In November 2011, Dr. Helen Cross and I had the great pleasure of visiting India to lecture but also learn from Dr. Janak Nathan about how he has been able to modify the ketogenic diet culturally to be effective in India. This country certainly has many patients with epilepsy, occasionally sadly untreated due to stigma or sometimes the high cost of anticonvulsant drugs. Dr. Nathan learned how to use the ketogenic diet in the 1990s during a visit to Johns Hopkins. Dr. John Freeman and Millicent Kelley RD taught Dr. Nathan the basics of the ketogenic diet which he then brought back to his hometown of Mumbai (Bombay).
Very quickly, he realized that it wasn't going to work if given the same way. First, the high fat foods often used in the West (hamburgers, butter, creams) were not as palatable for Indian children culturally. They missed the breads (naans and rotis) and used different meats (no cow products), often meals need to be vegetarian as well. Second, he found very high cholesterol values when foods like this (using ghee) were given. Dr. Nathan adapted quickly, using soy products and mixed fats (polyunsaturated). Since then, the diet is more widely accepted and appears interestingly to induce less elevation in cholesterol, something the rest of the world can learn from. His work with polyunsaturated fatty acids (PUFAs) was specifically discussed during the 2011 American Epilepsy Society ketogenic diet special interest group, in fact.
Dr. Nathan is just one man, so he has spent years training other ketogenic diet centers, including a large center in New Delhi coordinated by Dr.Suvasini Sharma, who has published several articles on her work, specifically on the modified Atkins diet and infantile spasms. In addition, he has lectured to centers nearby India such as in Sri Lanka. By bringing the diet to India and other regions nearby, he has done an amazing job in helping countless children get help.
This past November, Dr. Helen Cross (Institute of Child Health in London, UK) and I were the guest speakers at a 2-day workshop held in Mumbai, India. Dr. Nathan organized the meeting, which attracted approximately 50 neurologists and dietitians. Topics ranged from the history of diets to their implementation and eventual discontinuation, including basic science evidence for their use. On the final day, several individual centers provided their personal experiences and research findings to the group. Dr. Nathan has been in contact with the Anita Kauffman Foundation (http://akfus.org/), the creators of "Purple Day", and at the end of the meeting all participants wore purple shirts for a group photograph. These centers were in various stages of experience, but we believe are now more confident and eager to implement dietary therapy as a result of the conference.
Nathan JK, Purandare AS, Parekh ZB, Manohar HV. Ketogenic Diet in Indian Children with uncontrolled epilepsy. Indian Pediatr. 2009 Aug;46(8):669-73