Metabolic Effects of Three Ketogenic Diets in the Treatment of Severe Epilepsy

Schwartz, Ruby M.; Boyes, Stewart; Aynsley-Green, A

doi:10.1111/j.1469-8749.1989.tb03973.x

Cited by 106 publications

(44 citation statements)

References 15 publications

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“…This concurs with the results in healthy adults published by Musa-Veloso et al [12], where the time elapsed after each ketogenic meal revealed a significant negative effect on blood BHB and AA concentrations and that blood ketone bodies are rapidly metabolised for energy. Schwartz et al [24] obtained similar results and advise children with epilepsy to consume more frequent meals and snacks to keep blood ketone concentrations more stable and to avoid the acute rises and falls resulting from ketogenic meals. Some (≈40 %) of our subjects performed no additional physical activities, whereas the others engaged in activities of light to vigorous intensity, factors that may also influence temporary daytime fluctuations in blood and urinary ketones, as muscles consume this energy source rapidly [25].…”

Section: Discussionmentioning

confidence: 83%

Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?

Urbain

Bertz

2016

Nutr Metab (Lond)

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BackgroundThe ketogenic diet (KD) is a very low-carbohydrate, high-fat and adequate-protein diet with no calorie limit that induces a metabolic condition called “physiological ketosis”. It was first introduced to treat epilepsy in the 1920s and has become quite popular recently as weight-loss and performance-enhancing diet. Its therapeutic use in a range of diseases is under investigation. During KD interventions people are supposed to monitor compliance with the dietary regimen by daily urine testing for ketosis. However, there are no studies investigating the best time for testing.FindingsTwelve healthy subjects (37 ± 11 years; BMI = 23.0 ± 2.5 kg/m2) were instructed to, during the sixth week of a KD and with stable ketosis, measure their urine (8×) and blood (18×) ketone concentration at regular intervals during a 24-h period. According to their 1-day food record, the subjects consumed on average a diet with 74.3 ± 4.0 %, 19.5 ± 3.5 %, and 6.2 ± 2.0 % of total energy intake from fat, protein and carbohydrate, respectively. The lowest blood ß-hydroxybutyrate (BHB) (0.33 ± 0.17 mmol/l) and urine acetoacetate (AA) (0.46 ± 0.54 mmol/l) concentrations were measured at 10:00, respectively. The highest BHB (0.70 ± 0.62 mmol/l) and AA concentrations were noted at 03:00, respectively. Via urine testing the highest levels of ketosis were found at 22:00 and 03:00 and the highest detection rates (>90 %) for ketosis were at 07:00, 22:00 and 03:00, respectively.ConclusionsThese results indicate that ketonuria in subjects with stable ketosis is highest and can be most reliably detected in the early morning and post-dinner urine. Recommendations can be given regarding precise time of the day for measuring ketone bodies in urine in future studies with KDs.

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Section: Discussionmentioning

confidence: 83%

Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?

Urbain

Bertz

2016

Nutr Metab (Lond)

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“…It is associated with high mortality rates, low productivity, and cognitive loss 4 . There are a number of reports proving the efficacy of KD that ranges from 30 to 60% in different studies [5][6][7][8][9][10] . our results corroborate previous data, indicating that KD presents higher rates of efficacy than observed with use of several new generations AED 11 .…”

Section: Discussionmentioning

confidence: 99%

Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children

Freitas

Paz

Casella

et al. 2007

Arq. Neuro-Psiquiatr.

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Ketogenic diet (KD) is a high fat, low carbohydrate and adequate-protein diet, developed in the 1920's as an attempt to control refractory epilepsy, in an era when available antiepileptic drugs (AED), as well as their efficacy, were limited. There was a renewed interest in the 70s about KD, following a period of disuse during the 40's and 50's 1 . Several hypotheses have tried to explain the mechanism of action of KD. Some of these theories are: metabolic acidosis, extra and intra cellular dehydration, direct action of acetoacetate and b-hydroxybutyrate, and a shift of energy supply sources to the brain 2 . A recent study has shown that, despite advances in neuropharmacology and the development of a new generation of AED, KD remains as an important alternative therapy for epilepsy, especially in children 3 .This study analyzed the long term follow-up of a large series of children with refractory epilepsy who were consecutively enrolled, in the past 10 years, in the KD program of the Children's Institute of the University of São Paulo aiming to evaluate: (i) efficacy KETOGENIC dIET FOR THE TREATMENT OF REFRACTORY EPILEPSYA 10 year experience in children th month, 62.1% had E and 37.9% G. Antiepileptic drugs have been reduced, and generalized epilepsy was the most sensitive. Age-related differences were not observed. Adverse effects were rarely observed. In conclusion, KD proved to be an effective treatment for refractory epilepsy.KEy WoRDS: ketogenic diet, refractory epilepsy, children.Avaliação da dieta cetogênica no tratamento da epilepsia refratária em crianças: 10 anos de experiência RESUMo -A dieta cetogênica (DC) tem alto teor de gordura e baixo de carboidratos e proteínas, sendo usada no tratamento da epilepsia refratária. Analisamos os efeitos da DC em 54 crianças do Instituto da Criança da Universidade de São Paulo. Eficácia, tolerabilidade e efeitos adversos foram estudados. A DC foi considerada eficaz (E) quando houve redução de crises >75% e boa (B) quando a redução foi entre 50-75%. Correlacionamos, quando possível, esses resultados com a síndrome epiléptica e com a idade dos pacientes. observamos resultados (E) em 57,4%, 63,8%, 71,8% e 62,1% dos pacientes no 2º, 6º, 12º e 24º meses, respectivamente e (B) em 31,4%, 25,5%, 25,6% e 37,9%, respectivamente. Houve redução significativa das drogas antiepilépticas. A DC foi mais eficaz nas epilepsias generalizadas e não houve diferenças quanto a idade. Efeitos adversos foram raros. Em conclusão, a DC é um tratamento antiepiléptico eficaz em casos refratários.

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“…Although this diet is easier to prepare and produces greater ketosis (because the fats used, decanoic and octanoic acids, yield more ketones per calorie), it has not been widely accepted because it is associated with bloating and abdominal discomfort. A third variation on the diet, developed at the John Radcliffe Hospital in Oxford, England, represents a combination of the traditional and medium-chain triglyceride diets [8]. Despite some differences in their ability to generate ketones, all three diets have similar efficacy; the Hopkins protocol has been the most widely studied.…”

Section: Clinical Aspects Of the Ketogenic Diet Relevant To Its Mechamentioning

confidence: 99%

The Neuropharmacology of the Ketogenic Diet

Hartman

Gąsior

Vining

et al. 2007

Pediatric Neurology

280

169

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The ketogenic diet is a valuable therapeutic approach for epilepsy, one in which most clinical experience has been with children. Although the mechanism by which the diet protects against seizures is unknown, there is evidence that it causes effects on intermediary metabolism that influence the dynamics of the major inhibitory and excitatory neurotransmitter systems in brain. The pattern of protection of the ketogenic diet in animal models of seizures is distinct from that of other anticonvulsants, suggesting that it has a unique mechanism of action. During consumption of the ketogenic diet, marked alterations in brain energy metabolism occur, with ketone bodies partly replacing glucose as fuel. Whether these metabolic changes contribute to acute seizure protection is unclear; however, the ketone body acetone has anticonvulsant activity and could play a role in the seizure protection afforded by the diet. In addition to acute seizure protection, the ketogenic diet provides protection against the development of spontaneous recurrent seizures in models of chronic epilepsy, and it has neuroprotective properties in diverse models of neurodegenerative disease.

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Metabolic Effects of Three Ketogenic Diets in the Treatment of Severe Epilepsy

Cited by 106 publications

References 15 publications

Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?

Monitoring for compliance with a ketogenic diet: what is the best time of day to test for urinary ketosis?

Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children

The Neuropharmacology of the Ketogenic Diet

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