Interview with Martin del Campo, MD

The ketogenic diet, which has been used with some success in children, has not proven as effective in adults. Although the Atkins diet achieves a state of ketosis (like the ketogenic diet), there is limited experience in adults with this diet. Therefore, C. Martin del Campo, MD, staff neurologist, and colleagues at the Epilepsy Clinic, University Health Network, Toronto Western Hospital, Toronto, undertook a study to determine if the Atkins diet can be an effective and sustainable method of seizure reduction for adults when used in addition to standard drug therapy. Their findings were presented at the recent annual meeting of the American Epilepsy Society.

Methods

According to the study abstract, patients with pharmacoresistant epilepsy who could follow the Atkins diet were randomized into one of two treatment groups -- either basic or intensive dietary counseling -- and initiated on a 20-gram carbohydrate diet. Menu plans and Atkins diet guidelines were provided. A control group was aged-matched to groups 1 and 2 and consisted of patients who were unable to follow the Atkins diet. Patients were assessed by a dietitian, physician, psychologist and nurse. Cholesterol, triglycerides, and fasting blood sugar were measured at baseline and at 6 months. Food intake records, ketosis, weight and body mass index (BMI) were evaluated.

Seizure frequency, severity and recovery time were tracked, and cognitive status and health-related quality of life (QOLIE-31) were assessed.

Results

Seven patients completed six months on the Atkins diet. Based on the findings in this group, Dr. del Campo said, "The Atkins diet can achieve sustainable ketosis over time. Fifty percent of the 7 patients studied showed worthwhile improvement in their seizure disorder."

In addition to the patients achieving ketosis, their cholesterol and triglyceride levels remained in acceptable ranges.

The study abstract also noted, "There was a moderate improvement in attention and learning efficiency, both below average at baseline and at the six-month follow-up, but no change in quality-of-life ratings."

Conclusions

Dr. del Campo said, "Although results are preliminary, given the small sample completing the protocol at this point, the Atkins diet may be a useful adjunct in the treatment of refractory epilepsy." He emphasized that "There is limited experience in adults using ketogenic diets. We need a large, long-term study in a variety of clinical scenarios in order to determine if dietary manipulations can be effective. At this point we are extrapolating from the pediatric experience and the reported numbers in adults are too small to draw conclusions."

We asked Dr. del Campo what implications his work has for people living with epilepsy. He told us, "There are large numbers of patients whose seizures remain refractory to current antiepileptic drugs, surgery and various forms of brain stimulation (vagal nerve, thalamic, hippocampal). There seems to be a lack of interest, on the part of the R&D groups at pharmaceutical companies, to develop new drugs in this field due to the limited market and economic power of those involved. One strong cultural trend is to seek non-pharmacological methods to treat medical problems."

"Almost every patient, regardless of what their medical condition is, asks if there is a diet they should follow or foods to avoid. If we could make definitive recommendations in this regard, beyond cultural fads and anecdotal accounts, patients and their care-givers might embrace these concepts in a way that ensures compliance. There is also a possibility that we could find a particular subset of patients in whom a ketogenic diet is particularly efficacious," he said.

"There is a suggestion that patients on the diet become more alert and have an improved sense of well-being. This is likely multi-factorial perhaps related to having fewer seizures, losing weight and sometimes being able to reduce medications," added Dr. del Campo. "There is also a sense of empowerment gained by patients and care-givers when they see themselves as taking active part in their day-to-day treatment. If we were able to substantiate these anecdotal observations, maybe more people would get involved both from the medical community and the population at large."

Next steps

For the next phase of his research, Dr. del Campo said, "I need to accrue more patients and continue following the existing ones. Unexpectedly, there seems to be limited interest in following a diet in the adult population. I guess it is no different than what happens in the diets for weight-reduction experience. I would have thought that patients with epilepsy would be more motivated. Part of the problem may be the expense associated with purchasing meat and vegetables (typically, adult patients are on social assistance or underemployed). Cultural trends toward the use of 'comfort foods' may be another obstacle. Having a supportive family member seems to be of benefit."

Further research for this therapy

How is Dr. del Campo planning to further research this therapy? He said, "A modified ketogenic diet appears to be safe and in some cases effective. I will continue to recruit patients by means of local advertising through non-governmental organizations and social interest groups. Evidently, there are barriers that need to be further explored. A large number of patients decline participation without an explanation. I need to know why and see if there is a solution. This requires time and personnel, neither of which can be had without monetary support. So far, I have conducted this effort through donations from families. If strong supportive data are accumulated perhaps in combination with other centers/countries, granting agencies could be persuaded to fund a large scale endeavor."

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Interview with Dr. del Campo was based on A Randomized-Controlled Study of the Efficacy and Sustainability of the Atkins Diet To Treat Medically Refractory Seizures by Debra MacGarvie, Nina Politzer, Mary Pat MacAndrews, and Martin del Campo at the following institution: Epilepsy Clinic, University Health Network, Toronto Western Hospital, Toronto, ON, Canada.

Authored By: 
Rita Watson MPH
Martin del Campo MD
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Authored Date: 
12/2006