In this month’s issue of Ketogenic Diet News, we asked Dr. Adrianna Amari from the Kennedy Krieger Institute in Baltimore to report on her study which was published in the August 2007 issue of Epilepsy & Behavior. For many years, parents have asked me in their initial consultation, “Should my child go on the ketogenic diet? They LOVE bacon and eggs!” For years, I would then tell them, “They will probably love the food on the diet, and that’s good for sticking with it for a long time, but it has nothing to do with their epilepsy.” Dr. Amari has just proven that I am wrong! Her landmark study, which raises just as many questions than it answers, suggests that children’s brains are possibly telling their stomachs what to eat, and the ketogenic diet appears to be on the menu. Stay tuned for more studies to examine this exciting finding. | Eric Kossoff MD

By Adrianna Amari, PhD

Although the ketogenic diet has been found to be highly effective for the treatment of epilepsy, it is not always considered as a treatment option by pediatricians, neurologists, or families themselves. One of the reasons for this is the perception that children will find the high-fat/low-carbohydrate regimen unpalatable. Consequently, it is anticipated that it will be difficult to get them to comply with the diet, particularly eating the high fat items and being restricted from typical treat foods like candy or chips.

Until recently, this perception of unpalatability had not been assessed systematically. In the August 2007 issue of Epilepsy & Behavior, we report on a study our group conducted to assess the food preferences of children with seizures. Specifically, we assessed children’s preferences for high fat foods compatible with, and high carbohydrate foods incompatible with the ketogenic diet. We wanted specifically to study children who were not on the ketogenic diet to see what their preferences were.

Fifty-nine children between the ages of 2 and 17 years, 29 with seizure disorders and 30 without, participated in a food choice assessment, in which they were asked to choose which item they preferred from pairs of food items. Small tastes of foods were randomly presented in pairs from out of a selection of 7 high fat and 7 high carbohydrate foods, such that each food item was eventually paired with every other food item during the procedure. This method resulted in a rank order of preferences, and also enabled us to calculate preference scores for both the high fat and high carbohydrate food groups.

We were not surprised to find that children without seizure disorders preferred such typical treat items as candy corn and tortilla chips, but were quite surprised to find that children with seizure disorders actually preferred such atypical items as mayonnaise and cream cheese! Overall, children with seizure disorders had significantly higher preferences for high fat versus high carbohydrate items, while children without seizure disorders had the opposite preferences.

Parents were also surprised by these preferences. During this study, we had additionally assessed parents’ predictions of child food preferences, and found that parents’ perceptions of what their children may or may not prefer were often inaccurate.

Most parents did not think their children would prefer the high fat foods, and they were incorrect. Awareness of this may lead some caregivers to be more open to initiation of the ketogenic diet as a therapeutic option. In fact, several of the children in this study were subsequently started on the diet after now-convinced parents saw their children eating the high fat foods, much to their surprise.

Our group is planning a prospective study to track whether detection of these unusual preferences by systematic assessment can predict not only compliance with the diet, but perhaps even diet efficacy. Future research could also focus on understanding why these preferences exist.

Edited by Steven C. Schachter, MD
Submitted: August 7, 2007