News from COLUMBIA-PRESBYTERIAN MEDICAL CENTER
For immediate release
CONTACT: Karin Eskenazi: 212/305-5587
HIGH-FAT, LOW-CARBOHYDRATE DIET
CONTROLS SEIZURES IN YOUNG EPILEPTICS
NEW YORK, NY, JANUARY 13, 1997 -- Neurologists and nutritionists at Columbia-Presbyterian Medical Center are using a high-fat, low-carbohydrate diet to control seizures in epileptic children who do not respond to, or cannot tolerate, medication.
The "ketogenic diet" was devised in the 1920s, following anecdotal reports that fasting cured epilepsy. The first to confirm scientifically that fasting could moderate seizures was H.R. Geyelin, a physician at Columbia-Presbyterian. Around the same time, a doctor at the Mayo Clinic proposed a high-fat diet as a way to simulate the effect of starvation. Although the diet was found to be useful, it fell out of favor over the years with the advent of effective anti-seizure medications, according to Douglas Nordli, Jr., MD, Director of the Pediatric Epilepsy Program at Columbia-Presbyterian's Comprehensive Epilepsy Center.
The diet, however, is making a comeback as a therapy for children with epilepsy who either do not respond to medical treatment or suffer intolerable side effects. It is estimated that approximately 15 percent of the nation's 375,000 young epileptics fall into this category.
To begin the ketogenic diet, the patient must fast for about a day and a half; only water and sugar-free beverages are allowed. The fast continues until the child becomes "ketotic," as indicated by the presence of ketones in the urine. Ketones are produced when the body taps its fat stores for energy. The diet is then started. Because each meal is high in fat and low in protein and carbohydrates, the body continues to burn fat for energy, sustaining the ketotic state.
The fast, as well as the first three days of the dietary intervention, must be conducted in the hospital. "We have to monitor the child's electrolytes, and ensure that he or she doesn't become too hypoglycemic," says Joanne Carroll, MSRD, a nutritionist at Columbia-Presbyterian, where many children have been treated with the diet in recent years. "We also use this time to design a customized diet for each patient and to teach parents how to prepare the different meals and how to monitor the urine for ketones."
Studies show that the ketogenic diet eliminates seizures entirely in more than half of patients and reduces seizures significantly in another quarter. "Some children can be taken completely off medications," says Dorcas Koenigsberger, a nurse practitioner at Columbia-Presbyterian. Response times vary from a day to a month. Children who fail to respond within this period are unlikely to benefit later on. Younger children (ages one through eight) tend to gain the most from the diet. It is rarely helpful for adults.
Children who respond to the diet are kept on the regimen for an unlimited period of time, with monthly follow-up visits to the doctor or nutritionist.
Doctors do not understand how the diet works. However, animal experiments conducted at Columbia-Presbyterian by Darryl De Vivo, MD, Sidney Carter Professor of Neurology and Professor of Pediatrics, suggest that high-fat diets increase the ratio of adenosine triphosphate (ATP) to adenosine diphosphate (ADP), molecules involved in energy production. A higher ATP-to-ADP ratio, in turn, somehow enhances the stability of neurons in the brain.
The key to the diet is maintaining a four-to-one ratio of fat to carbohydrates and protein at every meal. Breakfast might include 1/4 cup of Rice Krispies with 4-2/3 tablespoons of heavy cream, plus 1/4 of a banana with 6-1/2 tablespoons of heavy cream. Lunch: 1/2 beef frank with 1/2 teaspoon of mayonnaise, plus 1/4 cup of green beans with 1 teaspoon of margarine. Dinner: 10 ounces of chicken with 6-2/3 tablespoons of mayonnaise, plus 1/4 cup of carrots with 1 tablespoon of margarine.
The diet allows many "food exchanges," so the menu can be varied and tailored to each child's food preferences. Instead of chicken and mayonnaise, one could substitute ham and mayonnaise or hamburger and heavy cream. "Free foods," which can be eaten at any time and in any amount, are also included. These include dill pickles, cucumbers, sugar-free drinks, and celery. A variety of seasonings, including garlic, dill, basil, and oregano, can also be used to spice up the meals.
Although the diet is limited, "the child gets enough calories and enough protein and carbohydrates to sustain proper growth and development," says Ms. Carroll. However, she notes, little is known about the regimen's long-term hazards.
The biggest problem with the diet is compliance. One slip can cause a major setback. "The most common problem resulting in lowered ketosis is ingestion of additional 'forbidden' foods... Even small amounts of additional sugar, e.g., one cookie, can throw the diet off and result in worsening seizures... Sugar in medications, mouthwashes, or toothpastes may also confound the diet," Dr. Nordli has written. Younger children tend to have an easier time with compliance, since they are less likely to have developed strong eating habits.
###
RSS