Comprehensive Epilepsy Center
Ketogenic Diet Therapy - Getting Started
Normally our bodies run on energy stores from glucose which is provided from food. When we go without food for 1 to 3 days,
our bodies use all of our stored glucose, and the brain and body switch to burn fat for energy stores. The ketogenic diet,
which is a diet high in fat and low in carbohydrates keeps the body burning fat instead of burning glucose.
The diet was originally discovered because patients with epilepsy were found to have a remarkable reduction in their seizures
when they were ill and not eating. So, it was noted that during times of starvation, the seizures improved. The ketogenic
diet actually tricks the body into thinking that it is starving.
During the ketogenic diet, 80% of calories are from fat, very little comes from carbohydrate and protein. Each meal has about
4 times as much fat as protein or carbohydrate, so the ratio is called a 4:1 ratio. Some centers restrict the amount of liquid
at each meal; however, at Thomas Jefferson University Hospital, fluids are not restricted.
The diet has been found in studies in adults to reduce seizures by at least 50% in 50% of patients. In our studies, some patients
have an even greater reduction of seizures (up to 90%).
If you are interested in the ketogenic diet, you need some blood studies and a screening EKG to monitor your heart. You also
need to meet with our outpatient nutritionist Barbara Whedon. People usually require 2 out-patient visits for education regarding
the diet.
We require that the patients commit to a 3-month period of trial of the ketogenic diet.
Once you have decided to try the diet, you are admitted to the hospital. This is to begin the starvation. During the first
2 days of the hospitalization, you are given fluids but no meals. Once your body has completed burning all the glucose stores,
you will begin to see that your body has high levels of ketones in your blood (ketosis). The ketones are checked simply with
the urine dipstick.
After reaching ketosis, you will begin a partial diet in the hospital, and if you are tolerating the diet after your first
full meal, you are discharged home.
Medical Follow-up
You will need to be seen approximately 2 weeks after the starting of diet and then you will be seen every 6 to 8 weeks as
deemed necessary by your doctor. You will have screening laboratory studies done as an outpatient before your 2-week visit.
Visits will be monthly for 3 months and then they will be completed every 3 months. Additionally, EKG studies will be done
periodically during your follow up, and a DEXA scan is typically performed once you have been on the diet for 3 months. If
you remain on a diet for longer than 1 year, the DEXA scan will be repeated.
