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Tuesday, 25 July 2017
Medical Team Required to Effectively Implement the Ketogenic Diet
As indicated in the previous article on side effects, the
Ketogenic diet must be initiated in a hospital environment to monitor and
effectively manage any adverse effects.
The Ketogenic Diet is Medical Nutrition Therapy and requires
a well-trained team to effectively implement. A Registered Paediatric Dietitian who
coordinates the diet programme, a Paediatric Neurologist who
is experienced in administering the ketogenic diet, a Registered Nurse, a Pharmacist who
can advise on the carbohydrate content of medicines to inform the Dietitian
when planning the diet ratio and a
Medical Social Worker who works with the family and does follow-up on
implementation. The patient and other caregivers must be educated in many
aspects of the diet for it to be safely implemented.
Indications, Contraindications and Side effects of the Ketogenic Diet
Indications
The Ketogenic diet is highly recommended for children with
uncontrolled or drug-resistant epilepsy and other neurological conditions. More research into the diet has indicated that
it could also be used to effectively manage other conditions, as indicated in
the follow-up articles. The diet should be introduced in a controlled setting,
preferably the hospital.
The Ketogenic Diet is approved by
national clinical guidelines in Scotland,[1] England and Wales[2] and reimbursed by nearly all
US insurance companies.[3] Kenya is however
quite behind in Clinical Nutrition, more so research and Medical Nutrition
Therapy, therefore the diet is not widely used in our country.
A liquid form of the ketogenic
diet is well tolerated by, infants on formula and children who are tube-fed.[4][5]
Advocates for the diet recommend
that it be seriously considered after two medications have failed, as the
chance of other drugs succeeding is only 10%.[6][7][8] The diet can be considered earlier for some epilepsy and genetic
syndromes where it has shown particular usefulness. These include Dravet
syndrome, infantile spasms, myoclonic-astatic
epilepsy and tuberous
sclerosis complex.[6][9]
The ketogenic diet alters the
body's metabolism, therefore it is a first-line
therapy in children with
certain congenital metabolic diseases such as pyruvate dehydrogenase (E1) deficiency and glucose
transporter 1 deficiency syndrome, which prevent the body from using carbohydrates as fuel, leading to a
dependency on ketone bodies. The ketogenic diet is beneficial in treating the
seizures and some other symptoms in these diseases.[13]
Contraindications
On the other hand, it is
absolutely contraindicated in the treatment of other diseases such as pyruvate carboxylase deficiency, porphyria and other rare genetic disorders of fat metabolism.[6]A person with a disorder of fatty acid oxidation is unable to metabolize
fatty acids, which replace carbohydrates as the major energy source on the
diet. On the ketogenic diet, their body would consume its own protein stores
for fuel, leading to ketoacidosis, and eventually coma and death.
Side
Effects
As we mentioned in the introductory article, the Ketogenic
diet/Keto-diet uses fats as the main energy source. Any drastic change from
using carbohydrates for energy to fat results in various side effects as the
body moves into a state of ketosis.
The side effects however occur during the initial stages as
the body adapts to the diet. The side effects are generally less severe and less frequent than with anticonvulsant
medication or surgery.
Common side effects include;
i.
Lethargy or lack of energy in the initial stages as
the body gets into a state of Ketosis.
ii.
Increased hunger, especially when the diet is
drastically introduced. To counter this, the Nutritionist should gradually
introduce the diet.
iii.
Decreased mental function
iv.
Nausea
v.
Stomach discomfort
vi.
Keto-breath
vii.
Sleep issues
viii.
A fruity urine smell. This is usually due to excretion
byproducts of the ketosis process
ix.
Some people experience digestion issues such as
constipation or diarrhea in the first 1 or 2 weeks. However this side effect
subsides once the body adjusts to the diet. If the problems persist, the
Nutritionist may look into increasing the fibre content in the diet and
prescribe Probiotics to improve the gastrointestinal system health.
x.
Depending on the type of fats included in the diet,
the blood lipids and cholesterol levels may be elevated. This can be averted by
choosing unsaturated fats. If it persists, the Ketogenic ratio can be changed,
to decrease the fat content.
xi.
Low Micronutrient intake. This can be solved by the
Nutritionist/Dietitian prescribing a Nutritional Supplement that covers the
deficit in Micronutrients.
xii.
Long-term use
of the ketogenic diet in children increases the risk of slowed or stunted
growth, bone fractures and kidney stones.
xiii.
The ketogenic diet
reduces levels of insulin-like growth factor 1 (IGF-1), which is important for childhood growth.
xiv.
The ketogenic
diet like many anticonvulsant drugs has an adverse effect on bone health. Many
factors may be involved such as acidosis and suppressed growth hormone.
xv.
About 1 in 20
children on the ketogenic diet will develop kidney stones (compared with one in
several thousand for the general population). Kidney stones are treatable and do not justify
discontinuation of the diet. Johns Hopkins Hospital gives oral potassium citrate supplements to all ketogenic diet patients,
resulting in a sevenfold decrease in the incidence of kidney stones.[16]
In order to minimize negative effects and ease your body into
the Ketogenic diet, the Nutritionist/Dietitian can start with a low Glycemic
Index diet, or the Atkins diet, which is a high protein, moderate fat, low
carbohydrate diet. The Nutritionist will then gradually increase the fat
content and decrease carbohydrates.
All three diets; the Ketogenic, Atkins and Low Glycemic Diet
MUST be prescribed by a qualified Dietitian/Nutritionist and both the patient
and diet reviewed frequently.
It is important to note that the Keto diet usually causes
weight loss. For weight lifters, muscle builders and athletes, it is important
to work closely with your Nutritionist/Dietitian to monitor protein intake, in
order to prevent muscle loss.
The ketogenic diet, more so the standard Keto diet is low in
Micro-Nutrients, therefore it is necessary to supplement. Your Nutritionist
should advice on whether and how you can include vegetables low in carbohydrates/Glycemic
Load in your meal plan to increase micronutrient intake.
Please note that the Ketogenic diet requires medical
supervision, to avert and effectively manage any side effects. Therefore the
diet needs to be initiated in a hospital setting.
References
1. Scottish
Intercollegiate Guidelines Network. Guideline 81, Diagnosis and management of
epilepsies in children and young people. A national clinical guideline(PDF).
Edinburgh: Royal College of Physicians; 2005. ISBN 1-899893-24-5.
2. Stokes T, Shaw
EJ, Juarez-Garcia A, Camosso-Stefinovic J, Baker R. The diagnosis and management of the
epilepsies in adults and children in primary and secondary care.(PDF). London:
Royal College of General Practitioners; 2004. ISBN 1-84257-808-1.
3. Turner Z,
Kossoff EH. The ketogenic and Atkins diets:
recipes for seizure control (PDF). Pract Gastroenterol.
2006 Jun;29(6):53, 56, 58, 61–2, 64.
4. Zupec-Kania BA,
Spellman E. An overview of the ketogenic diet for pediatric epilepsy. Nutr Clin
Pract. 2008 Dec–2009 Jan;23(6):589–96.doi:10.1177/0884533608326138. PMID 19033218
5. Kossoff EH,
McGrogan JR, Freeman JM. Benefits of an all-liquid ketogenic diet. Epilepsia.
2004 Sep;45(9):1163. doi:10.1111/j.0013-9580.2004.18504.x. PMID 15329084.
6. Kossoff EH,
Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et
al. Optimal clinical management of
children receiving the ketogenic diet: recommendations of the International
Ketogenic Diet Study Group.Epilepsia. 2009
Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
7. Kossoff EH,
Freeman JM. The ketogenic diet—the physician's perspective. In: Stafstrom CE,
Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004.
p. 53–61. ISBN 1-58829-295-9.
9. Wang S, Fallah
A. Optimal management of seizures associated
with tuberous sclerosis complex: current and emerging options. Neuropsychiatr
Dis Treat. 2014 Oct 23;10:2021-30. doi:10.2147/NDT.S51789. PMID 25364257
10. Mastriani KS,
Williams VC, Hulsey TC, Wheless JW, Maria BL. Evidence-based versus reported
epilepsy management practices. J Child Neurol. 2008 Feb 15;23(5):507–14.doi:10.1177/0883073807309785. PMID 18281618
11. Stafstrom CE,
Rho JM. The ketogenic diet as a treatment
paradigm for diverse neurological disorders. Front
Pharmacol. 2012;3:59. doi:10.3389/fphar.2012.00059.PMID 22509165.
12. Gasior M,
Rogawski MA, Hartman AL. Neuroprotective and disease-modifying
effects of the ketogenic diet. Behav Pharmacol.
2006;17(5–6):431–9. PMID 16940764
13. Huffman J,
Kossoff EH. State of the ketogenic diet(s) in epilepsy (PDF).
Curr Neurol Neurosci Rep. 2006 Jul;6(4):332–40. PMID 16822355
14. Zupec-Kania B,
Werner RR, Zupanc ML. Clinical Use of the Ketogenic Diet—The Dietitian's Role.
In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa:
Humana Press; 2004. p. 63–81. ISBN 1-58829-295-9.
15. Kossoff EH, Zupec-Kania
BA, Rho JM. Ketogenic diets: an update for child neurologists. J Child Neurol.
2009 Aug;24(8):979–88.doi:10.1177/0883073809337162. PMID 19535814
16. McNally MA,
Pyzik PL, Rubenstein JE, Hamdy RF, Kossoff EH. Empiric use of potassium citrate
reduces kidney-stone incidence with the ketogenic diet. Pediatrics. 2009
Aug;124(2):e300–4. doi:10.1542/peds.2009-0217. PMID 19596731
Monday, 24 July 2017
Ketogenic Diet’s Health Benefits (Keto Diet)
The Ketogenic diet is actually one of the most researched
diets, and numerous studies now indicate that this is not another fad diet. For
the Ketogenic diet to work effectively, all food high in carbohydrate must be
avoided and the total carbs intake calculated, including from medicine and
supplements sources.
Studies have shown that the Principles used in the Keto diet can
be used in the management of the following medical conditions;
I.
Cardiovascular/Heart diseases: The keto
diet can improve risk factors like body fat, HDL levels, blood pressure and
blood sugar (32, 33).
II.
Cancer: The diet is currently being used
to treat several types of cancer and slow tumor growth (4,
34, 35, 36).
III.
Alzheimer’s disease: The diet may reduce
symptoms of Alzheimer’s and slow down the disease’s progression (5,
37, 38).
IV.
Epilepsy: Research has shown that the
ketogenic diet can cause massive reductions in seizures in epileptic children (3).
V.
Parkinson’s disease: One study found that the
diet helped improve symptoms of Parkinson’s disease (39).
VI.
Polycystic ovary syndrome: The
ketogenic diet can help reduce insulin levels, which may play a key role in polycystic
ovary syndrome (40).
VII.
Brain injuries: One animal study found that the
diet can reduce concussions and aid recovery after brain injury (41).
VIII.
Acne: Lower insulin levels and eating
less sugar and processed foods may help improve acne (42).
I must emphasize that as much as the Keto diet is a high fat
diet, the dietary fat sources must be the healthy sources and most importantly,
unsaturated, which explains why you need to be guided by a qualified
Nutritionist before implementing this diet.
The ketogenic diet’s health benefits with metabolic,
neurological and insulin-related diseases have significant scientific backing.
There are many diseases whose management we are struggling with including
Cancer and Autoimmune conditions. We pump hefty funding in drug-related
researches, while there lay many unexplored answers in Nutrition. Truth be
told, sometimes the answers are simply hashed down and considering how much
money the Pharma industry makes from Non-Communicable and Autoimmune diseases,
the answers as to why these diets are hardly implemented are in black and
white.
NCDs and autoimmune diseases are very expensive to manage for
patients, their families and governments worldwide and it is time we became
cognizant of the fact that we need to go back to basics. The human body is 100%
Nutrition. We however ironically ignore this and go to chemicals for answers.
Now, I’m not saying that people should stop taking medicine, because
unfortunately there are many instances where medicines need to be used to
eliminate pathogens in the body, more so because the majority of people don’t
have optimal immune function.
In addition to sugary foods and foods high in unhealthy fats,
the Keto diet also limits fruits, legumes, pulses, grains, roots and tubers
which are high in carbohydrates. This goes against Conventional Nutrition, and
for that reason, the Ketogenic diet gets a lot of resistance from many quarters,
in spite of all the evidence that shows tremendous health benefits.
The most important thing to keep in mind even on the
Ketogenic diet and any other prescribed meal plan is that Micro-Nutrient
Supplementation must be done in order to support immune function and all body
functions. A qualified Nutritionist/Dietitian must closely monitor and review
the individual and the diet. More to this, all the medication the patient is
using must be regularly evaluated to identify any negative reactions with the
prescribed diet.
Sunday, 23 July 2017
The Ketogenic Diet (Keto-Diet) in Diabetes Management
The Ketogenic diet uses similar principles in Diabetes and
weight management. As mentioned in the previous article on weight management,
the Keto diet is a low carbohydrate, moderate protein, high fat diet.
Regulating blood sugars is very important in Diabetics to
prevent complications, such as Kidney/renal failure, amputations, heart disease,
impotence, retinopathy among other serious complications. In all types of
Diabetes; Type 1, 2 and gestational diabetes, the challenge of blood sugar
control and reduced insulin sensitivity is highly influenced by carbohydrate
intake, more so the amounts and type of carbohydrate.
The Keto diet can be implemented in diabetics and has
actually been seen to help persons with poor blood sugar control. To prevent
hypoglycemia, I would advise you to have a Nutritionist/Dietitian create an
individualized meal plan. Using the glycemic index and glycemic load of foods to
determine the overall carbohydrate intake gives better results in blood sugar
control.
As mentioned in the introductory article, the Ketogenic diet
uses fat as the main energy source, instead of carbohydrates. Fat and protein
take much longer to digest compared to carbohydrates. This means that it takes longer
for sugars to be released in the blood stream, which automatically solves the
problem of blood sugar spikes in diabetics.
Weight management is a challenge in most diabetics, and it is
majorly due to impaired insulin sensitivity. Various studies have found that the
ketogenic diet improved insulin sensitivity in diabetics. Diabetics on the Keto
diet have been reported to have better weight control, which prevents them from
developing obesity, which is a risk factor for other Non-Communicable Diseases.
Many diabetics also have various co-morbidities; therefore it
is important for the Nutritionist/Dietitian to work closely with the Endocrinologist
to ensure that the Keto diet does not cause any negative side effects.
Saturday, 22 July 2017
The Ketogenic Diet (Keto-Diet) and Weight Management
Can the Ketogenic Diet help you lose weight? As we discussed
in a previous article, the Keto Diet is a very low carbohydrate, high fat,
moderate protein diet. Research has shown that the Ketogenic diet is far more
effective in weight loss compared to the more common low-fat diet.
An analysis of the staple Kenyan diet which is mostly made up
of Ugali, rice, chapatti, githeri, bananas and potatoes, indicates that most
Kenyans feed on medium to high Glycemic Index foods on a daily basis. These
foods are digested much faster than low glycemic index foods, therefore the
person feels hungry much sooner, snacks several times in the day and ends up
taking way more calories than their body actually needs. The standard Kenyan
plate is high in Carbohydrate, medium to low protein depending on the
socio-economic status, low fat to medium fat, and low in vegetables.
In the Keto diet the body uses fat as the main energy source,
not carbohydrate. Fats release more energy compared to carbohydrates. The Keto
diet is more filling; therefore you stay full for a longer period and won’t
need to snack in between meals, which is a major contributing factor in weight
gain.
The limited carbohydrate, increased ketones, lowered blood
sugar levels and improved insulin sensitivity all play a key role in weight
management. Carbohydrates, more so, those with a medium to high glycemic index
are digested and released into the blood stream as glucose much faster in
comparison to fats and proteins. The increased glucose in the blood leads to
release of a hormone to help regulate the increased blood sugars, Insulin.
Insulin is a storage hormone. Its work is to basically remove
all excess glucose in the blood, and have it stored in the body as glycogen. Improving
insulin control and sensitivity has a significant influence in weight
management.
There are many factors that come to play in weight management
which include hormonal balance; however it is important to note that even on a
Ketogenic diet, physical fitness must be a part of the daily routine.
The Ketogenic Diet is more filling due to the high protein
and fat content and research indicates that it has more success in weight loss
compared to a low-fat diet. Sustainability is however something I always emphasize
on, before a person decides to choose any diet plan or like I prefer to call
it, meal plan.
Constant hunger, feeling lethargic among other side effects,
is some of the reasons why people don’t stay on different diet plans for the long-run.
The protein and fat content in the keto-diet ensure that there’s no constant
hunger, which would result in unhealthy snacking and increased simple
carbohydrate intake.
Considering the fact that the Ketogenic Diet has been proven
by research to have many health benefits for general health improvement and
disease management, I would recommend easing your way into the diet. You can implement
the standard Ketogenic Diet which is a high fat, moderate protein and low
carbohydrate diet, but go carbohydrates that are low in the glycemic index. Also,
please choose healthy sources of fats like nuts, fish, avocado, seeds, olive
oil, Omega 3 and unsaturated fats.
The Nutritionist/Dietitian needs to create an individualized
meal plan for you in order to incorporate low carbohydrate vegetables and most importantly, assess the total
daily Micro-Nutrient content in your diet to prevent low intake and
deficiencies that will compromise your immunity, organ function and overall
optimal health. Micro-Nutrient Supplementation is usually necessary for persons
implementing the Ketogenic diet.
Lastly, always consult your Nutritionist/ Dietitian before
implementing any diet that introduces drastic shifts to your usual meal plan.
For persons with any Fat-Metabolism Disorders, this is one Meal Plan both your
Doctor and Nutritionist Must
evaluate and give a green light for safety, before you can implement it.
The Evolution of the Ketogenic Diet
As mentioned in the introductory
article, the ketogenic diet is
a high fat, adequate protein, low carbohydrate diet that for years
has been used primarily to treat
difficult-to-control (refractory) epilepsy in children.
In a high
carbohydrate diet, which is the ‘normal’ diet for most people, the carbohydrates
contained in food are converted into glucose, which is then transported
around the body and is particularly important in fueling brain function.
However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace
glucose as an energy source. An elevated level of ketone bodies in the blood, a
state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1]
Physicians in ancient Greece
treated diseases, including epilepsy, by altering their patients' diet.
The original therapeutic diet
for paediatric epilepsy provides just enough
protein for body growth and repair, and sufficient calories to maintain the correct weight for age and height. This classic ketogenic diet contains a 4:1
ratio by weight of fat to combined protein and carbohydrate. This is achieved
by excluding high-carbohydrate foods such as starchy fruits and vegetables,
bread, pasta, grains and sugar, while increasing the consumption of foods high
in fat such as nuts, cream and butter.[1]
The classic therapeutic ketogenic
diet was developed for treatment of
paediatric epilepsy in 1924 by
Dr. Russell Wilder at the Mayo Clinic and
was widely used into the next decade, but its popularity decreased with the
introduction of effective anticonvulsant drugs.
Prior to the classic therapeutic ketogenic diet development
in 1924, Dr. Hugh Conklin used a more extreme method to treat epilepsy, the
"water diet" treatment.
There were even more harsh treatment modalities, for example, the royal
physician Erasistratus declared, "One inclining to epilepsy should be
made to fast without mercy and be put on short rations. In an early treatise in
the Hippocratic
Corpus, On
the Sacred Disease, which dates
from c. 400 BC.; the author argued against the prevailing view that
epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.
Dr. Hugh Conklin's fasting
therapy was adopted by neurologists in mainstream practice. In 1916, Dr. McMurray wrote
to the New York Medical Journal claiming to have successfully
treated epilepsy patients with a fast, followed by a starch- and sugar-free
diet, since 1912.
In 1921, Rollin Woodyatt reviewed
the research on diet and diabetes. He reported that three water-soluble
compounds, β-hydroxybutyrate, acetoacetate and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people
when they were starved or if they consumed a very low-carbohydrate, high-fat
diet.
Russel Wilder, at the Mayo Clinic, built on this research and
coined the term ketogenic diet to
describe a diet that produced a high level of ketone bodies in the blood (ketonemia)
through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the
benefits of fasting in a dietary therapy that could be maintained indefinitely.
His trial on a few epilepsy patients in 1921 was the first use of the ketogenic
diet as a treatment for epilepsy.[6]
Russel Wilder's colleague, Paediatrician Mynie Peterman, later
formulated the classic diet, with a
ratio of one gram of protein per kilogram of body weight in children,
10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's
work in the 1920s established the techniques for induction and maintenance of
the diet. Peterman documented positive effects (improved alertness, behaviour
and sleep) but also adverse effects (nausea and vomiting due to excess
ketosis).
The diet proved to be very
successful in children. Peterman
reported in 1925 that 95% of 37 young patients had improved seizure control on
the diet and 60% became seizure-free. By 1930, the diet had also been
studied in 100 teenagers and adults. Clifford
Barborka, also from the Mayo Clinic, reported
that 56% of those older patients improved on the diet and 12% became
seizure-free. Although the adult results are similar to modern studies of
children, they did not compare as well to contemporary studies. Barborka
concluded that adults were least likely to benefit from the diet, and the use
of the ketogenic diet in adults was not studied again until 1999.[6][7] Research into the Ketogenic diet largely
declined with the introduction of drugs.
Almost half of children and young
people with epilepsy who have tried some form of the ketogenic diet saw the
number of seizures drop by at least half, and the effects persist even after
discontinuing the diet.[2]
There is evidence that adults
with epilepsy may benefit from the diet, and that a less strict regimen, such
as a modified Atkins diet, is
similarly effective.[1] Clinical trials and studies in animal models (including C.
elegans[3]) suggest that ketogenic diets provide neuroprotective
and disease-modifying benefits for a number of adult neurodegenerative
disorders.[4][5]
Hollywood producer Jim
Abrahams, two year old son, Charlie Abraham had uncontrolled epilepsy, suffered from daily seizures despite trying
all available anti-seizure medications, alternative therapies and enduring a
futile brain surgery. Abrahams discovered a reference
to the ketogenic diet in an epilepsy guide for parents and brought Charlie
to John Freeman at Johns
Hopkins Hospital, which had
continued to offer the therapy.
Charlie started the ketogenic diet and remained on it for 5
years and the seizures stopped, the epilepsy was
rapidly controlled and his developmental progress resumed. In 1994, Jim
Abrahams and his family started The Charlie Foundation after his son’s complete
recovery. The Charlie Foundation promotes
the Ketogenic diet and actively funds research into the diet.
A multicenter prospective study
began in 1994; the results were presented to the American Epilepsy Society in
1996 and were published [8] in
1998. There followed an explosion of scientific interest in the diet. In 1997,
Abrahams produced a movie First
Do No Harm in which a young boy's intractable epilepsy is
successfully treated by the ketogenic diet.
By 2007, the ketogenic diet was
available from around 75 centres in 45 countries, and less restrictive
variants, such as the modified Atkins diet, were in use, particularly among older children and
adults. The ketogenic diet was also under investigation for the treatment of a
wide variety of disorders other than epilepsy.[1]
According to available research, the ketogenic diet reduces seizure frequency by more than 50% in half of
the patients who try it and by more than 90% in a third of patients.[9] Three-quarters of children who respond do so within two weeks, though
experts recommend a trial of at least three months before assuming it has been
ineffective.[10] Children with refractory epilepsy are more likely to benefit from the
ketogenic diet than from trying another anticonvulsant drug.[1] There is some evidence that adolescents and adults may also benefit
from the diet.[10]
A meta-analysis conducted in
2006, looked at 19 studies on a total of 1,084 patients.[11] It concluded that half the patients achieved a 50% reduction in
seizures and a third achieved a 90% reduction.[9]
References
1.
Freeman JM,
Kossoff EH, Hartman AL. The ketogenic diet: one decade later. Pediatrics. 2007
Mar;119(3):535–43. doi:10.1542/peds.2006-2447. PMID 17332207
2.
Levy RG, Cooper
PN, Giri P. Ketogenic diet and other dietary treatments
for epilepsy. Cochrane
Database Syst Rev. 2012 Mar
3.
Mobbs C. Treatment of diabetes and
diabetic complications with a ketogenic diet. Journal of Child Neurology. 2013
May;28(8):1009–14. doi:10.1177/0883073813487596.PMID 23680948
4.
Gasior M, Rogawski MA, Hartman
AL. Neuroprotective and disease-modifying
effects of the ketogenic diet. Behav Pharmacol.
2006;17(5–6):431–9. PMID 16940764
5.
Maalouf M, Rho JM, Mattson MP. The neuroprotective properties of calorie
restriction, the ketogenic diet, and ketone bodies. Brain Res
Rev. 2009 Mar;59(2):293–
6.
Wheless JW. History and origin of the ketogenic
diet (PDF). In: Stafstrom CE, Rho JM,
editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004. ISBN 1-58829-295-9 .
7.
Kossoff EH. Do ketogenic diets work for adults
with epilepsy? Yes! epilepsy.com. 2007, March.
Cited 24 October 2009.
8.
Vining EP, Freeman JM, Ballaban-Gil
K, Camfield CS, Camfield PR, Holmes GL, et al. A multicenter study of the efficacy of the
ketogenic diet. Arch Neurol. 1998
Nov;55(11):1433–7. PMID 9823827
9.
Kossoff EH, Zupec-Kania BA, Rho JM.
Ketogenic diets: an update for child neurologists. J Child Neurol. 2009
Aug;24(8):979–88.doi:10.1177/0883073809337162. PMID 19535814
10. Kossoff EH,
Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R, et
al. Optimal clinical management of
children receiving the ketogenic diet: recommendations of the International
Ketogenic Diet Study Group.Epilepsia. 2009
Feb;50(2):304–17. doi:10.1111/j.1528-1167.2008.01765.x. PMID 18823325
11. Henderson CB,
Filloux FM, Alder SC, Lyon JL, Caplin DA. Efficacy of the ketogenic diet as a
treatment option for epilepsy: meta-analysis. J Child Neurol. 2006 Mar;21(3):193–8.doi:10.2310/7010.2006.00044. PMID 16901419
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