The ketogenic diet KD traditionally was initiated using specified ketogenic ratios, limited calories and fluids. Recent work has shown that lower ketogenic ratio diets are frequently as efficacious as higher ones and result in fewer adverse effects. In animals, calorie restriction is anticonvulsant. In children however, the need for calorie restriction is less clear, but avoidance of excessive calories may improve efficacy of the diet. There is no evidence that fluid restriction is a necessary component of the KD. Given the higher risk of nephrolithiasis, adequate fluid intake should be encouraged. The ketogenic diet KD has been utilized for nearly a century to treat refractory seizures. The original description, published in from the Mayo Clinic, is similar to the traditional KD used today Wilder, This diet was initiated with a fast, used specified ketogenic ratio calculations, emphasized monitoring of ketosis, limited fluids and restricted calories. However, more recently reported lower ketogenic ratio variants Kossoff et al. Over the last decade, work done in animal models to elucidate mechanisms of action of the KD has provided further information on ketogenic ratio, fluid and calorie restriction.
A high fat, low carbohydrate diet was first described in the medical literature in as a treatment for epilepsy in children, following other reports of the beneficial effects of fasting on seizure control. The diet was designed to mimic the metabolic changes that occur in the body during starvation, i. Muscles and other tissues progressively switch energy source from glucose to free fatty acids which are converted to ketone bodies acetoacetate and b-hydroxybutyrate ; these become the primary energy substrate for brain and other metabolically active tissues in the absence of adequate glucose supply. This state of ketosis is characterized by the rising levels of ketone bodies which can be measured in the blood or urine. This classical diet is based on a ratio of ketone producing foods in the diet fat to foods that reduce ketone production carbohydrate and protein. Fat is usually provided from food sources such as butter, mayonnaise, margarine, oil, cream, or a supplement that is available on medical prescription. Protein intake is based on minimum requirements for growth and is generally provided by a high-biological value source at each meal such as meat, fish, eggs or cheese. Carbohydrate is very restricted; starchy foods are not allowed, the main sources being a limited portion of vegetables or fruit. The medium chain triglyceride MCT ketogenic diet was developed in the s as an alternative to the classical diet.
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