Ketogenic Diets: They Are Not Just for Epilepsy Any More

In the treatment of epilepsy, the ketogenic diet is often described as a "big fat miracle." Over 100 hospitals in the United States and Canada offer a mostly-fat ketogenic diet as a treatment for intractable, drug-resistant seizure disorders, often with dramatic results. The story of 11-year-old Sam is a good example of how the diet works.

At the age of four, doctors believe, Sam had a mild case of meningitis. Shortly after he recovered from the infection, he began to have epileptic seizures. First he had just one or two seizures a day, but eventually he suffered as many as 150 a day, and was in constant danger of status epilepticus, a condition of non-stop seizures that often ends in death.

Nothing the doctors could prescribe for Sam worked for his epilepsy. A neurosurgeon even suggested that Sam's parents consider the surgical removal of half of his brain, when a diet-oriented neurologist suggested that they try ketogenic diet first.

The Anti-Epilepsy Fat-Added Diet

Ketogenic diets are eating plans that force the body to generate and burn ketones rather than glucose. The body can turn both carbohydrates and proteins (when eaten in excess) in the sugar glucose. When the diet is nearly 100% fat, however, it "burns" fatty acids by converting them into acetone (the same chemical found in nail polish remover), which is exhaled through the breath and excreted in the urine, and beta-hydroxybutyrate (which is, stricly speaking, not a ketone but a ketone derivative).

Sam's diet is a conventional nutritionist's nightmare:

• For breakfast, Sam eats scrambled eggs made with egg yolks and cream and cooked in olive oil, along with five slices of bacon.
• For lunch, Sam has whole-milk Greek yogurt, with no fruit flavoring and no sugar of any kind, mixed with coconut oil to add enough calories.
• For dinner, Sam has sausages (with no carbohydrate in the filler), hot dogs (without a bun), macadamia nuts, and hard cheese. He can also have bacon.

The food Sam eats contains twice as much fat as a Big Mac and 25% more fat than the low-carb phase of an Atkins diet. Sam consumes almost no carbohydrate. Cookies, candy, pies, cake, and macaroni and cheese are strictly forbidden. On special occasions, Sam is allowed to trade cookies or cake for a present instead. And managing Sam's health on the ketogenic diet is not easy.

See Also: Ketogenic Diet as Epilepsy Treatment

Complications of Ketogenic Eating

Initial adoption may result in the "keto flu" with symptoms like headache, dizziness, nausea, and fatigue. Prolonged adherence can lead to nutrient deficiencies due to carbohydrate restrictions, which in turn can cause a lack of essential vitamins and minerals like vitamin C, potassium, and magnesium.

Ketogenic diets are constipating. Kids and adults who eat high-fat have to take stool softeners--never fiber supplements, because they contain sugar and bacteria in the gut can release sugar from the fiber--to stay regular. If Sam does not drink enough water, he can easily develop kidney stones. And because Sam's diet is deficient in most minerals and most vitamins, taking a daily nutritional supplement is an absolute must. For treating conditions other than epilepsy, however, a little leeway in the ketogenic diet is possible.

The safety of the ketogenic diet during pregnancy remains unclear due to limited research, and there's a potential interaction with certain medications, especially for diabetes and high blood pressure.

Modified Ketogenic Diets for Weight Loss and General Health

High-fat, ketogenic diets tend to have what researchers call a "time lock." If you following a ketogenic diet to treat a condition that can occur basically at any time, such as daily attacks of epilepsy, then you need to stay on your diet all the time. If you are following a ketogenic diet to treat a condition that occurs less frequently, such as migraine headaches, then you may not need quite as strict a "time lock" on your metabolism. Always follow professional advice, of course, but you may have just a little more wiggle room in your food choices if you are using a ketogenic diet to treat migraine, cancer, depression, or obesity.

Advocates of ketogenic diet for other health concerns usually emphasize consuming the "right" fats, typically the triglycerides found in coconut oil.

What's special about coconut oil? And by this is meant fresh, "natural" coconut oil, not the highly processed, hydrogenated, commercially refined version of the product.

Coconut oil is especially rich in compounds known as medium-chain triglycerides, or MCTs. Even in small amounts, too small to cause a ketogenic effect, MCTs:

• Fight certain kinds of pathogenic microorganisms, such as yeast, fungi, certain kinds of parasites (especially giardia), certain kinds of viruses (HIV, herpes, and cytomegalovirus), and certain kinds of bacteria (such as E. coli, Chlamydia, and Salmonella) without harming probiotic or "friendly" bacteria.
• Serve as fuel rather than for fat storage. The liver can burn MCTs for its own energy needs as soon as they enter they body.
• Have neuroprotective properties. Emerging research suggests that ketone bodies might have neuroprotective effects. This means they could protect brain cells from damage, reducing the risk of seizures and potentially benefiting various other neurological conditions.
• Increase HDL ("good" cholesterol) as well as LDL ("bad" cholesterol), but more specifically the kind of LDL cholesterol that really is not "bad." MCTs cause the liver to make of the larger particles of LDL, the kind of LDL that does not get stuck in the linings of arteries. Although total LDL may go up when someone consumes massive amounts of coconut oil, risk of atherosclerosis does not.
• Enhance brain energy metabolism. Some forms of epilepsy are believed to result from altered brain energy metabolism. Ketone bodies, which are increased by MCTs, can provide an alternative and efficient source of energy for brain cells, potentially improving brain metabolism and reducing the risk of seizures.

Even if someone is not on a ketogenic diet, adding 1-2 tablespoons (15 to 30 ml) of coconut oil a day to daily food consumption can be beneficial to health. But how can someone get the benefits of a modified ketogenic diet without living on just coconut oil, bacon, hot dogs, eggs, cheese, and macadamia nuts?

• Unless your doctor or nutritionist tells you otherwise, it is not absolutely, positively necessary to eat zero carbohydrates. Up to 240 calories a day from all carbs, in total, still allows the body to produce protective ketone bodies. That 240 calories a day, however, includes the carbohydrate in vegetables and even fiber supplements.
• Fruit, unfortunately, needs to be avoided, as well as any added fructose (or high-fructose corn syrup) in any food. The liver can burn fructose without insulin, but when it does this, it uses ATP that it would otherwise use to make ketones.
• Give your body a break every day. Eat in an 8-hour window, and the rest of the time drink water or possibly some sugar-free electrolyte drinks (sorry, not even coconut water is recommended outside the 8 hours a day you eat).
• Eat lots of healthy plant fats. Up to 12 teaspoons (60 ml) a day of coconut oil is helpful.
• Avoid protein drinks and protein bars. Eat real food!

See Also: Ketamine May Offer Quick, Effective Relief For Major Depression

This approach to dieting is helpful for migraines, Crohn's disease, inflammatory bowel disease, mutliple sclerosis, Parkinson's disease, bipolar disorder, Alzheimer's, and, of course, weight loss. The effects can be dramatic, even if the diet is not followed perfectly. It's OK to eat some vegetables and some protein foods in addition to fat, if the diet excludes fructose and glucose and includes MCTs.