Ketonuria and Seizure Control in the Medium Chain Triglyceride and Classic Ketogenic Diets

Lowe, Helen; Keller, Anne; Tanzini, Elise; Aimola, Sabrina; Liu, Y M Christiana; Zak, Maria; Chan, Vivien; Kobayashi, Jeff; Donner, Elizabeth

doi:10.1017/cjn.2021.122

Cited by 5 publications

(9 citation statements)

References 11 publications

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“…In another study comparing the efficacy of the MAD and classic KD, blood β‐OHB levels did not correlate with seizure control in either group. Finally, Lowe et al 28 demonstrated that although patients receiving the MCT KD had lower urine ketones than those on the classic KD, seizure outcomes were similar.…”

Section: Does the Ketogenic Ratio And The Degree Of Ketosis Influence...mentioning

confidence: 99%

Does the ketogenic ratio matter when using ketogenic diet therapy in pediatric epilepsy?

et al. 2022

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The ketogenic diet (KD) is a widely used therapeutic option for individuals with medically refractory epilepsy. As the diet's name implies, ketosis is a historically important component of the diet, but it is not well understood how important ketosis is for seizure control. The ketogenic ratio is defined as the ratio of fat to carbohydrate plus protein by weight in the diet (grams). Traditionally, the classic KD contains a 4:1 ratio, and a very high proportion of fat in the diet. The classic KD, with its high proportion of fat and limited carbohydrate intake can be restrictive for patients with epilepsy. Recently, there is experience with use of lower ketogenic ratios and less-restrictive diets such as the modified Atkins diet and the low glycemic index treatment. In this narrative review, we examine the role of ketosis and ketogenic ratios in determining the efficacy of the KD in children with epilepsy. K E Y W O R D Sbeta hydroxybutyrate, drug-resistant epilepsy, ketone bodies, low glycemic index treatment, low ratio diets, modified Atkins diet

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Section: Does the Ketogenic Ratio And The Degree Of Ketosis Influence...mentioning

confidence: 99%

Does the ketogenic ratio matter when using ketogenic diet therapy in pediatric epilepsy?

et al. 2022

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“…In addition, there was a reduction in seizure frequency by 90% or more in 32 and 36% of patients in the CKD and MCTKD groups, respectively. Although the CKD group had higher urine ketones, the MCTKD group experienced similar seizure control despite lower urine ketone levels [19]. Studies in children with drug-resistant epilepsy on the ketogenic diet have indicated that ketosis can result in reducing brain's oxidative stress by increasing beta hydroxybutyrate and arachidonic acid [33].…”

Section: Indications For the Use Of Ketogenic Diet Therapy And The Ro...mentioning

confidence: 97%

“…The higher ketogenic potential of MCT provides a more liberal alternative to the classic ketogenic diet, paving the way to improving tolerability in patients on dietary therapy. This diet is prescribed as a percentage of macronutrients with total fat intake starting at 71% of total daily caloric intake, 40–50% of which is from MCT oil [19]. Similar results in seizure freedom when compared with the classic ketogenic diet are thought to result from a potential anticonvulsant effects of medium chain fatty acids such as caprylic acid and capric acid [19].…”

Section: Medium Chain Triglyceride Dietmentioning

confidence: 99%

“…diet are thought to result from a potential anticonvulsant effects of medium chain fatty acids such as caprylic acid and capric acid [19]. Due to gastrointestinal side effects associated with the traditional MCT diet, a modified MCT diet is used by most centers.…”

Section: Key Pointsmentioning

confidence: 99%

“…This diet is prescribed as a percentage of macronutrients with total fat intake starting at 71% of total daily caloric intake, 40–50% of which is from MCT oil [19]. Similar results in seizure freedom when compared with the classic ketogenic diet are thought to result from a potential anticonvulsant effects of medium chain fatty acids such as caprylic acid and capric acid [19]. Due to gastrointestinal side effects associated with the traditional MCT diet, a modified MCT diet is used by most centers.…”

Section: Medium Chain Triglyceride Dietmentioning

confidence: 99%

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Dietary carbohydrates in the management of epilepsy

Haridas

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewThe role of dietary carbohydrates in the management of epilepsy is intrinsically linked to the ketogenic diet. The ketogenic diet has been in use for well over a century now. There have been numerous adaptations to the diet. It is crucial to understand the indications and role of the ketogenic diet in the management of epilepsy.Recent findingsThere have been new studies that have looked at the role of ketogenic ratios in seizure control. In addition, there has been new evidence in the role of using the ketogenic diet therapy instead of antiseizure medications. These data highlight that the ketogenic diet should be tailored for patients and caregivers. When used appropriately, it can result in a significant improvement in seizure control as well as cognitive and developmental gains.SummaryThe ketogenic diet therapy has undergone numerous revisions and reiterations from its initial reported use in patients a century ago. This has enabled us to tailor the diet specific to each patient's underlying diagnosis.

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Case for supporting astrocyte energetics in glucose transporter 1 deficiency syndrome

Xu,

Borges

2024

Epilepsia

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In glucose transporter 1 deficiency syndrome (Glut1DS), glucose transport into brain is reduced due to impaired Glut1 function in endothelial cells at the blood–brain barrier. This can lead to shortages of glucose in brain and is thought to contribute to seizures. Ketogenic diets are the first‐line treatment and, among many beneficial effects, provide auxiliary fuel in the form of ketone bodies that are largely metabolized by neurons. However, Glut1 is also the main glucose transporter in astrocytes. Here, we review data indicating that glucose shortage may also impact astrocytes in addition to neurons and discuss the expected negative biochemical consequences of compromised astrocytic glucose transport for neurons. Based on these effects, auxiliary fuels are needed for both cell types and adding medium chain triglycerides (MCTs) to ketogenic diets is a biochemically superior treatment for Glut1DS compared to classical ketogenic diets. MCTs provide medium chain fatty acids (MCFAs), which are largely metabolized by astrocytes and not neurons. MCFAs supply energy and contribute carbons for glutamine and γ‐aminobutyric acid synthesis, and decanoic acid can also block α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid glutamate receptors. MCTs do not compete with metabolism of ketone bodies mostly occurring in neurons. Triheptanoin, an anaplerotic but also gluconeogenic uneven MCT, may be another potential addition to ketogenic diets, although maintenance of “ketosis” can be difficult. Gene therapy has also targeted both endothelial cells and astrocytes. Other approaches to increase fuel delivery to the brain currently investigated include exchange of Glut1DS erythrocytes with healthy cells, infusion of lactate, and pharmacological improvement of glucose transport. In conclusion, although it remains difficult to assess impaired astrocytic energy metabolism in vivo, astrocytic energy needs are most likely not met by ketogenic diets in Glut1DS. Thus, we propose prospective studies including monitoring of blood MCFA levels to find optimal doses for add‐on MCT to ketogenic diets and assessing of short‐ and long‐term outcomes.

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Ketonuria and Seizure Control in the Medium Chain Triglyceride and Classic Ketogenic Diets

Cited by 5 publications

References 11 publications

Does the ketogenic ratio matter when using ketogenic diet therapy in pediatric epilepsy?

Does the ketogenic ratio matter when using ketogenic diet therapy in pediatric epilepsy?

Dietary carbohydrates in the management of epilepsy

Case for supporting astrocyte energetics in glucose transporter 1 deficiency syndrome

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