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Saturday, November 17, 2012

If you're going to go nutty ketotic ...

... you might want to take thiamine.

Optic neuropathy in ketogenic diet

SUMMARY A symmetrical, bilateral optic neuropathy is reported in 2 patients being treated with ketogenic diets for seizure control. Laboratory tests suggested a thiamine deficiency, and both patients recovered normal visual function after several weeks of treatment with thiamine. The risk of optic nerve dysfunction occurring during the treatment with a ketogenic diet can be minimised if routine vitamin B supplements are given and periodic evaluation of optic nerve function undertaken.

46 comments:

George Henderson said...

Fat and protein spare thiamine, carbohydrate spends it. there is something else going on here. Might phenytion or primidone have had something to do with it?
Both patients were prescribed vitamins - which they weren't given - because their prescribed diets were known to be deficient.
Not enough meat, dairy or offal is my guess.

Lighthouse keeper said...

Considering the fact that we are fundamentally primates not obligate carnivores, how can this ketogenic diet be apt in any way whatsoever? One noticed even Mr Nikoley is currently on an all potato diet a la Mr Voight the 'Potato guy'. Remembering the Jimmy Moore podcast with Mr Voight as Jimmy's finest half hour { or when J.M was at his most gobsmacked } it does seem strange that the paleo/LC crowd are weaving in and out in this manner as though practicing some dark art.

Evelyn aka CarbSane said...

Umm ... both parents said they complied with the diet but were not following supplements. They then supplemented thiamine and voila. Te boy on phenytoin and primidone remained on those drugs with the thiamine supplementation. So I don't get the reason for guessing at alternate explanations.

Lerner said...

Yep, the "science" of dieting is all just like showbiz these days, you've got to keep varying your routine to keep the fans coming back. They've all seen the much greater popularity and financial success of Tim Ferris and his hijinks.

So one thing not yet exhausted is ketosis. It's fresh meat, so to speak.

Lerner said...

One thing that the LC trendy gurus are almost unfailingly good at is in keeping the debate on their own terms. Taubes should have been laughed off the internet from day one because the Japanese weren't fat. Instead, people talk about insulin injection sites.

With LC, the superficial flaws completely obscure the fundamental flaws.

Wrt ketosis, why would Nature design a system that wastes the food/fuel which is a ketone body? Exhalation and urination, expelling fuel. This supposedly is an ideal and natural condition in everyday life for non-epilectics? Yeah, right.

Evelyn aka CarbSane said...

Yep ... so much time wasted chasing down tangents.

In addition to what you say about ketosis, one thing I've been repeating is why the body seems to fight it so. You have to consistently eat a truly unnatural diet to remain consistently in ketosis.

Re your other comment on ketosis, it's odd to me how it has been given new life. The populace, unfortunately, has a short memory, because there can be no doubt about why Atkins thought (or presented as his "science") his diet worked. I found the lack of discussion of ketosis in the New Atkins (Westman, Volek & Phinney) rather interesting, and in light of this new fangled take, I think at least Volek & Phinney have some 'splainin' to do.

blogblog said...

"Taubes should have been laughed off the internet from day one because the Japanese weren't fat."

In Japan obesity is considered taboo. It is literally a CRIME to be fat in Japan although no one is ever charged or prosecuted.

There is immense social pressure for Japanese to remain thin. Japanese people eat small meals and rarely snack.

Japanese women have a "correct" weight of 43kg. Even being a few kg overweight results in ridicule. A female Japanese friend of mine was called "Sumo" because she was considered grossly overweight at 55kg!

What about sumo wrestlers you ask? They cut back their food intake and try lose weight as quickly as possible after they retire. Most ex-sumo are normal weight.

blogblog said...

Note: I'm not defending Taubes just stating the strong cultural reasons why the Japanese aren't fat.

blogblog said...

This is a case of the "Macco's Razor' principle - wherein the LEAST likely explanation is probably correct.

Obviously the kids weren't enough raw liver and sheeps eyeballs and their butter wasn't from pature fed cows. /sarc

eulerandothers said...

It's not considered cool to be fat in France, either. Nor in Italy (that's what happens when you become aged and grandmotherly... granddads aren't the fat ones).

In these cultures, meat is eaten in rather small quantities, compared to the American diet. Vegetables are plentiful on plates, even in smaller-sized portions. And rice in Japan - every meal and many, many snacks are simply rice-based. In Italy, pasta and bread are staples , enjoyed with vegetables (which are carbs).

Tabus about being fat aside (offhand, I can't think of modern, civilized cultures in which fat women are considered sexy), the diets themselves are different. There are opportunities to eat more and more, just as there are those opportunities here - but you don't have gigantic portions (except maybe in restaurants in hotels that serve tourists).

My husband and I order fried calamari here in the States when it's on the menu. Not an appetizer in Italy the way it is here. Also, not portion-sized to serve four people as it is here. He and I split a portion. Really, with salad, that's a good-enough calorie hit to add salad and a mixed drink and you've got dinner! Make exactly the same dish with tempura batter on the calamari and it's the same scenario.

garymar said...

Japan is getting big on dieting. Informercials on TV all the time, full-page ads in the paper, even nonsense like the electric belt that 'melts' fat away. "Let's Diet" is a slogan for a diet shake sold at the department stores.

The young are still quite slender. The severely obese are rarer here than in North America or Europe, but you do see them. I'd say the population looks like the US around 1950 or so. Greater affluence and an aging population are part of it.

Oh, and about Okinawa. Okinawa now ranks next to last in longevity of all prefectures in Japan. So much for the healthy Okinawan diet -- which nobody eats any more!

garymar said...

My Mistake -- Okinawa not so unhealthy after all. (I could have sworn I read it in the newspaper). Anyway, 2007 statistics put WOMEN of Okinawa as #1 in longevity, but men of Okinawa are only 25th (out of 47), right in the middle.

The Health Ministry's "Healthy Life" ranking (computed by average age while not in long-term care or bedridden) puts Okinawan women at #4 and Okinawan men at #14. So Okinawa's not too shabby! Sorry I defamed her! They're still not eating the Okinawan diet, though.

garymar said...

Ignore my comments on Okinawa and read below.

garymar said...

http://stats-japan.com/t/kiji/11415 for men.

http://stats-japan.com/t/kiji/11421 for women.

screennamerequired said...

I've seen quite a few threads on paleo forums and low-carb forums having B1 thiamine deficiencies in their blood test. Whole grains tend to be the best source and the only really significant 'paleo' staple is pork. Not everyone eats bacon everyday, which probably isn't the best source either because most of the nutrients come from fat.

Evelyn aka CarbSane said...

The literature is littered with case studies like this. There are few longterm studies. One that I recall was in children and most of the evals were done 6mo-1yr after they stopped KD.

Recently came across a paper discussing ketones as substrate for de novo lipogenesis in the brain. Might explain a lot why babies might need ketones in addition to glucose to build their brains.

eulerandothers said...

http://www.ncbi.nlm.nih.gov/pubmed/22374558

'Rice intake and PRS were inversely associated with weight gain, and PRS was inversely associated with hypertension, but positively associated with fasting blood glucose elevation. No association between rice intake and PRS with the metabolic syndrome was found.'

PRS=Percentage of rice in staple food

Gabriella Kadar said...

screennamerequired: there is more to pork than bacon.

George Henderson said...

The ketogenic diet in the paper, if you know anything about the history of ketogenic dieting, is nothing like nutritional ketosis today.
It's a bunch of artificially made-up foods and extracted oils.
The diet was KNOWN to be deficient - that's why the supplements were prescribed.
It's not used today - a "modified Atkins' is used, it's more liberal and more sustainable.

it has happened before that drugs have introduced an element of malnutrition into ketogenic treatment of epilepsy. Valproate causes selenium deficiency independent of diet, this is a matter of record, but has resulted in a spurious connection between ketogenic dieting and selenium deficiency.

Vitamin deficiencies caused by drugs are commonplace and underdiagnosed. Anything that affects the gut can hinder absorption of those vitamins that depend on stomach acid, microflora, or metabolism in the gut lining.

Also, why was optic neuritis the only symptom of thiamine deficiency? Is this normal?
The supplements that corrected the problem were multivitamin, not just thiamine.

I linked to various papers on thiamine and diet here some time ago: http://hopefulgeranium.blogspot.co.nz/2012/08/the-role-of-vitamin-fortification-in.html

The sparing action of protein and fat on thiamine is mentioned here:
http://www.jbc.org/content/206/2/725.full.pdf

"In individuals with sub-clinical thiamine deficiency, a large dose of glucose (either as sweet food, etc. or glucose infusion), can precipitate the onset of overt encephalopathy"

http://en.wikipedia.org/wiki/Wernicke%E2%80%93Korsakoff_syndrome

Some people are also born sensitive to thiamine deficiency and transketolase insufficiency, this is thought to be the basis of Wernicke-Korsakoff syndrome.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2362.1984.tb01181.x/abstract;jsessionid=30B25BF6AF8031E8587F842548EA890A.d01t02

That something similar might be present in some cases of epilepsy doesn't seem out of the question.

Leo said...

Italians are getting fatter too
The problem is that researchers think of the "mediterranean diet" as a choice while it was actually a necessity.

In the past mediterranenan populations like italians ate a "meditteranean diet" with little meat, lot of beans, bread, season veggies and low calorie because they dind't have money to afford anything else.

Now that things are different and you can buy whatever you want, italians are eating exactly like americans. Not only, but it can be seen that the real traditional italian diet is anything but light or low calories.

Typical traditional foods in italy nowadays are: lasagna, panzerotti (fried dough filled with mozzarella), pizza, cotoletta (breaded fried meat) carbonara (eggs and bacon)) sgagliozze (fried cornmeal) barbequed pork ribs, fried liver with onions, fried sardines, pasta al forno (pasta, mozzarella, fried meatballs, sauce, parmesan, fried eggplants, mozzarella in cazzorra (fried bread with mozzarella cheese inside) and so on

The only reason why Italy was considered an healthy country consuming a mediterranean diet it's because people were too poor to eat those traditional dishes everyday, so they would resort to bread, beans, veggies. But now that people can afford it, the real traditional dishes can be seen for what they really are: high-carb, high-fat, mostly fried, high-calories. People don't eat many veggies in Italy, they don't eat beans anymore, the diet is definitely high in calories.

This proves once again that we're fatter because we can afford more calories, food ic cheaper and more caloric dense. There's no other reason. If certain population have a low-calorie diet and are thin it's because of necessity, because they can't afford more caloric-dense food. The only exception are health-conscious people who follow a nutritional regime and exercise and such. But spontaneous nutrition is low-calorie and low-fat when people live as poorer farmers and high-everything including calories when people can afford all the food they want.

George Henderson said...

J Food Prot. 1998 Dec;61(12):1681-3.
Thiamin, riboflavin, and alpha-tocopherol content of exotic meats and loss due to gamma radiation.
Lakritz L, Fox JB, Thayer DW.
Source
U.S. Department of Agriculture, Agricultural Research Service, Eastern Regional Research Center, Wyndmoor, Pennsylvania 19038, USA.
Abstract
Changes in thiamin, riboflavin, and alpha-tocopherol concentrations due to gamma irradiation were followed in alligator, caiman, bison, and ostrich (exotic) meats. The proximate composition showed that the exotic meats generally had lower fat content than domestic animal meats and that the thiamin content of the reptiles was lower. The changes in the vitamins due to irradiation were similar to those previously observed for domestic species. The results indicate that the loss of vitamins in these species is negligible insofar as the American diet is concerned, and that the concept of "chemiclearance" is applicable to exotic meats.

3 oz of braised beef liver has 9.2mg thiamine.

Typical analysis of canned ham per 100 g: 65-72 g water, 18 g protein, 5-12 g fat, 0.5-0.8 MJ, 1100-1250 mg sodium, 1.2-2.7 mg iron, 0.2 mg copper, 2 mg zinc, 0.5 mg thiamin, 0.2-0.25 mg riboflavin, 4 mg niacin, 0.2 mg vitamin B6, and may have residual ascorbic acid 10-60 ma.

Lean meat other than pork seems to be a poor source of thiamine; fish is the worst possible source, especially raw fish; nuts and milk are a good source.

George Henderson said...

I guess all they needed was some white rice to keep them out of ketosis then.
I mean, this is a harmful side effect of a KETOGENIC (raise hands in the sign of the cross) diet, isn't it?

As opposed to the effect of ANY diet deficient in thiamine (or maybe one or more other vitamin in the supplement).

And therefore telling us nothing worthwhile about nutty ketosis that doesn't also apply to diets of all macronutrient ratios.

George Henderson said...

Botez MI, Botez T, Ross-Chouinard A, Lalonde R. Thiamine and folate treatment of chronic epileptic patients: a controlled study with the Wechsler IQ scale. Epilepsy Res 1993 Oct;16(2):157-163.

Abstract: Seventy-two epileptic patients receiving phenytoin (PHT) alone or in combination with phenobarbital for more than 4 years were divided into four groups, the first taking two placebo tablets per day; the second folate (5 mg/day) and placebo; the third placebo and thiamine (50 mg/day); and the fourth both vitamins. The clinical trial lasted 6 months. At baseline assessment, 31% of the patients had subnormal blood thiamine levels and 30% had low folate. The vitamin deficiencies were independent phenomena. It was found that thiamine improved neuropsychological functions in both verbal and non-verbal IQ testing. In particular, higher scores were recorded on the block design, digit symbol, similarities and digit span subtests. Folate treatment was ineffective. These results indicate that, in epileptics chronically treated with PHT, thiamine improves neuropsychological functions, such as visuo-spatial analysis, visuo-motor speed and verbal abstracting ability.

Can J Neurol Sci. 1982 Feb;9(1):37-9.
Cerebrospinal fluid and blood thiamine concentrations in phenytoin-treated epileptics.
Botez MI, Joyal C, Maag U, Bachevalier J.
Abstract
Thiamine and folate levels in blood and cerebrospinal fluid (CSF) were determined by microbiological assays in 23 control subjects and 11 phenytoin-treated epileptics. There was no significant difference between the two groups for serum and CSF folate levels. There was, however, a statistically significant difference between the groups for both whole blood thiamine and CSF thiamine levels. Epileptic patients being treated with phenytoin had lower values than control subjects.i

George Henderson said...

Anticonvulsant therapy: Prolonged use of certain drugs, especially phenytoin, primidone, and carbamazepine, may lead to biotin deficiency; however, valproic acid therapy is less likely to cause this condition.[9] Some anticonvulsants inhibit biotin transport across the intestinal mucosa. Evidence suggests that these anticonvulsants accelerate biotin catabolism. Therefore, supplemental biotin, in addition to the usual minimum daily requirements, has been suggested for patients who are treated with anticonvulsants that have been linked to biotin deficiency.

Now, biotin is also required by transketolase and all the other thiamine-requiring enzymes. Deficiency of biotin is rare - except when taking these drugs - but would mimic thiamine deficiency by lessening its activity.

Epilepsy drugs will mess you up, which is why most parents of kids who did ketosis formerly say they would still recommend ketosis, despite side effects, if it lowers the need for drugs. Even parents whose kids didn't benefit tended to be in favour of others trying it.

Kade Storm said...

Not eating the 'Okinawan diet'. I believe this is why that older paper covering their diet in the mid 1900s--I believe the one Chris Kresser used in the Safe Starch Debate--reflects a much more positive and different picture with regards to the link between their longevity and diet.

There's no surprise that they no longer hold the same place they once did for longevity; their diet has undergone substantial changes.

George Henderson said...

So yes, this is in fact a spurious correlation between drug-induced thiamine deficiency and ketogenic dieting. But I can hardly fault you for not spotting it when the doctors responsible, who actually prescribed the drugs, couldn't or wouldn't see it.
Let this be a lesson for anyone who relies on the prescriber to identify a drug-induced malady. You have more chance of the pharmacist spotting it - always discuss treatment with the pharmacist as well as the doctor.

George Henderson said...

But see more recent comments higher in the stream - it was the drugs.

eulerandothers said...

Italians don't eat exactly like Americans. They can eat at McDonald's, but that's the most damaging 'eating like an American' habit any European can have.

http://www.ncbi.nlm.nih.gov/pubmed/22688375

'In conclusione, il nostro osservatorio ha permesso alcune importanti deduzioni:
a. un italiano su due ha problemi di peso;
b. la maggior parte degli obesi sono sedentari;
c. l’obesità è un fenomeno prevalentemente maschile;
d. gli uomini, sebbene più obesi, sono i più soddisfatti del proprio peso; in conseguenza sono meno portati a modificare i propri comportamenti;
e. l’obesità è una priorità dei nostri giorni, anche da un punto di vista culturale e di comportamenti;
f. l’obesità è un fenomeno che aumenta con l’età;
g. non vi sono rilevanti differenze del fenomeno obesità in termini di area geografica; si rileva solamente una leggera maggiore concentrazione di obesi nel Sud e nelle Isole;
h. il consumo eccessivo di alcol può essere considerato una delle concause dell’obesità;
i. è importante valorizzare i pasti come momento di convivialità e recuperare anche a tavola il piacere di intrattenersi a conversare;
j. è sconsigliabile mangiare meccanicamente senza distogliere lo sguardo dalla TV;
k. gli indici di aderenza e scostamento alle raccomandazioni si sono dimostrati validi indicatori.'

Italian eating behavior, 2011:
One in two Italians has a problem with weight. The obesity problem is predominantly a male problem, but men are actually pretty satisfied with their weight. And the obese person is likely one who is sedentary. Advice? Stop watching TV while you eat! Eat at the table and have conversations and enjoy your meal. You are more likely to gain weight as you age. And, oh, yes, don't drink so much alcohol!

Sanjeev said...

The food availability at a national level changes, sure ... but how are the various sub-categories spread out in the population - specifically,

Do you know if there's been anything like the "social contagion" modeling done on closely-monitored groups of Italians, like Christakis & Fowler did for Framingham, Massachusetts?

http://www.fas.harvard.edu/home/content/obesity-rate-will-reach-least-42-say-models-social-contagion

(ignoring the predictions, just concentrating on whether the math works out the same between a flu virus for example, and obesity)
or click here

other information on this type of model click here or copy & paste this into your URL location bar:

https://www.google.ca/search?client=ubuntu&channel=fs&q=social+contagion+model+obesity&ie=utf-8&oe=utf-8&redir_esc=&ei=cr2pULKeO7O1yQHR5oHABQ

PS - i re-evaluated my own spinach consumption - I really was eating way too much & I've reduced it hugely in favour of smaller amounts of a wider variety. Red cabbage is a new favourite.

Sanjeev said...

google mangled its own search link so the 2nd "click here" doesn't work - copy & paste is the only option

screennamerequired said...

"It's a bunch of artificially made-up foods and extracted oils."
Fair enough on the artificial foods, but as far as extracted oils go it seems pretty hard to do a ketogenic diet without them. Pretty much all low carbers love their added fats.

blogblog said...

A tasty ketogenic diet is incredibly simple. All it takes is some fatty meat and some non-starchy vegteables.

My local supermarket sells delicious gluten-free gourmet sausages in half a dozen varieties. They average 78% fat, 20% protein and 2% carbohydrate - then ideal ratio for a ketogenic diet.

The other alternative is to use coconut cream as an ingredient. It makes fantastic shakes and "icecream".

Evelyn aka CarbSane said...

Well, I can see I touched a real nerve here George. This was one of those rare off-the-cuff posts with little expanding on the topic. It's something I came across and basically passed along. You seem to be reading more into that study than there was. Two case studies where whatever their keto diet, predisposition to deficiency, or medication regime, developed optic neuropathy. They weren't taking the supps, and when they did, symptoms reversed.

So you make a great recommendation. The nutty ketotic should eat some liver from time to time.

@blogblog, That protein would apparently be too high for Jimmy and Attia.

BTW, I think most of these kids might run into problems of one sort or another without supplements as much due to calorie restriction as the limitations on foods.

True ketogenic diets are mostly no picnic for those following them, but I imagine when it works for the epileptic its well worth it.

Leo said...

eating sausages everyday is not my idea of tasty
also that would require buying more than a pound of sausage everyday, which is a lot of food, hassle (cooking and everything) and money

for some reason I can't picture someone eating sausage and spinach everyday as healthy and I'm pretty sure he/she would get tired of such diet in a matter of weeks.

eulerandothers said...

http://www.oecd.org/health/49716427.pdf

Italy is the one of the countries with the LOWEST rates of obesity. Korea and Japan and China, rice-eaters all, also have extremely low-rates, comparatively speaking.

What is surprising is how many more overweight/obese children there are - although the chart for adults confines the data to 'obese' and the chart for kids expands to include 'overweight/obese.' Greece, Italy and the United States seem to be in a race to see who can fatten up their children faster! Surprising because families share food and their food culture.

Leo said...

The only reason why in Italy there aren't many obese is that food is way more expensive than in america. Even a small burger costs more than what a bigger one costs on america. Not to mention the portion size of soft drinks, french fries, yogurt, croissant. Everything is bigger than cheaper in america.

The way italian eats (they love caloric dense, fried, fat and starchy foods) if food was as cheap in Italy as it is in america, italians would be more obese than americans are.

screennamerequired said...

Yeah. I also gag at the idea of sausauges. I followed a keto diet for over 6 months and although it can definitely be tasty it can start to get tiring and it certainly required me to use added fats. I wasn't following the nutty ketogenic diet with 85% fat and limited protein either. I'd imagine that would take a bit more planning. Towards the end of abandoning VLC it was strange I was craving foods like muesli and fruit, two foods I have never even cared for. I no longer crave meat and eggs these days and the thought waking up to cook myself another bacon and egg breakfast on a hot summers morning makes me cringe.

George Henderson said...

Well I've some awareness of the possible side effects of these kinds of drugs, my first interest was pharmacology.

if Jimmy Moore can be nutty ketotic and well nourished, is there any reason the epileptic kids couldn't eat as well?
Maybe not, according to this review: http://pediatrics.aappublications.org/content/119/3/535.full

A modified Atkins diet also is emerging as a possible alternative dietary treatment for seizures.28,29 With restriction of carbohydrates (10–20 g per day), the Atkins diet can induce ketosis and does not restrict protein, fluid, or calories and does not require an admission or a fast. In a follow-up study, 65% of patients on the Atkins diet had a >50% reduction in seizures and 6 (35%) had a >90% reduction.29 Additional studies of the modified Atkins diet are underway including adult patients with epilepsy.

A third diet is the low glycemic index diet,30 in which fruits, breads, and starches are discouraged. This diet has even fewer carbohydrate restrictions than the modified Atkins diet.

Low-glycemic-index treatment: A liberalized ketogenic diet for treatment of intractable epilepsy
Heidi H. Pfeifer, RD, LDN and Elizabeth A. Thiele, MD, PhD

http://www.neurology.org/content/65/11/1810.full

The ketogenic diet is often effective for intractable epilepsy, but many patients have trouble complying with the strict regimen. The authors tested an alternative diet regimen, a low-glycemic-index treatment, with more liberal total carbohydrate intake but restricted to foods that produce relatively little increase in blood glucose (glycemic index < 50). Ten of 20 patients treated with this regimen experienced a greater than 90% reduction in seizure frequency.

eulerandothers said...

I agree that food in America is cheap. The 'big and cheap' thing is noticed by anyone who visits here - although they may have some complaints about quality of various items.

George Henderson said...

Here's a question - epilepsy is pretty much regarded as the case where nutty-K is obligate if you're going to use diet.
Yet Pfeifer and Thiele are getting good results - good enough for 4 of 11 patients to have complete freedom from seizures - with a more liberal low carb diet based on low-GI carbs, that is, by minimizing glucose rather than by increasing ketones.
This should make us question which other benefits usually attributed to ketosis could be achieved with the same approach.
Full text here: http://www.direct-ms.org/sites/default/files/KetogenicDietModifiedEpilepsy.pdf

It's unfortunate that actual foods and carbs intakes aren't specified in the paper.

George Henderson said...

Here's more detail:

How is it different from the ketogenic diet?
The LGIT allows for an increased intake of carbohydrates, with a typical goal of 40-60 grams per day. Food quantities are not weighed out to the gram, but are based on portion sizes. Because it is based on portion instead of exact measurement, patients are able to live a more flexible lifestyle that includes eating at restaurants. Foods that are the basis for the ketogenic diet and are high in fat, such as heavy cream and high fat meats (bacon, sausage, hot dogs and eggs) are also included in the LGIT. However, on the LGIT the percentage of calories from fat is approximately 60%, compared with up to 90% on the ketogenic diet.

George Henderson said...

A case study: http://www2.massgeneral.org/childhoodepilepsy/families/rose.htm

Because Rose had tried several medications without success, and because her seizures were still impacting her quality of life, her family decided to speak with her doctors about other treatment options. Initially, a dietary therapy called the ketogenic diet was recommended, but for this teenager and her busy family, it didn't seem like a good fit. Both parents work full time, and Rose and her siblings have active schedules, so the planning and weighing of foods involved in the ketogenic diet felt too restrictive for them.

They chose instead to try a new dietary therapy, called the low glycemic index treatment (LGIT). The LGIT allows a more generous intake of carbohydrates than the ketogenic diet but is restricted to foods that are low in glycemic index, meaning foods that have a relatively low impact on blood glucose levels. For example, Rose cannot eat pasta, most breads, some tropical fruits, or candy because these foods raise blood glucose levels too high. Instead, she eats meats, cheeses, and most vegetables because these foods have a relatively low glycemic index. She doesn't have to weigh her foods but instead must pay attention to portion size, balancing her intake of carbohydrates throughout the day with adequate amounts of fats and proteins.

http://www2.massgeneral.org/childhoodepilepsy/medical/treatment.htm

The low glycemic index treatment (LGIT) is another dietary therapy currently being studied to treat epilepsy. Like the modified Atkins diet, the LGIT also attempts to reproduce the positive effects of the ketogenic diet. However, it allows for a broader range of food types and, again, does not require the weighing of foods.

Carbohydrate intake on the LGIT is less restricted than on the ketogenic diet. The LGIT allows for approximately four times as many grams of carbohydrates, provided that they come from foods with a low glycemic index. The glycemic index is a measure of a particular food's effect on the body's blood-sugar level. Foods that contain simple sugars, such as sucrose (table sugar), have a high glycemic index because they rapidly raise blood sugar after consumption. Conversely, many grains and legumes have a low glycemic index because they affect blood-sugar levels more slowly than high glycemic index foods. Counting carbohydrates and rough portion control is usually sufficient for the treatment to have a seizure-reducing effect.

As with other epilepsy treatments, it is not known how the LGIT works, but preliminary study results suggest that it may be as effective as the ketogenic diet, reducing seizures by half in 70 percent of patients. Because it is more easily tolerated than other dietary therapies, physicians and patients may be more likely to consider the LGIT a treatment option.

Taryl said...

Oh George, I don't know why you bother! It seems you get ignored if you point any research that doesn't support the favored conclusion of ketosis=EVIL! around these parts.

Still, I find the abstracts linked here and elsewhere highly educational and thought provoking, at the very least :)

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