The ketogenic diet can help in the treatment of drug-resistant epilepsy, argues Dr. Magdalena Dudzińska from the Chorzów Center of Paediatrics and Oncology in an interview with PAP journalist.
The hospital in Chorzów, where Dr. Dudzińska is the head of the pediatric neurology department, has been following the ketogenic diet for 7 years. In Poland, it is still underestimated, although it has proven effectiveness. It has been used in the world for almost a hundred years, in Poland it is used only in three centers: outside Chorzów, also in the Polish Mother’s Health Center in Łódź and in the Children’s Health Center in Warsaw. In several other institutions, incl. in Lublin, Szczecin and Bydgoszcz, the first attempts at such treatment of patients are made.
Magdalena Dudzińska, MD, PhD believes that more epilepsy treatment facilities, apart from other methods of therapy, should also offer their patients a ketogenic diet. The specialist explains this by the fact that, although many new antiepileptic drugs have appeared in recent years, 20-30 percent patients still fail to control epileptic seizures with pharmacotherapy.
“These patients can be treated with one of three non-pharmacological treatments: neurosurgery to remove an identified epileptic site, implantation of a vagus nerve stimulator, and treatment with a ketogenic diet,” he adds.
According to Dr. Dudzińska, the effectiveness of neurosurgery in correctly qualified patients reaches 80%. Patients with epilepsy with localized epilepsy are eligible for this method; they account for almost a quarter of patients with drug-resistant epilepsy.
The effectiveness of the use of the vagus nerve stimulator is much lower, it only reaches 30-40%, which means that only this percentage of patients is able to significantly reduce the number of epileptic seizures. “The effectiveness of this method, however, can be increased up to 70% if simultaneous treatment with a ketogenic diet is used” – argues Dr. Dudzińska.
The term “ketogenic diet” was first used in 1921 by Dr. Russell M. Wilder of the famous Mayo Clinic. He then wrote that it was possible to provoke ketogenesis (oxidation of free fatty acids in the liver – PAP) by eating diets that are very high in fat and low in carbohydrates. “Therefore, I propose the use of ketogenic diets in patients with epilepsy,” he said.
During fasting, within 12-24 hours of stopping feeding, the body is forced to use fat as a source of energy. This creates ketone bodies that activate mechanisms that fight epileptic seizures.
The keto diet began to be abandoned in 1938 with the advent of phenytoin, a new anti-epileptic drug. However, it later turned out that neither this drug, nor many others, was able to stop seizures in all patients. From 1994, there was renewed interest in the ketogenic diet. It is used by all major neurological and epileptological centers in the world, both among sick children and, recently, also in adults.
In Poland, it was first used 16 years ago by Dr. Maria Zubiel from the Polish Mother’s Health Center in Łódź. “Perhaps its name should be changed and instead of the term ketogenic diet it would be better to use the term metabolic therapy or nutritional therapy for epilepsy” – says Dr. Dudzińska.
Ketogenic diet in 50-60 percent of patients reduces the number of epileptic seizures by half, and in about 30% – by over 90 percent In 10-15 percent in patients, seizures disappear completely. The effects are visible after 2 weeks, at the latest after 3 months.
This diet helps regardless of the type of seizure. Some congenital metabolic diseases and serious diseases, such as liver diseases, are contraindications. The side effects are generally temporary and manageable. “The diet must only be used under the strict supervision of a neurologist and an experienced dietician,” emphasizes Dr. Dudzińska.
According to the American recommendations, the diet should be started in the hospital, because the patient is fasted for 2 days (only fluids are consumed). This is to prepare the body for metabolic transformation, in which the main source of energy will be ketone bodies, i.e. fats. Over the next 2-3 days, meals are introduced gradually according to the appropriate menu.
The composition of the ketogenic diet is selected individually. It is determined depending on the child’s age, weight, activity and type of disease. The doctor must determine the correct ketogenic ratio, i.e. the amount of calories and protein needed, and then calculate the amount of fat and carbohydrates. Most children start a 4: 1 diet of four ketogenic foods (fats).
Each meal should contain 4 basic groups of products: lean meat, fish, poultry, eggs (source of protein), fruits and vegetables (source of carbohydrates), oils, olive oil, butter, mayonnaise, bacon, bacon (source of fat) and fatty foods 36 percent cream, which is both a source of protein, as well as carbohydrates and fat.
More on this subject in the recently published first Polish guide by Dr. Magdalena Dudzińska, “Ketogenic Diet. When AEDs Don’t Help.