Marleen Van Driessche Dietitian University Hospital Ghent, Belgium. The Ketogenic Diet

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2 Marleen Van Driessche Dietitian University Hospital Ghent, Belgium The Ketogenic Diet

3 The Ketogenic Diet, what is it?

4 What is it? High En% of fat En% Adequate protein intake 6 7 En% Low En% of carbohydrates 5 9 En% 4 / VOETTEKST

5 Why? The ketogenic diet Ketones Less epileptic seizures (mechanism?) Energy for the brain instead of glucose 5 / VOETTEKST

6 Population Children with refractory epileptic seizures Children with metabolic diseases Glucose transporters deficiency (GLUT 1) Pyruvate dehydrogenase deficiency (PDH) Near future? Alzheimer, brain tumor, autism, parkinson, ALS 6 /

7 Contra-indications Fat oxidation deficiencies Pyruvate carboxylase deficiencies Primary carnitine deficiencies Porphyria Hyperlipidemia, diabetes, hyperinsulinism Liver, kidney and pancreas diseases 7 / VOETTEKST

8 Different kinds of the ketogenic diet

9 Different kinds of the ketogenic diet Classic Ketogenic diet MCT Ketogenic diet Modified Atkins diet (MAD) Low glycemic index diet (LGID) 9 / VOETTEKST

10 Classic Ketogenic diet 90 En% fat (LCT) 10 En% protein + carbohydrates MCT Ketogenic diet En% MCT + 10 En% LCT 11 En% protein + 19 En% CH Modified Atkins diet (MAD) 60 En% fat 30 En% protein 10 En% carbohydrates No restriction of calories or fluids 10 / VOETTEKST

11 ? Pros and cons classic + All products available in supermarkets + Products for bottle, tubefeeding and drinkfood available in pharmacy - Very low carbohydrates - Nutrition deviates strongly from normal diet - Constipation, nausea, vomiting and growth 11 / VOETTEKST

12 ? Pros and cons with MCT + More carbohydrates + Nutrition more comparable with normal diet, except for fat emulsion. - Use of dietary preparations - Constipation, nausea, vomiting and growth 12 / VOETTEKST

13 ? Pros and cons with Modified Atkins diet (MAD) + Ketones + Decreasing epileptic seizures + No weight loss, but growth + More carbohydrates + More protein intake - High intake of fat 13 / VOETTEKST

14 TREATMENT WITH THE KETOGENIC DIET Introduction 1 : Informative consult to parents/ patient - What is a Ketogenic Diet - Different types - Side - effects of the diet - Clinical start - Expectations from parents and patient - Attainability for the family - Feeding method ( oral, tube feeding, PEG ) 14 / VOETTEKST

15 2 : Decision of the parents IF YES : - Request to keep a three days food diary (parents) - Calculation of the diary - Calculation of the energy and protein requirements - Calculation of the classic ketogenic diet 15 / VOETTEKST

16 Classic ketogenic diet and ratio RATIO 4 : 1 For every 4 grams of fat there is 1 left for combining potein + carbohydrates RATIO 3,5 : 1 and 3 : 1 is used in young children (higher protein need) 16 / VOETTEKST

17 HOSPITALISATION 5 days : monday till friday Day 1 -All sugars ommited ( sweets, medicine containing sugar) - Ratio 1 : 1 Day 2 = Ratio 2 : 1 Day 3 = 3 : 1 Day 4 = 4 : 1 Day 5 = Fine tuning 17 / VOETTEKST

18 Controle ketones Goal : in urine, use ketostick Start 2 times a day, morning and evening In steady ketosis once a day, evening More controle : ill, in urine, increasing seizures, changes in medication 18 / VOETTEKST

19 Controle weight In first 3 months : once a week After 3 months : once a month Decreasing weight or growth stop : increase calories 19 / VOETTEKST

20 Controle glycemia Start controle 2 times a day, before breakfast and before dinner. Hypoglycemia < 40 mg/ dl : If no symptoms no treatment control after 20 minutes, > 40 mg/dl stop control Positive symptoms ( pale, dozy, sweaty, ) Give 0,5 ml fruitjuice / kg bodyweight control after 20 minutes Hypoglycemia < 30 mg/dl 0,5 ml fruitjuice/kg 20 / VOETTEKST

21 KETOSIS Goals Urine : (8-16 mmol/l) ketones Blood : 2 5 mmol/l ketones Measuring ketones in urine : ketostick Measuring ketones and glucose in blood : Fingerprick with the Precision Xceed ( Abbott) to determine. 21 / VOETTEKST

22 PREPARATIONS NUTRICIA : Ketocal 4 : 1 (vanilla, neutral taste) Ketocal 3 : 1 Liquigen ( 50% MCT oil + 50% water ) Calogen ( 50% soya oil + 50% water ) VITAFLO : Betaquick, Carb Zero Keyo 22 / VOETTEKST

23 MARLEEN VAN DRIESSCHE Dietitian Pediatric department of the university hospital Ghent, Belgium Universitair Ziekenhuis Gent C. Heymanslaan 10 B 9000 Gent T +32 (0) E info@uzgent.be Volg ons op

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