- Last Updated on 14 December 2016
The ketogenic diet is a very specialized diet in which the vast majority calories come from fat, with only minimal carbohydrates and protein. This is considerably more extreme than the popular Atkins® diet. Ketogenic diet therapy must be coordinated with an experienced team including a neurologist, dietitian, and other support staff.
There is robust evidence in the scientific literature for treatment of epilepsy with the ketogenic diet, and limited but encouraging data supporting the treatment of infantile spasms, specifically. The ketogenic diet appears to be nearly as effective as prednisolone, ACTH, and vigabatrin, but it takes considerably longer to achieve a clinical response (several weeks to months). This delay in response is a major factor limiting its use. As such, it is not recommended as a first-line therapy, but should be strongly considered when first-line therapies fail.
Patients are carefully evaluated to determine whether they are candidates for the this diet therapy. It is crucial to verify that children do not have specific metabolic disorders related to the processing of fats (beta oxidation). Administration of the ketogenic diet to patients with specific metabolic disorders can be dangerous and even life-threatening.
Ketogenic diet therapy is generally started gradually over several days during an inpatient hospitalization, and then fine-tuned over weeks to months on an outpatient basis. The dose of the diet is generally indicated by the ratio of fat to non-fat constituents. Typical "ratios" range from 3:1 to 4:1, meaning that calories derived from fat generally range from 75 to 80% of total calories. Other tools to assess the strength of the diet include testing for the presence of ketones in the urine, and measurement of betahydroxybutyrate (BHB) in blood.
Like conventional medications, the ketogenic diet has numerous potential side-effects. Some of the more common side-effects include constipation, diarrhea, acidosis, kidney stones, and growth impairment, all of which are carefully addressed by specialized ketogenic diet teams.
This treatment should be administered only under the direct supervision of a physician.