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Low Carb and Epilepsy

History of Ketogenic diets for epilepsy

A dietary approach for the treatment of epilepsy can be traced back to ancient Greece where the noted physician Hippocrates noticed that a man’s seizures were cured when abstaining from all food and drink. This was the first clue that food and drink could be linked to seizure control. However this connection was lost and it was not until the early 20th century that this link between fasting and seizure control was made again. At that time, fasting for up to 25 days was seen as a standard protocol to help individuals who suffered from epilepsy but, as you can imagine, being in a prolonged fasted state had its limitations both clinically and practically.

In 1921, it was first suggested that a diet that was low in carbohydrate but high in fat could help bring about the same benefits of fasting but without being so extreme. The first 3 patients with epilepsy that were prescribed this high fat, low carbohydrate diet reported significant seizure control. The 1920s and 30s saw various studies looking into the benefits of this dietary eating pattern for seizure control, however with the advent of the first anticonvulsant drugs to manage seizures at around the same period brought about a lack of interest into the dietary management of epilepsy. After all, the prospect of medication to help manage epilepsy was and still is, perceived as a simpler and possibly more appetising option than following a ketogenic diet. Today the interest in ketogenic diets as an alternative means of managing epilepsy is growing.

What is a Ketogenic Diet?

There are two types of diets that can trigger dietary ketosis: (i) fasting through starvation, the method traditionally used in the 20th century for epilepsy management, and those that trigger ketosis through (ii) carbohydrate restriction. This latter approach is a low carbohydrate (40-60g total carbohydrate daily), adequate protein, high fat diet which biochemically re-creates a fasting state but without the need for starvation.

Recent interest in the latter approach for epilepsy management saw resurgence in the late 1990s. Due to this there has seen a number of research efforts, both in the US and here in the UK at Great Ormond Street Hospital in London looking into the efficacy of ketogenic diets as a viable alternative treatment over anti-epileptic drugs (AEDs). What is also interesting is that over the past 20 years there have been various forms of the ketogenic diet that have been trialled both for efficacy and acceptability.

Types of Ketogenic Diets available

The ketogenic diet is no longer a one size-fits-all dietary prescription. Over the past 20 years there have been alternative ketogenic dietary prescriptions which have been shown to induce the same beneficial effects of the classical ketogenic diet or the medium-chain triglyceride diet. Most notably are the uses of the Modified Atkins Diet (MAD) as well as the Low Glycaemic Index Treatment (LGIT).

The aim of all of these dietary prescriptions is to promote a state of nutritional ketosis whereby the body switches from burning dietary sugar for energy to burning dietary fat for energy. When this happens, the body will start to metabolise a combination of dietary fatty acids and ketone bodies.

There have been various studies looking at the safety and efficacy of following this dietary prescription. The results have been very positive but it is important to consult with your team of specialists as they are best placed at advising according to your unique needs.

Illustration of the macronutrient ratios in place for the different ketogenic diet treatments:




How can a dietary prescription help with managing epilepsy?

The common aspect shared by these varied ketogenic approaches is that the major component is dietary fat but the underlying biochemical mechanisms that provide the clinical efficacy of the ketogenic diet seen in practice are not fully understood. However, the evidence currently suggests that the beneficial effects seen from a ketogenic diet are not directly linked to the effect of ketone bodies but rather stems from the shift to an increase in fatty acid metabolism.

Where does the Natural Low Carb Store fit into this?

All our products have been specially designed to ensure that they are low in sugar and starches. Due to this, they can be used to complement any ketogenic dietary prescriptions. Again we would advise discussing any changes to your diet with your care team.

References:

Bough, K. and Rho, J. (2007). Anticonvulsant mechanisms of the ketogenic diet. Epilepsia, 48(1), pp.43--58.

Clark, B. and House, F. (1978). Medium chain triglyceride oil ketogenic diets in the treatment of childhood epilepsy. International Journal of Food Sciences and Nutrition, 32(2), pp.111--116.

Hartman, A., Gasior, M., Vining, E. and Rogawski, M. (2007). The neuropharmacology of the ketogenic diet. Pediatric neurology, 36(5), pp.281--292.

Helmholz, H. (1927). THE TREATMENT OF EPILEPSY IN CHILDHOOD: FIVE YEARS'EXPERIENCE WITH THE KETOGENIC DIET. Journal of the American Medical Association, 88(26), pp.2028--2032.

Janigro, D. (1999). Blood--brain barrier, ion homeostasis and epilepsy: possible implications towards the understanding of ketogenic diet mechanisms. Epilepsy research, 37(3), pp.223--232.

Kossoff, E., Rowley, H., Sinha, S. and Vining, E. (2008). A prospective study of the modified Atkins diet for intractable epilepsy in adults. Epilepsia, 49(2), pp.316--319.

Kossoff, E., Zupec-Kania, B., Amark, P., Ballaban-Gil, K., Christina Bergqvist, A., Blackford, R., Buchhalter, J., Caraballo, R., Helen Cross, J., Dahlin, M. and others, (2009). Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study GroupEpilepsia, 50(2), pp.304--317.

Lord, K. and Magrath, G. (2010). Use of the ketogenic diet and dietary practices in the UK. Journal of human nutrition and dietetics, 23(2), pp.126--132.

Maalouf, M., Rho, J. and Mattson, M. (2009). The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies. Brain research reviews, 59(2), pp.293--315.

Neal, E., Chaffe, H., Schwartz, R., Lawson, M., Edwards, N., Fitzsimmons, G., Whitney, A. and Cross, J. (2008). The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. The Lancet Neurology, 7(6), pp.500--506.

Neal, E., Chaffe, H., Schwartz, R., Lawson, M., Edwards, N., Fitzsimmons, G., Whitney, A. and Cross, J. (2009). A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia, 50(5), pp.1109--1117.

Neal, E. (2012). Dietary treatment of epilepsy and other neurological disorders. 1st ed. Oxford: Wiley-Blackwell.

Peterman, M. (1924). The ketogenic diet in the treatment of epilepsy: a preliminary report. American journal of diseases of children, 28(1), pp.28--33.

Pfeifer, H. (2012). The Low Glycaemic Index Treatment. Dietary Treatment of Epilepsy: Practical Implementation of Ketogenic Therapy, pp.100--108.

Sills, M., Forsythe, W., Haidukewych, D., MacDonald, A. and Robinson, M. (1986). The medium chain triglyceride diet and intractable epilepsy. Archives of disease in childhood, 61(12), pp.1168--1172.

Yudkoff, M., Daikhin, Y., Horyn, O., Nissim, I. and Nissim, I. (2008). Ketosis and brain handling of glutamate, glutamine, and GABA. Epilepsia, 49(s8), pp.73--75.

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