Ketogenic Diets and Epilepsy

 

What is a Ketogenic Diet?

A keto diet is well-known for being a low-carb diet, in which the body produces ketones in the liver to be used as energy. It’s referred to by many different names – ketogenic diet, low-carb diet, low-carb high-fat (LCHF), and so on. Though some of these other “names” have different standards, we’ll stick with the standards of keto.

When you eat something high in carbs, your body will produce glucose and insulin. Glucose is the easiest molecule for your body to convert and use as energy, so it will be chosen over any other energy source.

Insulin is produced to process the glucose in your bloodstream, by taking it around the body. Since the glucose is being used as a primary energy, your fats are not needed and are therefore stored. Typically, on a normal, higher carbohydrate diet, the body will use glucose as the main form of energy.

By lowering the intake of carbs, the body is induced into a state known as ketosis.

 

What is Ketosis?

When you eat carbohydrate-based foods or excess amounts of protein, your body will break this down into sugar – known as glucose. Why? Glucose is needed in the creation of ATP (an energy molecule), which is a fuel that is needed for the daily activities and maintenance inside our bodies. Glucose is also the main energy source for our brains.

Excess glucose is used in different ways. There are two main things that happen to glucose if your body doesn’t need it:

  • Glycogenesis – Excess glucose will be converted to glycogen and stored in your liver and muscles. Estimates show that only about half of your daily energy can be stored as glycogen.
  • Lipogenesis – If there’s already enough glycogen in your muscles and liver, any extra glucose will be converted into fats and stored.

Epilepsy

Epilepsy is a disturbance of the nervous system with recurrent seizures, loss of consciousness, convulsions, motor activity, or behavioural abnormalities. The seizures result from excessive neuronal discharges in the brain.

  • A grand mal seizure involves an aura, a tonic phase, and a clonic phase.
  • A petit mal seizure involves momentary loss of consciousness.
  • A single seizure does not imply epilepsy.

There are many forms of epilepsy, each with its own symptoms.

  • In two thirds of cases, no structural abnormality is found. Incidence is two to six in 1000 people.
  • Approximately 45,000 children under the age of 15 develop epilepsy each year, often those with cerebral palsy or spina bifida.

A ketogenic diet should be considered as treatment for epilepsy. Chronic ketosis modifies the TCA (tricarboxylic acid) cycle, increases GABA (gamma-Aminobutyric acid) synthesis in the brain, limits the formation of ROS (reactive oxygen species) and boosts energy production in brain tissue. All these changes stabilize synaptic function and increase the resistance to seizures throughout the brain.

  • In layman’s terms; the effects of chronic ketosis on the nervous system increases the body’s resistance to seizures.
  • The ketogenic diet is a low-carbohydrate, adequate protein, high-fat diet that biochemically mimics the fasting state and has been used to successfully treat seizures for 85 years.
  • MCTs are more ketogenic, having more rapid metabolism and absorption. MCTs provide 60% of kcal.
  • If the pure ketogenic diet is not tolerated, modify it with low–GI foods.

However, everything isn’t always easy and there are some risks and obstacles involved. Obstacles include:

  • Difficulty of compliance and acceptance.
  • The diet is/ may be unpalatable.
  • The diet follows a ratio of 3:1 or 4:1 of fats to carbohydrate and protein.
    • Diet may slow growth.
  • Stimulants such as tea, coffee, colas, and alcohol are not usually recommended with the ketogenic diet.
  • Numerous factors are affected by use of antiepileptic drugs: Bone health, altered hepatic cytochrome P-450 enzymes, decreased metabolism of vitamin D, resistance to parathyroid hormone, inhibition of calcitonin secretion, and impaired calcium absorption.
  • Supplements may be needed, especially calcium, vitamin D, folic acid, vitamins B6 and B12.
  • Add sufficient fibre and fluid for relief of constipation.

There are various benefits but also numerous obstacles that need to be taken into account when embarking on the lifestyle change of ketosis, especially for epilepsy patients. If making the change, please consult your physician and dietician for close by monitoring.

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