The ketogenic diet
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Transcript of The ketogenic diet
The Ketogenic Diet
Ketogenic diet initially was developed in 1920
in response to the observation that fasting had anti seizure properties.
Ketogenic diet can stimulate metabolic effects of starvation.
Ketogenc diet-High fat and low carbohydrate
Introduction
It has beneficial effect on variety of metabolic,
Oncologic, neurodegenerative and psychatric disorders with different mechanism of actions.
It also has anti angiogenic effect
Direct and Indirect effects (neurotransmission, ATP production)
CLASS 1 CLASS 3EPILEPSY PARKINSONS DISEASE
ALZHEIMER DISEASE AMLTRAUMATIC BRAIN INJURY
AUTISM DEPRESSION
Indication
Epilepsy-mutation in GLUT-1,PDH deficiency DRAVERT SYNDROME: severe myoclonic epilepsy febrile seizuresDOOSE SYNDROME: myoclonic astatic epilepsy
Metabolic defects: PFK deficiency, McArdle diease(glycogenolysis type V)
Indications
Malignancy : Advanced astrocytoma,Gliomas
Trauma and ischemia: fuel to injured brain and cardio protective effects.
Neurodegenerative diseases: PD,AD calorie restriction itself is protective, ketogenic diet enhance mitochondrial function, improvement in UPDRS
Ketogenic diet protect against deposition of
amyloid. In AD high carb diet worsens the memory.
Mitochondrial dysfunction is found to be the cause of progression of ALS
Autism: patients on modified Radcliffe diet shown improvement in Childhood autism rating scale(CARS)
Depression: Ketogenic diet shown
improvement in Porsolt test and behavioural changes.
Migraine , Headache and Narcolepsy
In ketogenic diet body uses fat as primary
source.
Fat break down in liver-Ketones
In neuronal tissue ketones are used in mitochondria to generate ATP.
Relation between urine ketones and seizure control is imprecise .
Mechanism of action
Enhancement of GABA function by ketone
bodies and increases the expression of GAD( 65 & 57)
Saturated fatty acid and PUFA has neuro protective effect. Arachidonic acid inhibit voltage gated sodium channels.
Brain metabolizes ketone better under conditions of reduced glucose(calorie restriction)
DIRECT INDIRECT
KETONE BODIESSUBSTRATE DELIVERY
ENHANCEMENT OF MITOCHONDRIAL FUNCTION
ATP PRODUCTIONDECREASE ROS
NEUROTRANSMISSIONION CHANNELSMITOCHONDRIAL BIOGENISIS
Potential mediators
16
49
35
ProteinCarbFat
Standard diet
90
2 8
fatCarbProtein
Ketogenic Diet
646
30
FatCarbProtein
Modified Atkins diet
Diet compostion Ketogenic diet Atkins Diet
Fat(% by weight) 80 60
Protein(% by weight) 15 30
Carbs 5 10
Calorie(% of DRA) 75 Not restricted
Typical ketogenic
diets
Salad with walnuts Bluberry tart
Sausage and cabbage dinner with cream
Day prior to admission(Sunday): Reduce carb for 24 hr on fasting from evening
Day 1(Monday) On non carb fluids only, fasting continues till dinner(1/3 rd of the calculated maintainance). fluid restriction 60-75 cc/kg BG Q6H, orange juice for glucose
John Hopkins Protocol
Day 2 (Tuesday)Urine ketones periodicallyDinner increased to 2/3 rd. of maintenance.
Day 3 (Wednesday)Breakfast and lunch given providing 2/3 rd of maintainanceDinner full Ketogenic meal
Day 4 (Thursday)Full ketogenic diet breakfastEducation completedPrescription for carb free dietChild discharged
Low level acidosis
Lack of weight gain
Constipation
Diarrhoea and bloating
Side effects
Significant dyslipidemia
Kidney stones
Hypoalbuminemia
Pancreatitis
Vitamin deficiencies
Less common
After 2 years of seizure free or no
improvement after 3- 6 months
Dietary factors that worsen seizure:1. Glutamate eg: MSG2. Caffeine3. Alcohol4. betel nuts5. Herbal remedies
Discontinuation
59 year old male known case of Diabetes, CVA
,HTN came with history of diplopia and blurring of vision.
1 st episode of CVA on 2012 during that time he presented with blurring of vision with pupil dilated right eye and ptosis with left homonymous hemianopia. With no EOM involvement.
No limb weakness, DTR NORMAL.
Case presentation
At that time provisional diagnosis was mid
brain stroke.
The images MRI Brain showed
On 2015 jan CVA with slurring of speech and
right facial palsy. At that time CT brain was took
Patient presented with diplopia
SUMMARY
Final diagnosis: CVA-RIGHT OCCIPITAL ,LEFT
PARIETAL(MCA/PCA) RIGHT MEDIAL RECTUS PALSY PARTIAL 3RD NERVE PALSY (RIGHT SIDE) RIGHT FACIAL N UMN PALSY (RECOVERED) T2DM UNCONTROLLED (HBA1C :11) HTN