The effect of the classical and medium chain triglyceride ketogenic diet on vitamin and mineral levels

Abstract

Changes in plasma vitamins A and E and the decline in magnesium status after 12months of KD treatment suggest that micronutrient status may be suboptimal in this group and that available formulations for KD supplementation may need reviewing.

Ketogenic diet guidelines for infants with refractory epilepsy

“…Vitamin C deficiency has been reported in one child on the KD [38] but plasma levels of fat soluble vitamins A and E can often be raised as a consequence of a high fat intake [23]. A fall in carnitine status of children and young adults during the first few months of the KD has been seen with some cases requiring supplementation [39], although levels tended to normalise with time on diet therapy.…”

“…Hypomagnesaemia has also been seen [25], and may be a particular problem in children on the classical KD despite micronutrient supplementation [23].…”

“…The classical KD contains insufficient micronutrients [23,24] The potential presence of absorbable / resorbable carbohydrate in vitamin/mineral supplements however should not be overlooked. It is known that various anticonvulsants have interactions with some minerals and vitamins, for example, influencing the absorption of folic acid and the metabolism of calcium and vitamin D [22].…”

Recomendaciones para el manejo clínico pediátrico de la dieta cetogénica en el tratamiento de la epilepsia refractaria

“…20,21 En esta etapa, también pueden aparecer alteraciones metabólicas, como acidosis, hipokalemia, hipomagnesemia, déficit de carnitina (principalmente, en pacientes que reciben ácido valproico), anemia y deficiencias de elementos traza, como el selenio, el cobre y otros. 10,18 Todas estas últimas manifestaciones deben ser evitadas a través de un monitoreo estricto con el suplemento adecuado de micronutrientes.…”

Recommendations for the clinical management of children with refractory epilepsy receiving the ketogenic diet

“…1,2 The classical ketogenic diet lacks in minerals and vitamins 3,10 due to the little variability in macronutrient offered by this treatment; therefore, patients on this diet should always use supplements with carbohydrate-free formulations ( Table 4). It is especially important to administer calcium supplements because these children have a risk of developing osteopenia and osteoporosis due to the long-term use of anticonvulsant agents and metabolic acidosis with compensatory hypercalciuria generated by the diet.…”