There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.
When a person goes off the ketogenic diet and regains much of their original weight, it’s often not in the same proportions, says Kizer: Instead of regaining lean muscle, you’re likely to regain fat. “Now you’re back to your starting weight, but you no longer have the muscle mass to burn the calories that you did before,” she says. “That can have lasting effects on your resting metabolic rate, and on your weight long-term.”
Saturated fat is not harmful in the context of a low carb diet. This study from Johns Hopkins Medical School confirms this. The ketogenic diet plan is healthier because the higher saturated fat intake increases your HDL cholesterol, and at the same time, a lower carb intake decreases your triglycerides levels. These two factors are the major markers for heart disease, and the closer your triglyceride/HDL ratio is to 1, the healthier your heart. In reality, the cause of heart disease is a chronically high carbohydrate consumption, not a high saturated fat and cholesterol intake. I think the best way to learn this is to get a full blood test before you start a ketogenic diet plan, then do the diet faithfully for 3 months. Then have your blood work checked again. You'll see the difference and discover how much better you feel.
So, we have a situation where the body has way too much insulin in the blood—yet the insulin is not able to do its job in the cells, either. The cells are resisting it. As a result, the body keeps making more and more insulin. These hormones are on a constant feedback loop, sending and receiving messages of “Sugar is high—release more insulin. . . . Must lower blood sugar for the body to stay alive.”
For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (two weeks) but the long-term seizure reduction rates are unaffected. Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.
Before starting, ask yourself what is really realistic for you, Mattinson suggests. Then get your doctor’s okay. You may also work with a local registered dietitian nutritionist to limit potential nutrient deficiencies and talk about vitamin supplementation, as you won’t be eating whole grains, dairy, or fruit, and will eliminate many veggies. “A diet that eliminates entire food groups is a red flag to me. This isn’t something to take lightly or dive into headfirst with no medical supervision,” she says.
Drink lots of water. This is especially crucial on a low carb or keto diet. Why? When you eat carbohydrates, your body stores the extra as glycogen in the liver, where they are bound to water molecules. Eating low carb depletes this glycogen, which allows you to burn fat – but it also means you are storing less water, making it easier to get dehydrated. Instead of the traditional recommendation of 8 cups of water per day, aim for 16 cups when following a low carb lifestyle.
A computer program such as KetoCalculator may be used to help generate recipes. The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower and green beans are all equivalent. Fresh, canned or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.
Keep in mind that the doctor is getting nutritional ketosis confused with a much more dangerous condition called ketoacidosis. These are two different conditions. Ketoacidosis is mostly a concern for Type 1 diabetics and others whose bodies are unable to make or process insulin correctly. Ketoacidosis usually develops when a person with type 1 diabetes develops an serious infection, has a heart attack or other debilitating illness. It is accompanied by dehydration, high blood sugars and is precipitated by the inability of the sick patient to administer proper amounts of injected insulin.
In the 1960s, it was discovered that medium-chain triglycerides (MCTs) produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides). MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system. The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on twelve children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
It can be tricky calculating the precise kind of diet that leads to a long life. Part of the problem is that (thankfully) we don't live our lives in highly controlled laboratory conditions. Until that terrifying day arrives and we all become well-studied lab rats, we have to rely on long-term observational data, usually in the form of surveys, to know more about which diets are the best long-term plans.
Initially you may be surprised that on keto diets you eat less frequently. That’s because the fats are pretty satisfying. But as you normalize and adjust into a ketogenic state, that may change and your appetite may increase. That’s fine and completely normal. Use whatever diet you decide to follow as a starting point – it should be “written in pencil” so that you can make changes along the way. Consider adding an extra meal, marginally increasing the size of the meals or just adding a shake between meals. It’s up to you – just listen to your body. For example for me, I added a low-carb “green powder” shake supplement to my regimen along with either flax seed oil or some nuts in order to satisfy my hunger.
The “Slaw Hash” Which is a actually eggroll filling without the wrapper is delicious even without being keto. My husband requests it every other week and he isn’t even really fond of cabbage. I use shredded cabbage, a few finely sliced white mushrooms, sliced white onion, ground pork or turkey, soy sauce, white pepper, a cap-full of bombay sapphire gin (tastes sort of like sake, without having to add a TON of sake), and one shredded carrot.
Note: Are you a vegetarian or vegan and want to go on a ketogenic diet? It’s still possible! Just keep in mind that the dietary restrictions can sometimes be a little bit intense. Make sure to plan ahead and prepare to aid your success. To help out, we’ve published articles (with 7 day meal plans included) for both the vegetarian ketogenic diet and the vegan ketogenic diet.