The Ketogenic Diet

The ketogenic diet is a high fat, low carbohydrate diet used to treat seizures. It is most often used for very difficult to control seizures (drug resistant epilepsy) where multiple medications have been tried and seizures continue. It is a medical treatment and requires the supervision of a specially trained dietitian and epileptologist.

The ketogenic diet changes the way our body uses energy – typically we get most of our energy from carbohydrates and sugar, but with the ketogenic diet, almost all of our energy comes from fat. When fat is broken down for energy, it produces ketones which can be detected in the blood and urine. Seizure control is directly related to the amount of ketones detected in urine and blood.

The ketogenic diet provides around 90% of calories from fat, including cream, butter and oil. The diet is low in carbohydrates, meaning that bread, potatoes, rice, cereal, crackers, pasta, cookies and candy are removed from the diet. Fruits and vegetables are eaten in limited amounts. The diet provides just enough protein, usually from eggs, lean meats, fish, poultry, and cheese.

The ketogenic diet is very restrictive and needs to be followed closely by a dietitian. Since the diet is so restrictive, vitamin and mineral supplementation is needed. All food is weighed on a gram scale and recipes are prepared carefully and accurately for the diet to work. It can be time consuming to prepare the diet. If food is eaten that is not part of the diet, a seizure could happen within a short period of time.

The ketogenic diet can have side effects, including vomiting, constipation, kidney stones, dehydration, high cholesterol, electrolyte changes, vitamin deficiencies, decreased bone density, changes in heart rhythm, and slowed growth. Speak to your Ketogenic Diet team to discuss all of the side effects and treatments.

To determine if the ketogenic diet is right for your child, they must first be referred to or followed by a neurologist at Children’s Hospital, LHSC. From there, your child would be assessed by the epileptologist and dietitian to determine if the diet would a good treatment option for your child (blood, urine and a heart test called an ECG is also done). If the diet is a good option for your child, you are taught how to prepare the diet and how to preform monitoring tests in a 3 hour teaching session with the dietitian. The diet is typically started as an outpatient (meaning your child is not admitted to the hospital). You work closely with the dietitian and the diet is progressively started over a 4-6 week period. It can take a few months to adjust the diet; we ask for a 3 month commitment to stay on the diet to see if it works; if it’s not helpful, it will be stopped. On average, it will cost between $450 -$500 to start the diet. This includes a scale for weighing food, monitoring supplies, and vitamin/mineral supplements. If you have private insurance, some of the monitoring supplies may be covered.

While on the ketogenic diet, there are regular clinic appointments with the Ketogenic Diet team, bloodwork, and other medical tests. Typically kids stay on the ketogenic diet for 2 years and then are slowly taken off the diet. For most kids, the positive effects of the diet will continue once the diet is stopped.

*There are modified ketogenic diets available that may be offered to your child in specific cases.

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