5:1; these ratios are worked out by fine-tuning the diet
once the child has been started on it.
PREPARATION.The most important aspect of
preparation for the ketogenic diet is deciding whether
it will benefit the child. Most doctors prefer not to use
it if the child is taking medications that are effective in
controlling seizures without producing severe side
effects. If, however, the child has tried two or more
anticonvulsants without success, or is having serious
side effects from the drugs, the ketogenic diet offers a
chance to have a more normal life. It helps if the child
is not a fussy eater and is willing to try foods that he or
she might not ordinarily choose. The child also must
be capable of self-control, as eating only a few cookie
crumbs or anything else containing sugar (including
toothpaste and other oral care products), will break
the effect of the diet and possibly bring on a seizure.
Another important aspect of preparation is com-
mitment on the part of the entire family. It takes
considerable time and care to measure food portions,
test the child’s urine at home, watch for possible side
effects, and keep a balance between the needs of the
epileptic child and the food preferences of other family
members. Parties and holiday meals may require some
advice from the dietitian so that the child can have a
treat that won’t break the diet and will allow him or
her to enjoy the meal or party with other friends or
family members.
INITIAL FAST.The classic ketogenic diet begins
with placing the child on a 24- to 48-hour fast followed
by a stay of several days as a hospital inpatient, so that
his or her body fluids can be measured and possible
side effects monitored. The reason for the fast is to
force the body to exhaust its glucose supply and begin
burning stored fat for energy. The foods that are given
after the fast are intended to keep the process of fat
burning going by providing slightly fewer calories
than the body needs and providing 80% of those
calories in the form of fat.Prior to coming to the hospital, the child’s food
records are kept over a three-day period so that the
doctors will know the average daily calorie intake in
order to tailor the special diet to the child’s need for
growth. The goal is to maintain the child’sbody mass
indexat the 50th percentile. The amount of protein in
the diet is based on the child’s age, kidney function,
and stress factors. While the child is in the hospital, the
parents are given a four-day educational program to
help them understand the diet and give them practice
in preparing meals as well as monitoring the child.
The Johns Hopkins schedule for the child’s hos-
pital stay is as follows:
Sunday (night before admission): Child begins fast-
ing at home in the evening.
Day 1 (Monday): Child is admitted to the hospital;
fasting continues; fluid intake is restricted; and blood
glucose is monitored every 6 hours.Potential side effects of the Classic Ketogenic Diet
Abnormally high levels of blood lipids after discontinuing the diet
Decreased bone density
Dehydration
Growth retardation caused by protein deficiency
Inflammation of the pancreas
Kidney stones or gallstones
More frequent infections due to a weakened immune system
Nausea, vomiting, or constipation
Protein deficiency, causing growth retardation
Menstrual irregularities
Vitamin and mineral deficiency(Illustration by GGS Information Services/Thomson Gale.)KEY TERMS
Amyotrophic lateral sclerosis (ALS)—A rare pro-
gressive and eventually fatal disease affecting the
nerve cells that control movement. It is also known
as Lou Gehrig’s disease. As of the early 2000s, there
is some evidence that the ketogenic diet can slow
the progression of ALS.
Anticonvulsant—A drug given to prevent or control
seizures.
Double-blind study—A study in which neither the
researchers nor the subjects know the identity of
the persons in the experimental and control groups
during the course of the research.
Ketone bodies—A group of three compounds (ace-
toacetic acid, acetone, and beta-hydroxybutyric
acid) that are formed in an intermediate stage of
fat metabolism and excreted in the urine. Measur-
ing the level of ketone bodies in the urine of a
patient on the ketogenic diet is the primary way of
assessing the diet’s effectiveness.
Ketosis—An abnormally high level of ketone
bodies in the blood or urine, produced when the
body begins to burn fat for energy instead of glu-
cose (sugar).
Longitudinal study—A clinical study in which the
researchers follow the same group of patients over
a period of time. Most studies of the ketogenic diet
have been longitudinal studies.Ketogenic diets