The Ketogenic Diet

Marleen Van Driessche

Dietitian

University Hospital Ghent, Belgium

The Ketogenic Diet, what is it?

High En% of fat

70 – 90 En%

Adequate protein intake

6 – 7 En%

Low En% of carbohydrates

5 – 9 En%

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What is it?

Why?

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The ketogenic diet

Ketones

Less epileptic seizures(mechanism?)

Energy for the braininstead of glucose

Population

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Children with refractory epileptic seizures

Children with metabolic diseases

Glucose transporters deficiency (GLUT 1)

Pyruvate dehydrogenase deficiency (PDH)

Near future?

Alzheimer, brain tumor, autism, parkinson, ALS

Fat oxidation deficiencies

Pyruvate carboxylase deficiencies

Primary carnitine deficiencies

Porphyria

Hyperlipidemia, diabetes, hyperinsulinism

Liver, kidney and pancreas diseases

Contra-indications

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Different kinds of the ketogenic diet

Different kinds of the ketogenic diet

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Classic Ketogenic diet

MCT Ketogenic diet

Modified Atkins diet (MAD)

Low glycemic index diet (LGID)

Classic Ketogenic diet

90 En% fat (LCT)

10 En% protein + carbohydrates

MCT Ketogenic diet

50-60 En% MCT + 10 En% LCT

11 En% protein + 19 En% CH

Modified Atkins diet (MAD)

60 En% fat

30 En% protein

10 En% carbohydrates

No restriction of calories or fluids

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+ All products available in supermarkets

+ Products for bottle, tubefeeding and drinkfood available

in pharmacy

- Very low carbohydrates

- Nutrition deviates strongly from normal diet

- Constipation, nausea, vomiting and growth

?Pros and cons classic

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+ More carbohydrates

+ Nutrition more comparable with normal diet, except for

fat emulsion.

- Use of dietary preparations

- Constipation, nausea, vomiting and growth

?Pros and cons with MCT

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+ Ketones

+ Decreasing epileptic seizures

+ No weight loss, but growth

+ More carbohydrates

+ More protein intake

- High intake of fat

?Pros and cons with Modified Atkins diet (MAD)

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1 : Informative consult to parents/ patient

- What is a Ketogenic Diet

- Different types

- Side - effects of the diet

- Clinical start

- Expectations from parents and patient

- Attainability for the family

- Feeding method ( oral, tube feeding, PEG )

TREATMENT WITH THE KETOGENIC DIETIntroduction

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2 : Decision of the parents

IF YES :

- Request to keep a three days food diary (parents)

- Calculation of the diary

- Calculation of the energy and protein requirements

- Calculation of the classic ketogenic diet

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RATIO 4 : 1

For every 4 grams of fat there is 1 left for combining

potein + carbohydrates

RATIO 3,5 : 1 and 3 : 1 is used in young children

(higher protein need)

Classic ketogenic diet and ratio

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Day 1

-All sugars ommited ( sweets, medicine containing

sugar)

- Ratio 1 : 1

Day 2 = Ratio 2 : 1

Day 3 = 3 : 1

Day 4 = 4 : 1

Day 5 = Fine tuning

HOSPITALISATION

5 days : monday till friday

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Goal :

3 – 4 + in urine, use ketostick

Start 2 times a day, morning and evening

In steady ketosis once a day, evening

More controle : ill, 1-2 + in urine, increasing seizures,

changes in medication

Controle ketones

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In first 3 months : once a week

After 3 months : once a month

Decreasing weight or growth stop : increase calories

Controle weight

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Start controle 2 times a day, before breakfast and

before dinner.

Hypoglycemia < 40 mg/ dl : If no symptoms no

treatment control after 20 minutes, > 40 mg/dl

stop control

Positive symptoms ( pale, dozy, sweaty,…) Give 0,5 ml

fruitjuice / kg bodyweight control after 20 minutes

Hypoglycemia < 30 mg/dl 0,5 ml fruitjuice/kg

Controle glycemia

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Urine : 3 – 4 + (8 - 16 mmol/L) ketones

Blood : 2 – 5 mmol/L ketones

Measuring ketones in urine : ketostick

Measuring ketones and glucose in blood : Fingerprick with

the Precision Xceed ( Abbott) to determine.

KETOSISGoals

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NUTRICIA :

Ketocal 4 : 1 (vanilla, neutral taste)

Ketocal 3 : 1

Liquigen ( 50% MCT oil + 50% water )

Calogen ( 50% soya oil + 50% water )

VITAFLO :

Betaquick, Carb Zero

Keyo

PREPARATIONS

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Universitair Ziekenhuis Gent

C. Heymanslaan 10 | B 9000 Gent

T +32 (0)9 332 21 11

E info@uzgent.be

www.uzgent.be

Volg ons op

MARLEEN VAN DRIESSCHE

Dietitian

Pediatric department of the university hospital Ghent, Belgium