothpaste. Treatment is most often started in the hospital, where patients undergo monitoring of ketosis and acidification.
Fot. P. Werewka
– The ketogenic diet used in neurology is a form of treatment. It is extremely restrictive, allowing the patient to eat four units of fat per unit of protein, and 3:1 modifications are also allowed. This is the complete elimination of carbohydrates, so strictly observed that we check whether there is no sugar in the toothpaste. There are special preparations that help with this diet, e.g. powdered ones that can replace milk, and are almost pure fat with a bit of protein. The idea is that, to put it simply, the brain starts feeding on fat and not glucose – explains Prof. Maria Mazurkiewicz-Bełdzińska, head of the Department of Developmental Neurology at the Medical University of Gdańsk, head of the Department of Developmental Neurology at UCK, president of the Polish Society of Pediatric Neurologists.
The ketogenic diet is very effective in many cases. According to prof. Maria Mazurkiewicz-Bełdzińska has a huge anti-inflammatory potential, and yet a large number of epileptic seizures can cause an inflammatory reaction. Therefore, sometimes in case of a large number of attacks, steroid therapy is used, which also has an anti-inflammatory effect.
The expert assures that parents are willing to implement a ketogenic diet in their children because it is something they have influence and control over.
– Imagine the despair of a mother whose child has many epileptic seizures a day, is small, and is worried regarding his health, so she is willing to do something for him. In our clinic, we have training with dietitians and keto menus. There are also preparations available on the market that can help parents: keto cheese, cottage cheese. It is true that they have as much in common with cheese or cottage cheese as vegan kabanos has in common with kabanos. It is easier to maintain a diet in younger children because their menu may be slightly more modest, says Prof. Maria Mazurkiewicz-Bełdzińska.
The ketogenic diet is a high-fat, high-protein and low-carbohydrate diet that aims to switch the body to using fat as the main source of energy instead of glucose.
When do we talk regarding drug-resistant epilepsy?
Epilepsy is the most common disease of the central nervous system in children. In approximately 70 percent cases it is treated very effectively. In approximately 30 percent patients, despite the treatment, the attacks persist.
– If we use at least two appropriately selected therapies and they do not work, we can conclude that epilepsy is drug-resistant. Little patients with drug-resistant epilepsy are the most demanding for us. We want to achieve the best possible seizure control and the best possible quality of life. We do not want side effects to prevent everyday functioning. The ketogenic diet can be a very beneficial therapeutic option despite its strict rules – says Prof. Maria Mazurkiewicz-Bełdzińska.
And he assures that at the moment, good drugs are available for children with drug-resistant epilepsy, in addition to the ketogenic diet. Two new drug programs have been introduced.
– In Poland, we are not far behind the rest of the world. Several medicines are unavailable because the pharmaceutical companies producing them were not interested in entering the Polish market, but it is possible to import these medicines directly. The availability of surgical treatment for Polish patients with epilepsy is much worse. Preoperative diagnostics is failing, notes an expert from the Medical University of Gdańsk.
Data on the ketogenic diet
Only 11 percent Poles know that it is a non-pharmacological method of treating drug-resistant epilepsy. In regarding 75 percent patients, this disease manifests itself before the age of 19, and the largest number of cases are diagnosed already in infancy. Almost every third patient, despite the use of antiepileptic drugs, does not experience improvement in their health – the ketogenic diet is a chance for normal functioning for these people.
The composition of the ketogenic diet must be precisely and individually calculated for each patient, taking into account their age, body weight, physical activity and type of disease.
The ketogenic diet was first introduced in 1921 by American physician Dr. Russell Wilder as a way to reduce difficult-to-control epileptic seizures in children. It not only significantly reduces the number of epilepsy attacks – it also improves the functioning of patients and has a positive impact on the development of children. Today, many epileptologists treat it as one of the most effective non-pharmacological methods of treating drug-resistant epilepsy, and it is also used as the treatment of choice for metabolic diseases such as type I glucose transporter deficiency (GLUT1) and pyruvate dehydrogenase deficiency.
“In regarding 80 percent Patients using this method of therapy experience improved concentration and learning ability, better rehabilitation results, improved behavior and sleep quality. However, in approximately 30 percent Children on a ketogenic diet manage to stop taking antiepileptic drugs or significantly reduce them,” emphasizes Magdalena Dudzińska, M.D., Ph.D.
The ketogenic diet can be used by patients of all ages. It was once not recommended for infants. It was explained that the infancy period is critical in terms of neurological development, and this method of therapy may result in deficiencies of important nutrients. Meanwhile, the latest research results indicate that the ketogenic diet can be used even in premature babies. It is adapted to the needs of the constantly developing body, so that it is not deficient in protein, vitamins and minerals needed for the proper growth and development of the child.
High effectiveness of the ketogenic diet in the treatment of drug-resistant epilepsy
Studies on the effectiveness of ketogenic diet therapy in the treatment of drug-resistant epilepsy showed a complete absence of seizures in 55%. patients following three months of its use.
Meta-analyses on ketogenic diet therapy confirm these results, showing that:
- in adults: at least half of patients experience almost half as many seizures following 6 months of following a ketogenic diet;
- in children: more than half of those undergoing this therapy experienced a reduction in the number of seizures by more than 50%.
In 1/3 of patients, the reduction of seizures exceeded 90%, and in approximately 10-15%. the attacks stopped completely. Moreover, a significant improvement in functioning was observed in the majority (80%) of children, and in approximately 30%. it was possible to discontinue antiepileptic drugs.
Sources:
Statistical data, citation of research from the press release of the Nutricia Foundation
Opinion survey “Ketogenic diet as a treatment method” on 15-16/02/2022 by the SW Research research agency on a group of 1,025 Poles
Dudzińska M.: Ketogenic diet – when antiepileptic drugs do not help. PZWL.2015
Armeno M.L. i wsp. Use of ketogenic dietary therapy for drug resistant epilepsy in early infancy. Epilepsia open. September 23
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