keto for epilepsy

do you know how your magic diet works? i can't remember. it sends very special chemicals to your brain, called ketones, that help tokeep your seizures away. we don't actually know whythe ketogenic diet works. there's a lot of different theories, and in fact there are several labs across north america. several research labs across north america, that are working on exactly that question.

"how does the ketogenic diet stop seizures?" and we don't know. does it help your seizures to go away? yeaaaah, yeah. the ketogenic diet is not a "natural" treatment. it's not even really a healthy diet. what it is, is a treatmentfor children who have seizures that are very serious andnot controlled by medication. and what kind of things do you eatwith your magic food?

um, hot dogs? hot dogs, you lucky boy! what else? i did a presentation to hiskindergarten class last year about jack's magic food. we call it the magic food becauseit makes the seizures disappear. we do have a whole bunch of patients who respond well to medications and are not affected too much with side effects and do have seizure control.

but we're talking more todayabout the ones at home that the simple approach does not work. one shouldn't perceive thatdiet therapies for epilepsy are more benign or more easily tolerated thanother medical treatments for epilepsy. so how are things? things are pretty good-- he's still having the headdrops in the morning. i don't know if it's like an oil or diettweak i need to suggest with christiana about the head drops--for the head drops in the morning.

most of jack's calories come from... --it's called mct oil. medium chain triglyceride oil. that's really where sixty percentof his calories come from. mct oil is a pro-ketonic oil. what that means is that for every calorieof mct oil that a person eats, they'll make more ketones than if they were to eat the same number of caloriesof long-chain oils, or long-chain fats.

so by adding mct oil to food, you can actually encourage your bodyto make more ketones. what are his keytones? they're the same sincei last talked to her a week or two ago, like 8 -- 16 at night. although it is clear to those of us that usethe ketogenic diet for epilepsy that if you can measure ketonesin a child while they're on a diet that the higher the ketones are, usually the more effective the dietwill be at controlling seizures.

that said, the direct relationshipbetween ketones causing seizure control has not been established in a laboratory. did she talk to you about making a change to get them up in the morning? no. 'cause maybe she shouldgive him a little bit more at night, make him have more ketones in the morning. ketones are the breakdown product of fat. when your body does nothave enough carbohydrate

or sugar to use as a fuel, it will convert and changeto using fats as a fuel. the breakdown product of fatas a fuel are ketones. ketones are a very effectivefuel for the brain, and we know that the braincan use ketones to make energy. how are his seizures now? he still has head drops in the mornings, he drinks the oil with his dietevery two and a half hours, then he's fine throughout the day, he sleeps,

and then he has like a ten-twelve hour gapbetween getting the oil... and then we see those seizuresin the morning, so-- so he's only having the head-drop seizures? no more big convulsions. since going on the diet, it's been miraculous. he hasn't had one of the twenty-minute seizures. is the magic food working for your seizures? yeah. yeah, good for you! do you knowany other kids that eat magic food?

he can't remember a lot of things today. should we discussmed side effects at this point? he was on a whole bunch of medications. now he's just on a few. he's subtherapeutice on boththe carbomenzopine and the motrigin. so that's to me an impetus to get kidsoff drugs when you can. the other issue is that this foodis based on fat, and there's the concern forlong term cardiovascular concerns. the reasons to stop the dietinclude some of the chronic

or long-term side effects like,weakening of the bones, short growth. but then when he stops the diet is he justgoing to have to go right back on it? well, he'll have to go on something, but not necessarily the tergritol. most of the epilepsies that children growout of are easily treatable with medication. and so in most cases of epilepsythat children would grow out of, we wouldn't need to use a ketogenic diet. what is possible, however, is that if we use the diet in childrenwith more severe epilepsy,

and we give their brain a restfrom daily seizures. that we may be interfering with thephenomenon of seizures causing seizures, and the more seizures you have, the more seizures you will have in future. and that even if we don't cure the epilepsy, we really allow it to settleinto a more mild pattern. one of the things that we'vereally found with the ketogenic diet is that it's definitely beena positive trend in his medical condition whereas for the first year and halfor two years before we came to sickkids

in many respects it was out of control. what's involved in starting the dietis the children fast for several days. so they come into the hospital fasting,and to be monitored, so it needs to be doneonly under medical supervision-- you can never start this diet at home. and a dietician specifically calculatesthe diet for each child, working out exactly how much fat, carbohydrate,and protein that child should get in a day. jack's lunch is a yummy hot dog,some toast, and some milk with oil. you need to weigh all foods andbe very certain of portion sizes,

which means not only areportion sizes sometimes limited, but on the flip side children have to eatthe portion that is presented to them, and we all know it can sometimesbe hard to get kids to stop eating and sometimes to finishwhat's on their plate. it's so meticulous in having to weigh out every little morsel that goes into his mouth,down to the 0.1 of a gram. so no extra little hidden sources of carbohydrates or sugar can sneak into the diet. so that includes things like toothpaste,which can be sweetened,

and there's no chips or cookiesor birthday cake or anything like that. that could be allowed on the diet. the other thing is thatwe need to be very careful with the medications that kidson the ketogenic diet take because one teaspoon of cough syrup,which is heavily sweetened, could actually have the full day'svalue of carbohydrates. just in that one little spoon. any change in the diet thatactually drops the ketone levels can result in an increase in seizures,and can even be dangerous.

so children that are on theketogenic diet need to be very careful not to even by mistakeget extra bits of carbohydrate. be it food, medication, snacks,even things like gum. we can use sugar-free flavourings,ones that are sweet can be added to cream andfrozen to form a type of ice cream. and ones that are more savoury can be addedinto mayonnaise to make dressings. so you can make the ketogenic diet taste good. the magic diet is what we callthe ketogenic diet for jack. and we've just reallypositioned it in a way

that he needs to eatin a certain way to be healthy. our two-year old has an egg allergy, so we tell jack that there'scertain foods that christopher, your little brother needs to eat to stay healthy. we just got a puppy,the puppy eats puppy food, and you eat this magic foodand that's what works for your body. last year when i did a littlepresentation to his kindergarten class, that several of the children thought, upon hearing that jack was on a magic dietthat he could actually fly.

so it's really important thateverybody that works with a kid, or takes care of a kid, knows that they're on a special diet,and knows the consequence of the diet. the hope is that the effect of the ketogenicdiet will be sustained after we stop the diet. brain surgery was also mentionedto us as a possible treatment. and we do know children who come off the diet and stay seizure-free. this is probably mostly relatedto the underlying cause of the seizures. when the time comes that jack can no longer be on the diet then we'll probably be pursuing surgerymore aggressively if the seizures return.