Food- Fuel-Fitness; 3rd Edition - Healthy Living With Food Demineralization
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These occur when cortical neurons fire excessively, hypersynchronously , or both, leading to temporary disruption of normal brain function. This might affect, for example, the muscles, the senses, consciousness, or a combination. A seizure can be focal confined to one part of the brain or generalised spread widely throughout the brain and leading to a loss of consciousness. Epilepsy can occur for a variety of reasons; some forms have been classified into epileptic syndromes , most of which begin in childhood.
Epilepsy is considered refractory not yielding to treatment when two or three anticonvulsant drugs have failed to control it. When drugs fail, other options include epilepsy surgery , vagus nerve stimulation , and the ketogenic diet. The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus , On the Sacred Disease , covers the disease; it dates from c. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.
The first modern study of fasting as a treatment for epilepsy was in France in Two benefited enormously, but most failed to maintain compliance with the imposed restrictions.
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The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide , which dulled the mind. Around this time, Bernarr Macfadden , an American exponent of physical culture , popularised the use of fasting to restore health. His disciple, the osteopathic physician Dr. Hugh William Conklin of Battle Creek, Michigan , began to treat his epilepsy patients by recommending fasting. Conklin conjectured that epileptic seizures were caused when a toxin, secreted from the Peyer's patches in the intestines, was discharged into the bloodstream. Conklin's fasting therapy was adopted by neurologists in mainstream practice.
In , a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since In , prominent endocrinologist Henry Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite having studied the patients for only a short time.
Further studies in the s indicated that seizures generally returned after the fast. Charles P. Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. In , Rollin Turner Woodyatt reviewed the research on diet and diabetes. Russell Morse Wilder, at the Mayo Clinic , built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood ketonemia through an excess of fat and lack of carbohydrate.
Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely.
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His trial on a few epilepsy patients in was the first use of the ketogenic diet as a treatment for epilepsy. Peterman's work in the s established the techniques for induction and maintenance of the diet. Peterman documented positive effects improved alertness, behaviour, and sleep and adverse effects nausea and vomiting due to excess ketosis. By , the diet had also been studied in teenagers and adults. Clifford Joseph Barborka, Sr. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until During the s and s, when the only anticonvulsant drugs were the sedative bromides discovered and phenobarbital , the ketogenic diet was widely used and studied.
This changed in when H. Houston Merritt, Jr.
With the introduction of sodium valproate in the s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox—Gastaut syndrome , declined further.
In the s, medium-chain triglycerides MCTs were found to produce more ketone bodies per unit of energy than normal dietary fats which are mostly long-chain triglycerides.
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The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.
https://cidoliperssi.cf The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John M. Freeman at Johns Hopkins Hospital , which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research. There followed an explosion of scientific interest in the diet.
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In , Abrahams produced a TV movie, First Do No Harm , starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet. By , the ketogenic diet was available from around 75 centres in 45 countries, and less restrictive variants, such as the modified Atkins diet, were in use, particularly among older children and adults. The ketogenic diet was also under investigation for the treatment of a wide variety of disorders other than epilepsy. These studies generally examined a cohort of patients recently treated by the physician a retrospective study and selected patients who had successfully maintained the dietary restrictions.
However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias , as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort the patients in the study are chosen before therapy begins in which the results are presented for all patients regardless of whether they started or completed the treatment known as intent-to-treat analysis.
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy.
Early and modern studies also differ because the treatment protocol has changed. Concerns over child health and growth led to a relaxation of the diet's restrictions. A study with an intent-to-treat prospective design was published in by a team from the Johns Hopkins Hospital  and followed-up by a report published in The study enrolled children. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it.
During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better.
Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response. It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in , looked at 19 studies on a total of 1, patients.
A Cochrane systematic review in found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures. The other trials compared types of diets or ways of introducing them to make them more tolerable. A systematic review in looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, the side effects relatively mild.
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However, many patients gave up with the diet, for various reasons, and the quality of evidence was inferior to studies on children. Health issues include high levels of low-density lipoprotein , high total cholesterol , and weight loss. The ketogenic diet is indicated as an adjunctive additional treatment in children and young people with drug-resistant epilepsy. Some clinicians consider the two less restrictive dietary variants—the low glycaemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.
These include Dravet syndrome , infantile spasms , myoclonic-astatic epilepsy , and tuberous sclerosis complex. Several possible explanations exist for this gap between evidence and clinical practice. Because the ketogenic diet alters the body's metabolism, it is a first-line therapy in children with certain congenital metabolic diseases such as pyruvate dehydrogenase E1 deficiency and glucose transporter 1 deficiency syndrome ,  which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies.
The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.
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On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to ketoacidosis , and eventually coma and death. The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful.
Some evidence of synergistic benefits is seen when the diet is combined with the vagus nerve stimulator or with the drug zonisamide , and that the diet may be less successful in children receiving phenobarbital. The ketogenic diet is not a benign, holistic, or natural treatment for epilepsy; as with any serious medical therapy, complications may result.