Nutrition and Traumatic Brain Injury Improving Acute and Subacute Health Outcomes in Military Personnel (2011) / Chapter Skim
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11 Ketogenic Diet
11 Ketogenic Diet
Pages 140-156
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From page 140... ...
KETOGENIC DIET AND THE BRAIN Since their development to treat epileptic children in 1921, ketogenic diets have been most studied in the context of pediatric epilepsy syndromes (Kossoff et al., 2009) , but the ketogenic diet has been further shown to be neuroprotective in animal models of several central nervous system (CNS)
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From page 141... ...
The traditional ketogenic diet consists of four parts fat to one part protein, with the fat components derived primarily from long-chain fatty acids. Modifications to the ketogenic diet have included a change of ratio to three parts fat to one part protein, the use of medium-chain triglycerides (MCT)
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From page 142... ...
Human Studies There are no known human clinical trials evaluating the role of ketogenic diet in TBI; however, ketogenic diets have been shown to be effective in difficult-to-treat childhood epilepsy syndromes in many cohort studies and two recent clinical trials. The classic 4:1 ketogenic diet, as well as modified ketogenic diets like the MCT diet, demonstrated similar efficacy in symptomatic generalized epilepsy syndromes and partial epilepsy syndromes, with the majority of cohort studies indicating greater than 50 percent reduction in seizures (Beniczky et al., 2010; Coppola et al., 2010; Nathan et al., 2009; Porta et al., 2009; Sharma et al., 2009; Villeneuve et al., 2009)
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From page 143... ...
The type of ketogenic diet also n=94 children diet or had no significant effect on the number aged 2–16 years, of children achieving > 50% or > 90% medium-chain followed up at triglycerides seizure reduction. 3, 6, and 12 ketogenic diet months The classical ketogenic diet group had (MCT)
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From page 144... ...
or other antiepileptic treatment Tier 2: Observational studies Beniczky Severe Retrospective Ketogenic diet After 3 months, 33 of the 50 patients had reduced seizure frequency of ≥ 50%. Of et al., 2010 pharmacoresistant study these 33 patients (responders)
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While 96% of survey responders would recommend ketogenic diet treatment to median others, only 54% would try said diet ketogenic diet prior to anticonvulsants if given the treatment choice again. duration was 1.4 years (range The effect of ketogenic diet on growth 0.2–8 years)
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BCAA. Fat-to-protein Addition of BCAA did not reduce seizure ratio with in patients who didn't already experience addition seizure reduction on ketogenic diet only.
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. Children's serum fatty acid levels were tested.
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Digestive disorder was the most common side effect, experienced by 74% of patients. 14 patients had > 50% reduction in Spulber Pharmotherapy- Prospective Ketogenic diet et al., 2009 resistant epilepsy study for 12 months seizure frequency.
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From page 149... ...
, 20 study children were seizure free, 21 had 90– 99% seizure reduction, 24 had 50–90% n=150 children reduction, and 18 had < 50% reduction. with difficult-to control seizures 83 of the 150 children were still on the diet at 12 months; of these, 11 were seizure free, 41 had > 90% reduction in seizure frequency, and 74 had > 50% reduction.
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From page 150... ...
. Compared to injured rats on normal diet, injured rats fed with ketogenic diet had decreased cytosolic cytochrome c level (p < 0.01)
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and decreased by ketogenic diet (p < 0.01 vs. rats on normal diet)
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From page 152... ...
The main reason given for discontinuing the ketogenic diet beyond 24 months was the patient being seizure-free or having a significant seizure reduction. Although there are no human short- or long-term studies evaluating the ketogenic diet for TBI, these data suggest that use of the ketogenic diet should be most strongly considered during the initial rehabilitation interval associated with the greatest gains.
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From page 153... ...
. As mentioned earlier, animal studies have evaluated the ketogenic diet in stroke, another form of acquired brain injury, as well as in neurodegenerative disorders such as AD, Parkinson's disease, and ALS (Gasior et al., 2006; Prins, 2008; Zhao et al., 2006)
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From page 154... ...
Although it would not be feasible to prescribe ketogenic diets to improve resilience against TBI, identifying dietary compounds that are precursors of ketones, such as medium-chain triglycerides, and evaluating whether they have positive effects when administered after the injury is warranted. There is a general need for demonstration of the benefit of ketone bodies and ketogenic diets in human TBI, including the use of exogenous agents to enhance the production and utilization of ketone bodies.
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From page 155... ...
2009b. Ketogenic diet reduces cytochrome c release and cellu lar apoptosis following traumatic brain injury in juvenile rats.
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From page 156... ...
2009. Comparison of seizure reduction and serum fatty acid levels after receiving the ketogenic and modified Atkins diet.
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