The ketogenic diet - review

A review of the ketogenic diet describes its waning popularity mid-century before a resurgence in the 1990s. Despite its long history, little is known of the underlying seizure-control mechanisms or its long-term effects.The review is written by authors from the Johns Hopkins Hospital, the institution credited with rekindling interest in the diet after using it to successfully treat a young boy with intractable seizures in the early 1990s. They say that reports of dietary therapy to treat epilepsy date back to biblical times. In 1911, French physicians reported the use of fasting as an epilepsy treatment, leading to a number of other case reports showing similar results. In 1921, the Mayo clinic proposed a diet similar to the ketogenic diet used today that mimicked the biochemical changes that occur during fasting.The introduction of anticonvulsants from 1938 resulted in waning popularity for the ketogenic diet. Interest was renewed after the father of the boy created the Charlie Foundation, which the authors say has helped inform patients and physicians about the diet.The review describes patient selection, the main indication for the diet being the presence of seizures that are difficult to control. The authors also describe initiation, maintenance, discontinuation, and side effects of the diet. They point out, "Any beliefs that the diet is 'holistic' or 'all-natural' are erroneous. The diet is not without side effects, which can be grouped into common, less common and rare." Although a large part of the review is dedicated to the proposed mechanisms of action of the diet, the authors say, "It has proved difficult to determine which of these many changes [in the biochemistry and physiology of the CNS] or their downstream effects are actually responsible for the diet's efficacy." Other unanswered questions include the diet's long-term effects on growth and development and the clinical consequences of side effects such as hyperlipidemia. Work is still required to determine which patients will benefit most from the diet, and ways to optimise the diet's efficacy and side effects.Reference...