Safety and Effectiveness of the Prolonged Treatment of Children with a Ketogenic Diet

Abstract

Background: The ketogenic diet (KD) is an effective treatment against drug-resistant epilepsy in children. The KD is a diet rich in fats that produces anticonvulsant and neuroprotective effects that reduces seizures and improves the cognitive state. Nevertheless, it can produce side effects that sometimes can be serious. Further, the effect on growth is quite controversial when used for an extended period of time. The aim of this paper was to assess the effectiveness, side effects, and repercussions in the development of children who have been treated with a KD for more than 2 years. Methods: Observational descriptive study of 26 pediatric patients on a KD, with data collection at baseline, at 3, 6, and 12 months, and then once a year. Number of seizures, type of seizures, anti-seizure drugs, anthropometry, side effects, and alterations in laboratory assessment were monitored. Results: In every assessment, about 60%–75% of the patients experienced a reduction in number of seizures of over 90%, and at least 50% experienced side effects, of which digestive issues, alteration in the lipid metabolism, and hypercalciuria were the most common. The KD significantly affected height after 2 years of treatment. Conclusions: The KD is an effective treatment for drug-resistant epilepsy. Its side effects, although common, are very mild; therefore, this constitutes a very safe treatment for children of all ages. More studies are needed to identify and prevent potential causes of growth retardation in children on the KD.

Classic Ketogenic Diet and Modified Atkins Diet in SLC2A1 Positive and Negative Patients with Suspected GLUT1 Deficiency Syndrome: A Single Center Analysis of 18 Cases

“…The decrease in growth may be reversed after patients are taken off the KDT [ 46 ], but KDT in GLUT1DS should be used life-long. Long-term treatment with KDT can significantly affect height, especially in those children who start the diet before the age of 2 years [ 47 ]. Ferraris and co-authors [ 43 ] retrospectively investigated the occurrence of linear growth retardation in 34 children on a KDT, 20 of them with GLUT1DS, of which 16 did not show growth retardation at 12 months.…”

Commentary: Consumer Reports of “Keto Flu” Associated With the Ketogenic Diet

“…At follow up appointments (between 2 and 16 months) some patients have reported infections (6)(7)(8)(9). Even during childhood, the KD is an efficient and safe treatment and side effects such as nausea or constipation are early onset and not frequent (10). Moreover, "Flu KD" is neither a MeSh term nor a keyword related with this area of research.…”

Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned

“…Adverse effects were not the main reason for the KD discontinuation, nearly half of the patients discontinued the diet because of lack of efficacy [139]. In fact, authors observing patients on KD for prolonged periods of time (over 2 years) state that KD is very safe, with mild side-effects, growth retardation remaining the main problem that needs to be overcome [147]. Of great concern is KDs effects that could have implications for the patients' long-term health, including atherosclerosis, osteoporosis, liver, and muscle dysfunction that need elucidation in the future.…”