The Ketogenic Diet

In the January Foods Matter Ruti Chang described how she developed life- threatening epilepsy as a result of her parents attempts to ‘fatten her up’ as a child. She now describes the ketogenic diet and the dramatic effect that it had on her condition.

When I was told that I would be mimicking starvation on a diet high in fats and just enough carbohydrates to prevent hypoglycaemia, I was understandably worried. My body was going to be forced into using fat for fuel instead of carbohydrates and I was going to have to eat meat, eggs, double cream and cheese. I was shocked to hear that I would initially lose weight and that prohibited foods included bread. This seemed to go against all healthy eating principles.

Measures and ratios, percentages of fat, glucose and ketone figures were laid in front of me as the dietitian smiled and told me not to worry. I didn't even know what a ketone was. I was told that a ketone was produced when fatty acids break down in the body and are used for fuel but felt no wiser for the explanation.

Short history
The ketogenic diet is thought to have been the original human diet of modern man some 10,000 years ago. During this era man ate meat, bone, flesh and the offal of his prey. The body of 'meat eating man' would have relied on fat for his fuel source.

In the 1930s American neurologist, Dr Wilder Penfield, treated his epileptic patients with such a dietary regime. He developed an equation which he believed would enable a safe state of ketosis that proved successful in reducing or controlling seizures. His complex theory requires weighing each food product and knowing its exact nutritional make up. Patients are prescribed a ratio of each food group to be consumed per meal.

Dr Wilder's adaptation of a ketogenic diet begins once all stored carbohydrate reserves are used up. The blood sugar level should be just above the risk of hypoglycaemia. To achieve this condition the patient must abstain from all carbohydrates/sugars for a short period, existing solely on protein and fat products.

With no carbohydrates to use for fuel, the body relies on fat. Fatty acids break down and compounds called 'ketones' are released. A body existing in this way is known to be in 'ketosis'. In a nutshell, the body is tricked into acting as if it were in the state of starvation. He claimed that the brain benefits from this status but could not prove exactly how.

Dr Wilder's complex equation is still providing benefits for thousands of companies who realise that the average patient would find food preparation quite beyond them. Software and catering companies alike have jumped on the band wagon to provide menu sheets, books, daily planners and data recording technology; the food industry has provided exclusive ready made products at top-of-the range prices.
In the early 1970s neurologist Dr Peter Huttenlocher, working at the University of Chicago, developed his own adaptation of a ketogenic regime named the Medium Chain Triglyceride (MCT). Without the need for Dr Wilder's calculation, MCT could be used as an alternative to powerful and unwanted anti-convulsant medication as a primary treatment for hard-to-control epilepsy.

Despite the media controversy which surrounds the ketogenic lifestyle, Aimee Bowen of the Epilepsy Action group says: 'The ketogenic diet is not a fad or quack diet. It is an alternative medical treatment for children with difficult-to-control epilepsy and should only be used under the supervision of a physician and dietitian. We believe that only a small number of children in the UK are on the diet because there are very few centres offering the treatment.

‘We have seen that it can be a highly effective treatment and we believe that all children with uncontrolled epilepsy should be assessed for their suitability to go on the diet.’

Not just for epileptics
Although the ketogenic diet is popular as a treatment for epilepsy this diet is not simply for the sick and ailing.

In the 1920s Harvard-trained anthropologist Vilhjalmur Stefansson became intrigued by the excellent health of certain ethnic and cultural groups. After extensive observation of the ‘ketogenic culture’ of the Eskimos, he lived, for a year, on a 100% meat diet emerging from the experience in excellent health and with none of the expected cardiovascular, kidney or liver diseases. Amidst the shadow of controversy he designed a ketogenic diet for public therapeutic use.

Athletics – body building
For those at the peak of muscle aesthetics, fat burning diets have always been popular. It is believed that constantly damaged muscle tissue is repaired faster on a ketogenic diet.

Body builders constantly damage muscle tissue during training sessions. To speed up, repair and continue to gain lean muscle tissue the diet of choice is ketogenic. Designed for peak- of-fitness athletes, an average body building adaptation demands a 3,000 calorie intake of fat and high quality protein.

This demand is obvious in most sport shops. Huge banners advertise 'milkshakes' to enhance muscle gain with 'no net carbohydrate content' . In other words any carbohydrates in the container are not broken down into sugar/carbohydrate to be used by the human body as fuel.

It is important to note here that fast fat burning diets are used by professional athletes and monitored by nutrition experts.

The Atkins diet
You may be aware of the American heart specialist Dr Atkins who used the ketogenic diet in his work. Presented as a diet to correct type 2 diabetes and reduce weight without restricting calories, his adaptation has been used, corrupted and abused. His plan does not require difficult calculations to keep the body in ketosis. The popular Atkins Diet is essentially a diet that temporarily reduces carbohydrates.

When correctly followed, cereal products are reintroduced to maintain the required body weight. Recognising that starvation is no longer a risk, the body adapts according to the carbohydrate intake. Less fat is taken as carbohydrate levels are increased and the body becomes less ketogenic (fewer ketones are being produced).

Living with the diet
Denied comfort foods and alienated at meal times, depression and emotional upheaval often accompany the ketogenic patient. Surrounded by the foods of habit, denied the succulent foods of pleasure and aware of how easy it is to break the diet, life can be miserable.

Food is no longer a social event but a mathematical encounter. Each product must be weighed, recipe sheets adhered to and, most annoyingly, convenience foods banned from the new eating lifestyle.

As volatile ketone compounds increase, patients suffer from the unique 'bad breath' of the body in ketosis. Adding insult to injury, the favoured toothpaste may be on the forbidden list as even toothpaste contains carbohydrates.

Getting to know the diet
However, luxurious eating is a great compensation for the restriction of carbohydrates.
It does not take long to understand the ketogenic diet when you realise that you just need to ensure that you have lots of fat, adequate protein (your dietitian will advise) and lower than usual carbohydrates. Yesterday's special treats (double cream for example) are now prescribed foods! Large amounts of meat and cheese are recommended and you no longer need to worry about weight gain. A dietitian will instruct you regarding amounts of vegetables and berries and give you delicious recipe sheets as part of your therapy.
The craving for carbs diminishes quickly as you find luxurious alternatives to your usual foods. Instead of a couple of slices of toast and instant coffee for breakfast you can enjoy a pancake made from eggs and ground almonds, fried in butter and topped with sweetener and double cream.

Although references are provided the ketogenic diet is not a do-it-yourself diet to allow meat and fat gorging without adverse effect. Epileptic patients are carefully monitored; professional body builders adhere to strict training and lifestyle regimes.

References:
The Ketogenic Diet: A Treatment for Epilepsy by Freeman, Freeman and Kelly

The ketogenic diet and me– Ruti reports on her own experiences

Standing at only 164 cms and weighing only 50 kg, my reaction to the suggestion that I should be placed on the 'supermodel' diet was one of horror. I had spent my life trying to put weight on and now at my most vulnerable I was introduced to a diet. The suggestion followed a consultation with my neurologist. He advised me that my brain could not cope with the constant barrage of epileptic seizures that plagued me.

Suffering from constant attacks during my waking hours, I had become semi-housebound and could not always communicate. My language system had left me for a childish version of gargling and inappropriate words some time previously. The neurologist spoke plainly. If the seizures did not stop it was likely that one of them would kill me. I should try anything that held the possibility of reducing these violent, brain-scarring attacks.

He introduced me to an organisation that dealt with the families left behind after a patient had died from a syndrome called 'Sudden Unexpected Death in Epilepsy' before arranging an appointment with a specialist in the ketogenic diet. I was glad that I did not have the words to speak my mind. I did not like the woman he introduced me to and found her to be too sharp for such a lifeless brain as mine. She spoke as if I understood her but I understood nothing.

My comfort foods were to be removed. My fatteners were being prohibited. My only source of pleasure was obliterated. This may sound dramatic but for a housebound young woman plagued with unconsciousness, seizures and a lack of words, food is a pleasure far above anything else.

Within days the smaller ‘absence attacks’, which had left me alone and confused, were gone. As time went on I became well enough to measure my own foods. For the first few months the effectiveness of my new regime was so apparent that I would 'cheat' just to see if it really was the diet working. I would sneakily eat toasted bread for a day or two but would always crash into a seizure afterwards.

I do not know why I felt it so important to prove to myself that it was working. Perhaps it was a result of the warning that I could die from the level of seizures I was experiencing. Perhaps it was just to good to be true.

The catamenial seizures (associated with the menstrual cycle) continued but the other types of seizures reduced or stopped. I could tell quite easily when someone had added a little sugar 'just to take the bitterness' off a dish because the next day I would start having seizures again. My body became so sensitive to flour and sugar in particular that smaller and smaller amounts of either of these products seemed to trigger trembles, spasms or a full fit. Thankfully this senstivity balanced itself.

The benefits of withdrawing from these products (along with the list of prohibited foods) helped me more than I can explain, but did not fully control my seizures. The ketogenic diet was not a complete control therapy and I would not like to give the impression that it was a miracle cure. But, as an adjunct therapy, it has given me back a part of my brain which has been clogged and separated from a normal life. I began to remember things again, speak again, feel emotions again – at last I had a feeling of being alive again!

First published in 2009