The relationship between diets, nutrition, and diseases has been known since the dawn of medicine. It is also known that diet influences the development and maintenance of proper brain function.
In pediatric neurological diseases for which dietary recommendations are usually made are: cerebral palsy, refractory epilepsy, autism spectrum disorder, attention deficit hyperactivity disorder.
What is the ketogenic diet or keto diet?
The ketogenic or “keto” diet is characterized by a reduction in carbohydrate consumption and a higher intake of proteins and fats. While fat contains between 80% and 90% of the total daily energy; proteins only provide between 5% and 10% of the total energy, similar to carbohydrates.
Many people use it as a diet style to reach their ideal weight, and there is no doubt that among the evidenced results is a decrease in body weight. But there’s more; since the 1920s, the famous “keto diet” has been recognized as a useful tool for the treatment of epilepsy in children, which was later displaced by the appearance of antiepileptic drugs. However, it should be noted that approximately 25% of epilepsies are refractory to pharmacological treatment.
What is epilepsy?
Epilepsy is a chronic neurological disorder of the brain characterized by repeated episodes of diverse manifestations, generally sudden in onset and brief in duration. It is a frequent and treatable disorder, caused by an abnormal increase in the electrical activity of neurons in some area of the brain, which causes brief and sudden changes in its function. The clinical picture depends on the affected brain area, and a series of manifestations of exacerbation or inhibition of motor, sensory, or psychic functions are found. Motor manifestations, called seizures, are uncontrolled and repetitive body movements, which are called «epileptic attacks». These attacks usually recur with some frequency.
The ketogenic diet and epilepsy
The ketogenic diet, indicated as one of the lines in the treatment of refractory or intractable epilepsy, consists of replacing carbohydrates with lipids for energy generation, with ketone bodies being the main source of energy production in this case. Its management requires strict and individualized nutritional monitoring. Despite various studies to determine the mechanism of action of the ketogenic diet against epilepsy, it still remains uncertain. The most probable factor is an increase in the formation of ketone bodies, which reproduces the biochemical changes that appear during fasting.
Nevertheless, the ketogenic diet is considered part of comprehensive treatment worldwide due to numerous observational studies suggesting that these diets are effective in a significant proportion of cases. Therefore, this diet is considered a possible option for patients with difficult-to-control epilepsy. It can bring benefits such as a reduction in medication use and a 30% to 50% reduction in epileptic attacks in pediatric patients.
Indications for the ketogenic diet
The indications for the ketogenic diet are:
- In relation to seizure type: children who have frequent small generalized or focal seizures that do not respond to any anticonvulsant.
- In relation to age: its application is preferred in patients over 1 year of age up to adolescence.
- In relation to family and social environment: motivated and capable.
- In relation to drug tolerance: children who do not tolerate anticonvulsants due to side effects.
Diets and Medication for Neurological Disorders
All studies agree that diet does not replace anticonvulsant treatment and is only an adjunct that must be prescribed by a doctor. Otherwise, it can have complications. It has a high dropout rate (the main problem with the diet) and requires successive medical check-ups. Studies are still being conducted to understand its impact on neurological diseases such as Alzheimer’s, Parkinson’s, and brain trauma.