Low Carbohydrate Diets and The Brain
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1 Low Carbohydrate Diets and The Brain Eric H. Kossoff, MD Medical Director, Ketogenic Diet Center Associate Professor, Neurology and Pediatrics Johns Hopkins Hospital Baltimore, Maryland July 9, 2010
2 Topics The Ketogenic Diet for Epilepsy What is the Modified Atkins Diet? Other neurological disorders and low carbohydrate diets?
3 What is Epilepsy? Repeated seizures Electrical abnormality of the brain Can be genetic or a structural cause Unpredictable and terrifying Medications started in most cases
4 Seizure-Free Rates With Different Seizure-free monotherapy 1st AED 47% Strategies? Not seizure-free All regimens attempted 36% Seizure-free monotherapy 2nd AED 13% Seizure-free monotherapy 3rd AED 1% Seizure-free polytherapy 3% Kwan P, Brodie MJ. N Engl J Med
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6 The Ketogenic Diet: Basics 90% calories are fat 4:1 ratio of fat: carb+protein (grams) most common Fluid and calorie-limited Foods weighed on gram scales Typically started in the hospital over 4 days 24-hour fasting period optional Children continued for about 2 years if effective
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8 ~400 BC
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15 Henderson J Child Neurol 2006
16 6-Month Seizure Reduction from Ketogenic Diet Seizure-free 90-99% <50% 50-90%
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18 Bough Epilepsia 2007
19 Ideal Diet Situations Glut-1 deficiency Pyruvate dehydrogenase deficiency Infantile spasms Doose syndrome Severe myoclonic epilepsy of infancy (Dravet) Rett syndrome Patients receiving formulas only Combination therapy with vagus nerve stimulation Patients on zonisamide Recently worsened seizures
20 Ketogenic Diet: Side Effects Common (50%) Constipation Slowed weight gain Acidosis Occasional (5%) Reduced height velocity Significant dyslipidemia Renal stones Gastrointestinal upset Rarely leads to diet discontinuation
21 Kossoff Epilepsia 2009
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23 What about years after the ketogenic diet is over? 101 families surveyed Current age: 13 years (2-26) Median 6 years post-kd Seizure control generally still good Labs normal Mean total cholesterol: 158 mg/dl Height/weight/BMI normal No myocardial infarctions Patel Epilepsia 2010
24 Is There an Alternative Diet?
25 Topics The Ketogenic Diet for Epilepsy What is the Modified Atkins Diet? Other neurological disorders and low carbohydrate diets?
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28 No calorie restriction No fluid restriction No hospital admission (clinic education) No weighing of foods on gram scales No fasting required
29 How is it modified? Atkins High fat foods are allowed Modified Atkins High fat foods strongly encouraged
30 How is it modified? Atkins High fat foods are allowed Modified Atkins High fat foods strongly encouraged Carbs 20 grams per day induction Carbs grams per day indefinitely
31 How is it modified? Atkins High fat foods are allowed Modified Atkins High fat foods strongly encouraged Carbs 20 grams per day induction Carbs grams per day indefinitely Weight loss is a goal monitor calories Weight loss not usually a goal
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37 Modified Atkins Diet: (49%) of 160 children and adults with >50% seizure reduction to date 18 (11%) became seizure-free Appears more effective when a ketogenic diet formula milkshake is used during the initial month in children* 80% with seizure reduction after 1 month Improvement can be very rapid Kossoff Neurology 2003; Kossoff Epilepsia 2006; Kang Epilepsia 2007; Kossoff Epilepsy Behav 2007; Ito Brain Dev 2007; Kossoff Epilepsia 2008; Carrette Clin Neuro Neurosurg 2008; Weber Seizure 2008; Porta Seizure 2009; *Kossoff J Child Neurol 2010
38 Topics The Ketogenic Diet for Epilepsy What is the Modified Atkins Diet? Other neurological disorders and low carbohydrate diets?
39 Neurologic Uses for Diets Other than Epilepsy Autism 2003 Brain tumors 2003 Depression 2004 Narcolepsy 2004 Glycogenosis Type V 2005 Alzheimer s 2005 Traumatic brain injury 2005 Parkinson s 2005 ALS (Lou Gehrig s Disease) 2006 Migraine 2006 Sleep disorders 2007 Post hypoxic myoclonus 2007 Post anoxic brain injury 2008 Schizophrenia 2009
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42 Axona Approved March studies showing benefit Both sponsored and authored by Accera, Inc. Alzheimer s Association medical foods a subject of concern Henderson Neurotherapeutics 2008 Henderson Nutr Metab 2009
43 Head trauma Fluid percussion model; KD started immediately after trauma. Prins J Neurosci Res 2005
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45 Seyfried J Cancer Res Ther 2009
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47 Summary Low carbohydrate (and high fat) diets are becoming very widely used in epilepsy Other neurologic disorders under investigation
48 James Rubenstein MD Adam Hartman MD Patti Vining MD Mackenzie Cervenka MD Johns Hopkins Ketogenic Diet Center Zahava Turner RD Jennifer Dorward RD Bobbie Henry RD Paula Pyzik Gerry Harris Jaimie Franz Anita Charpentier, PharmD Paula Heneberry, LCSW Cheryl Connors, RN Rebecca Fisher, RN
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27/08/58. Kwan, P. and M.J. Brodie, Early identification of refractory epilepsy. N Engl J Med, (5): p
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