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Wednesday, January 15, 2014

As in prior years, our January edition of Keto News is devoted to a recap of research from the prior year. 2013 was another excellent year with some very interesting studies published. We also saw the special issue published that recapped the 2012 Chicago ketogenic diet conference.

Similar to other Top 10 lists, these articles are in no particular order and are certainly not exhaustive of all the approximately 100 published. Feel free to look up the entire article if you are more interested.

  • “Catch-up growth after long-term implementation and weaning from ketogenic diet in pediatric epileptic patients” by Kim et al. Dr. Kim and his team from Korea continue to add to the ketogenic diet literature, this time with 40 children both before, on and after the ketogenic diet was stopped. They found, similar to many other studies, that height and weight gain are impacted by the diet, but in this unique study, children (especially those who can walk) were able to catch up after the diet was over (measured 1 year later). This research continues to add to a growing interest in long-term effects of the diet after it’s stopped.

  • “Epilepsy characteristics and psychosocial factors associated with ketogenic diet success” by McNamara et al. The team at University of Michigan evaluated social factors in 23 families (e.g., family functioning, insurance status) and found that these factors did not influence the success of the diet (only lower seizure frequency before starting did). The diet should not be discouraged for families that have significant challenges in making it work (but these challenges certainly should be addressed before starting!).

  • “Intermittent fasting: a ‘new’ historical strategy for controlling seizures?” by Hartman et al. This study was highlighted back in the February edition of Keto News. In a very small series of 6 children receiving the ketogenic diet, an intermittent fasting protocol (2 days per week) led to improvement in seizure control in 4, but was difficult to adhere to. This shows that fasting and the ketogenic diet may be two separate treatments.

  • “Efficacy and safety of the ketogenic diet in Chinese children” by Suo et al. Continuing to advance the ketogenic diet internationally, China is perhaps one of the most exciting new ketogenic diet countries. I had the pleasure of visiting with the team from Szenzhen last year and discussing this research with Dr. Liao (the second author). Continue to expect new research from China in the future!

  • “Can children with hyperlipidemia receive ketogenic diet for medication-resistant epilepsy?” by Liu et al. In this study from Toronto, Christiana Liu and her team demonstrated that 12 children with high serum cholesterol had reduction in their baseline lab results by 12 (and sometimes even 6) months on the ketogenic diet. This important study was highlighted in the May edition of Keto News.

  • “Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse” by Sussman et al. This study found that pregnant mice fed the ketogenic diet had embryos with differences in organ size. At 13.5 days, the embryos had smaller brains but larger hearts…but at 17.5 days there were smaller hearts and larger brains and spines. The significance of this (and why these changes flipped) is not clear, but further research into this is clearly needed as more adults (including women interested in childbirth) are starting ketogenic diets.

  • “Transitioning pediatric patients receiving ketogenic diets for epilepsy into adulthood” by Kossoff et al. I highlighted this study from my team in July. We reported on the value of an Adult Epilepsy Diet Center in helping find ketogenic diet care for children who become adults and still required dietary treatment.

  • “The ketogenic diet: Initiation at goal calories versus gradual calorie advancement” by Bansal et al. The team at Children’s National Medical Center in Washington, DC, evaluated their experience starting children on the diet with full calories (vs. a more traditional gradual introduction of calories). There was no difference in tolerability, but better outcomes at 3 months. This study would suggest that in some situations the diet can be started more quickly, and perhaps the benefit is a shorter hospitalization.

  • “Glucose transporter type 1 deficiency effective treated with modified Atkins diet” by Haberlandt et al. Although only a single case report, this 6 year old girl did very well with the modified Atkins diet for her GLUT1 deficiency, a concept not traditionally recommended (vs. the ketogenic diet). This article and other questions about the diet and GLUT1 was discussed in the last Keto News.

  • “Ketogenic diet improves core symptoms of autism in BTBR mice” by Ruskin et al. The group from Trinity College in Connecticut, which has shown the diet to be helpful in pain models, has now investigated it for juvenile mice with a model of autism. Mice treated with the ketogenic diet had less repetitive behaviors and more social communication. This effect did not seem related to fewer seizures. Obviously more work needs to be done in children with autism, but dietary treatments may have value.

References

  • Kim JT, Kang HC, Song JE, Lee MJ, Lee YJ, Lee EJ, Lee JS, Kim HD. Catch-up growth after long-term implementation and weaning from ketogenic diet in pediatric epileptic patients. Clin Nutr 2013;32:98-103.
  • McNamara NA, Carbone LA, Shellhaas RA. Epilepsy characteristics and psychosocial factors associated with ketogenic diet success. J Child Neurol 2013;28:1233-1237.
  • Hartman AL, Rubenstein JE, Kossoff EH. Intermittent fasting: a “new” historical strategy for controlling seizures? Epilepsy Res 2013;104:275-279.
  • Suo C, Liao J, Lu X, Fang K, Hu Y, Chen L, Cao D, Huang T, Li B, Li C.. Efficacy and safety of the ketogenic diet in Chinese children. Seizure 2013;22:174-178.
  • Liu YM, Lowe H, Zak MM, Kobayashi J, Chan VM, Donner EJ. Can children with hyperlipidemia receive ketogenic diet for medication-resistant epilepsy? J Child Neurol 2013;28:479-483.
  • Sussman D, van Eede M, Wong MD, Adamson SL, Henkelman M. Effects of a ketogenic diet during pregnancy on embryonic growth in the mouse. BMC Pregnancy Childbirth 2013;13:109.
  • Kossoff EH, Henry BJ, Cervenka MC. Transitioning pediatric patients receiving ketogenic diets for epilepsy into adulthood. Seizure 2013;22:487-489.
  • Bansal S, Cramp L, Blalock D, Zelleke T, Carpenter J, Kao A. The ketogenic diet: Initiation at goal calories versus gradual calorie advancement. Pediatr Neurol 2013;online early.
  • Haberlandt E, Karall D, Jud V, Baumgartner SS, Zotter S, Rostasy K, Baumann M, Scholl-Buergi S. Glucose transporter type 1 deficiency effective treated with modified Atkins diet. Neuropediatrics 2013; online early.
  • Ruskin DN, Svedova J, Cote JL, Sandau U, Rho JM, Kawamura M Jr, Boison D, Masino SA. Ketogenic diet improves core symptoms of autism in BTBR mice. PLoS One 2013;8:e65021.  
Authored by: Eric Kossoff MD on 1/2014
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