*Geek Box: Ketogenic Diet
Although we often talk about the ‘ketogenic diet’ in the singular, in the clinical management of epilepsy there are in fact a number of therapeutic options available to dietitians. The first is as mentioned above, the ‘Classical Ketogenic Diet’ – 4:1 ratio of carbs and protein combined, and the rest dietary fat. This is often 90% fat, 6% protein and 4% carbs. This is generally the go-to for young children, in home the diet can be administered by carers. There is also a ‘Medium Chain Triglyceride [MCT] Ketogenic Diet’, where of the total fat is around 75% of energy, but MCTs make up 60% of that fat. This is because, due to the unique metabolism of MCTs where they are absorbed directly by the hepatic portal vein and utilised for energy, slightly more carbohydrate can – up to 17% – can be consumed. This allows for some diversification of food choices. Finally, there is a Modified Ketogenic/Atkins Diet, which is a 1:1 ratio of protein:carb to fat, but in this case is 30% protein, 5% carbs, and 65% fat. All of these diets may achieve similar metabolic effects, and it may depend on the stage of clinical management for drug-refractory epilepsy in terms of choice for diet option. However, it is useful to bear in mind that ‘ketogenic diet’ may mean different things in terms of research, so it is important to look at the actual diet composition.