A Case Study on Copper Supplementation
The pediatric keto team from Toronto (Hospital for Sick Children) recently published a case report of a child with epilepsy who began to have nosebleeds and fatigue 8 years after starting the ketogenic diet. Labs showed anemia and neutropenia (low blood counts), and she was found to be copper deficient. All her blood counts improved after taking extra copper supplementation.
While we don’t know how common this is, this case report is important and raises the issue of making sure that children (and adults) on ketogenic diets take their vitamin and mineral supplements daily.
Families often ask me …
Which vitamins and minerals are the critical ones that can be low on diets?
B vitamins (B1/thiamine, B2 riboflavin, B3 niacin, B7 biotin, B12, folic acid)
These vitamins help convert food into fuel and energy. Fortified cereals, fruits, and vegetables can have B vitamins, which is why they are low on ketogenic diets. Most multivitamins contain B vitamins (e.g., Flintstones Complete, Centrum, etc.).
This helps prevent scurvy, repairs tissues, and fights infections. It is present in oranges and citrus (not many on the diet), but also available in broccoli, brussel sprouts, and kale.
This vitamin is technically a steroid, made in your skin with sunlight exposure, and helps your body absorb calcium. It is found in fatty fish and eggs, but also added to milk and orange juice, which are not on ketogenic diets. Children with low Vitamin D levels on ketogenic diets are at risk for bone density problems. Supplementation is recommended, along with checking levels.
This mineral (not a vitamin) helps the immune system and wound healing. Without it you can have hair thinning. It is found in beef, pork, and lamb, but is also in nuts, spinach, oysters, and grains. It can be supplemented in over-the-counter cold lozenges.
This mineral is needed to keep bones healthy and is always supplemented on ketogenic diet. It is found naturally in milk (not heavy cream), kale, sardines, yogurts, cheese, and broccoli.
This mineral also has been shown in several studies to be low on ketogenic diets and, without it, can lead to heart arrhythmias. It is found in brazil nuts, yellowfin tuna, sardines, beef, and halibut. Many centers check selenium levels in children on ketogenic diets and supplement extra if low.
See the reference to the case study above.
Fortifying the Diet with Vitamin and Mineral Supplements
It is very important to make sure your child is getting enough vitamins while on ketogenic dietary therapy. Most centers will use a standard over-the-counter multivitamin and supplement with calcium, Vitamin D, and other minerals.
There are currently two pre-made ketogenic specific vitamins:
Please discuss any additional supplementation with your ketogenic diet team!
Rashidian H, Liu YMC, Geraghty MT, Kobayashi J, Donner EJ, Klaassen RJ. Severe Neutropenia and Anemia in a Child With Epilepsy and Copper Deficiency on a Ketogenic Diet. Pediatric Neurology 2017 Aug 24. pii: S0887-8994(17)30792-0. doi: 10.1016/j.pediatrneurol.2017.08.007. [Epub ahead of print]