Ketogenic diet

History of the origin

More than 100 years ago, it was discovered that children with epilepsy had fewer seizures when they fasted. To understand why this was the case, scientists studied the processes that take place in the body during fasting. Where the body can quickly obtain energy from burning carbohydrates (including sugars and starch) under normal circumstances, it is forced to use another source of energy during fasting, namely body fat. The process of burning fat releases substances into the blood, the so-called ketone bodies or ketones for short. The brain, which normally only uses glucose as fuel, appears to be able to use these ketones as an alternative fuel, which had a positive effect on the epileptic brain. Dr. Russell Wilder of the Mayo Clinic understood that by limiting the intake of carbohydrates (glucose) to a strict minimum and combining this with a high fat intake, the body, just like during fasting, switches to burning fat - but from food and not from the fat reserve - and therefore produces ketones.

Over the years, different forms of ketogenic diets have emerged, including the strict or classic ketogenic diet, the MCT diet, the modified ketogenic diet and the Modified Atkins diet or MAD. What they all have in common is a strong restriction of carbohydrate intake and a high(er) fat intake. The amount of proteins varies, depending on the form used and the individual needs. The doctor and dietician determine which diet form is suitable.

Not for everyone

The ketogenic diet may be a possible treatment option, but is not suitable for everyone. For metabolic disorders such as GLUT1 deficiency and Pyruvate dehydrogenase deficiency, this is a primary treatment therapy. Some epilepsy syndromes have a greater chance of seizure reduction than others. However, there are a number of contraindications that must be taken into account, such as lipid metabolism disorders or organ failure. The social and family situation must also be able to provide sufficient support for a diet that can be followed strictly.

For all ages

The ketogenic diet can be started in infants, children and adolescents as well as in adults. In children and adolescents, the ketogenic diet will be started during an average of 5 days in hospital. During this stay, the diet will be set and education will be provided. The intention is that after admission you will be able to independently prepare ketogenic meals according to the individual diet prescription. The ketogenic diet can be given as bottle feeding, solid food and as tube feeding.

Ketogenic diet start-up process

Before starting a ketogenic diet, you will visit a dietician and a metabolic physician. They will determine whether a ketogenic diet is suitable for you or not. Your dietary habits will be mapped out, whether there is sufficient support available to follow the ketogenic diet in practice, and some blood will be taken to rule out possible contraindications. Medication will be checked and should preferably be exchanged for sugar-free alternatives.

During admission or outpatient start-up, a meal is prepared every day in which the amount of fats increases daily and the carbohydrates decrease. A blood ketone meter is used to check whether ketones are formed. Once you produce sufficient ketones and you remain in a stable ketosis for 24 hours, your diet is set. You receive daily education. You learn, among other things, to read nutritional labels in function of the diet, calculate meals, measure ketones in urine and in blood, what to do if you produce too few or too many ketones.

Once your diet is set, you will be monitored regularly. You will have your first check-up with the doctor and dietician after about 1 month. After that, this will be every 3 months. In between, you can always contact the dietician with questions about the diet.