Function
The function of ketogenic diets is therapeutic—
improved control of seizures in children, adolescents,
and some adults with epilepsy; treatment of some
other rare metabolic disorders; and slowing the pro-
gression of such other diseases as amyotrophic lateral
sclerosis.
Benefits
The benefits of the ketogenic diet are improved
seizure control without the need for large doses of
anticonvulsant drugs with their associated side effects.
Patients who respond well to the diet are able to lead
more nearly normal lives.
Patients with amyotrophic lateral sclerosis or
other disorders being treated experimentally with a
ketogenic diet may benefit by having their disease
progress at a slower rate even when a cure is not
possible.
Precautions
The most important precaution to note is that the
ketogenic diet isnota do-it-yourself nutritional regi-
men. It is a serious form of therapy and requires care-
ful medical supervision as well as parental monitoring.
Patients on the diet must be followed by an experi-
enced treatment team, usually based in a specialized
epilepsy treatment center. Even though the diet may
seem like a more ‘‘natural’’ way to control seizures
than taking medications, it is based on a highly
unnatural selection of foods and forces the body to
obtain its necessary energy in an unusual way.
Another important precaution is preventing the
child from accidentally ingesting sugar in over-the-
counter medications, toothpastes, mouthwashes, or
similar products. A list of sugar-free products can be
found in PDF format on the Charlie Foundation
website.
Risks
Success rate
Not all patients respond to the ketogenic diet.
According to the Johns Hopkins treatment center, about
half the children who begin the classic ketogenic diet will
have at least a 50-percent reduction in seizures within
6 months. Half of that group will show greater than
90-percent improvement, with about 15% completely
seizure-free. Many families are able to taper or completely
eliminate the use of anticonvulsant medications.
As of the early 2000s, there is no way to predict
ahead of time whether a child will respond to the diet.
It is recommended that the child follow the diet for a
period of 2–6 months before deciding that it isn’t
working. Ineffectiveness is the single most common
reason for children’s discontinuing the diet, although
some discontinue it because they cannot tolerate the
foods allowed even after fine-tuning, or because of
side effects. The Johns Hopkins program reports that
about half the children who begin the ketogenic diet in
their treatment center are still using it a year later.
Side effects
Because the 4:1 ketogenic diet is an unnatural way
to obtain nutrition, it has some potential side effects.
Reported adverse effects in patients using the classic
ketogenic diet include:
Growth retardation caused by protein deficiency.
Vitamin and mineral deficiencies.
Nausea, vomiting, or constipation.
Abnormally high levels of blood lipids after discon-
tinuation of the diet.
Kidney stones or gallstones. Parents are taught to
monitor the child’s urine for blood as well as ketone
levels, because blood in the urine is often an early
sign of kidney stone formation.
More frequent infections due to a weakened immune
system.
Inflammation of the pancreas.
Dehydration.
Decreased bone density.
Menstrual irregularities (in adolescent and adult
females).
Research and general acceptance
The 4:1 ketogenic diet was the subject of a number
of longitudinal studies in the years immediately fol-
lowing Dr. Wilder’s initial case report in 1921.
Although research lagged in the years after World
War II, there has been a significant burst of interest
in the diet since the 1990s, with over 200 articles pub-
lished in the period between 1996 and 2006. As of early
2007, the National Institutes of Health (NIH) is
recruiting subjects for three clinical studies of the
effectiveness of the classic ketogenic diet and the modi-
fied Atkins diet in weight reduction as well as in the
management of epilepsy. The NIH recently completed
a double-blind study of the effectiveness of the keto-
genic diet compared to other forms of treatment in
children with epilepsy but has not released its findings
Ketogenic diets