Long‐term outcomes of children treated with the ketogenic diet in the past

Abstract

SUMMARYPurpose: The ketogenic diet has well-established shortand long-term outcomes for children with intractable epilepsy, but only for those actively receiving it. However, no information exists about its long-term effects years after it has been discontinued. Methods: Living subjects were identified who were treated at the Johns Hopkins Hospital with the ketogenic diet from November 1993 to December 2008 for ‡1 month, and had discontinued it ‡6 months prior to this study. Of 530 patients who were eligible, 254 were successfully contacted by phone or e-mail with a survey and request for laboratory studies. Results: Questionnaires were completed by 101 patients, with a median current age of 13 years (range 2-26 years). Median time since discontinuing the ketogenic diet was 6 years (range 0.8-14 years). Few (8%) still preferred to eat high fat foods. In comparison to the 52% responder rate (>50% seizure reduction) at ketogenic diet discontinuation, 79% were now similarly improved (p = 0.0001). Ninety-six percent would recommend the ketogenic diet to others, yet only 54% would have started it before trying anticonvulsants. Lipids were normal (mean total cholesterol 158 mg/dl), despite most being abnormal while on the ketogenic diet. The mean Z scores for those younger than age 18 years were )1.28 for height and )0.79 for weight. In those 18 years of age or older, the mean body mass index (BMI) was 22.2. Discussion: This is the first study to report on the longterm effects of the ketogenic diet after discontinuation. The majority of subjects are currently doing well with regard to health and seizure control.

Hyperlipidemia induces resistance to PTH bone anabolism in mice via oxidized lipids

“…Our findings of shortened bone length and matrix maturation in the skeletally immature mice on the HFD are consistent with previous reports that show that bone length and maturation are reduced in the offspring of pregnant mice fed a diet high in fat. (35) In addition, our findings are consistent with recent reports that show small size as well as decreased height in preadolescents and adolescents with hyperlipidemia, (36,37) supporting the need for further investigation into the regulatory mechanism of this phenomenon. Interestingly, changes in serum IGF-1 levels did not correspond with the changes in bone formation.…”

Ketosis may promote brain macroautophagy by activating Sirt1 and hypoxia-inducible factor-1

“…For example, the increase in brain capillary density evoked by three weeks of a ketogenic diet in rats could be expected to persist for some time after the diet is discontinued. It should also be noted that temporary ketogenic dieting has been reported to sometimes achieve a lasting remission of epilepsy [140,141]. It would be worthwhile to conduct studies to determine whether intermittent ketogenic dieting could exert worthwhile effects in rodent models of neurodegenerative disorders, and, if so, to determine the durations of ketogenic dieting and regular dieting that would be compatible with benefit.…”

Ketogenic diet guidelines for infants with refractory epilepsy

“…Long-term follow up of children treated with the KD in the past suggests that although growth does improve after the diet is discontinued, height gain can still be below expected [31]. Although growth retardation appears to be a problem in children on both classical and MCT KDs despite the latter providing a significantly higher protein intake [32], a prescribed protein-to-energy ratio of at least 1.5 g protein/100kcal has been suggested to help prevent growth faltering [33].…”