Epilepsy and the Ketogenic Diet: Assessment of Ketosis in Children Using Breath Acetone

Musa-Veloso, Kathy

doi:10.1203/01.pdr.0000030717.77598.40

Cited by 21 publications

(12 citation statements)

References 19 publications

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“…29 Because of its volatile nature, acetone can be detected in breath where, at high concentrations, a typical fruity aroma results. As breath acetone increases during diabetic ketoacidosis, 9 fasting, and high-fat diets, 14,15,30 it is a reliable indicator of circulating ketone bodies. 9,16 To date, however, only substantial increases in exhaled acetone have been useful as biomarkers.…”

Section: Discussionmentioning

confidence: 99%

“…13 Acetone, a ketone body derived from oxidation of non-esterified fatty acids, is normally produced by humans in baseline conditions with very little circadian fluctuations. 14 Its production is known to increase with highfat ketogenic diets, 15 in diabetic ketoacidosis, 9 and in other catabolic conditions, such as starvation, during which hypoinsulinemia favors lipolysis and oxidations of lipids as a preferential energy substrate. 16 We hypothesized that subtler changes in exhaled ethanol and acetone, significantly smaller than those observed in the conditions reported above, may occur during the comparatively small fluctuations in blood glucose that physiologically follow ingestion of a normal meal and that the integrated analysis of these exhaled gas profiles may yield an indirect assessment of circulating glucose levels.…”

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confidence: 99%

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Breath Ethanol and Acetone as Indicators of Serum Glucose Levels: An Initial Report

Galassetti

Novak

Nemet

et al. 2005

Diabetes Technology & Therapeutics

190

147

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Background: Many volatile organic compounds are present in exhaled breath and may represent by-products of endogenous biological processes. Ethanol is produced via alcoholic fermentation of glucose by gut bacteria and yeast, while acetone derives from oxidations of free fatty acids, influenced by glucose metabolism. We hypothesized that the integrated analysis of breath ethanol and acetone would provide a good approximation of the blood glucose profile during a glucose load.Methods: We collected simultaneous exhaled breath gas, ambient air, and serum glucose and insulin samples from 10 healthy volunteers at baseline and during an oral glucose tolerance test (OGTT) (ingestion of 75 g of glucose followed by 120 min of sampling). Gas samples were analyzed by gas chromatography/mass spectrometry.Results: Mean glucose values displayed a typical OGTT pattern (rapid increase, peak values at 30-60 min, and gradual return to near baseline by 120 min). Breath ethanol displayed a similar pattern early in the test, with peak values at 30 min; this was followed by a fast return to basal levels by 60 min. Breath acetone decreased progressively below basal levels, with lowest readings obtained at 120 min. A multiple regression analysis of glucose, ethanol, and acetone was used to estimate glucose profiles that correlated with measured glucose values with an average individual correlation coefficient of 0.70, and not lower than 0.41 in any subject.Conclusion: The integrated analysis of multiple exhaled gases may serve as a marker of blood glucose levels. Further studies are needed to assess the usefulness of this method in different populations.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Breath Ethanol and Acetone as Indicators of Serum Glucose Levels: An Initial Report

Galassetti

Novak

Nemet

et al. 2005

Diabetes Technology & Therapeutics

190

147

View full text Add to dashboard Cite

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“…Breath acetone correlates with plasma ketone body measurements in children consuming a ketogenic diet [24] and, although it is assumed that acetone is eliminated mainly via pulmonary ventilation, some of it is metabolized further into other products, including acetol, 1,2-propanediol, methylglyoxal, and pyruvic acid. These metabolites are unlikely to contribute to the anticonvulsant effects of acetone in vivo [20].…”

Section: Do Ketone Bodies Mediate the Effects Of The Ketogenic Diet?mentioning

confidence: 99%

The Neuropharmacology of the Ketogenic Diet

Hartman

Gąsior

Vining

et al. 2007

Pediatric Neurology

277

169

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The ketogenic diet is a valuable therapeutic approach for epilepsy, one in which most clinical experience has been with children. Although the mechanism by which the diet protects against seizures is unknown, there is evidence that it causes effects on intermediary metabolism that influence the dynamics of the major inhibitory and excitatory neurotransmitter systems in brain. The pattern of protection of the ketogenic diet in animal models of seizures is distinct from that of other anticonvulsants, suggesting that it has a unique mechanism of action. During consumption of the ketogenic diet, marked alterations in brain energy metabolism occur, with ketone bodies partly replacing glucose as fuel. Whether these metabolic changes contribute to acute seizure protection is unclear; however, the ketone body acetone has anticonvulsant activity and could play a role in the seizure protection afforded by the diet. In addition to acute seizure protection, the ketogenic diet provides protection against the development of spontaneous recurrent seizures in models of chronic epilepsy, and it has neuroprotective properties in diverse models of neurodegenerative disease.

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“…The ketogenic diet (KD) is a high-fat, low-carbohydrate, and low-protein diet that is now widely used to treat epilepsy (1)(2)(3)(4). Although the diet has not undergone the rigorous evaluation process required for marketing of antiepileptic drugs, there is now a considerable body of evidence indicating that the KD is efficacious in the treatment of epilepsy (1,2,5,6).…”

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Detrimental Effects of the Ketogenic Diet on Cognitive Function in Rats

et al. 2004

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The ketogenic diet (KD) is a high-fat, low-carbohydrate, and low-protein diet that is widely used to treat epilepsy in children. Although the KD has been shown to be efficacious in the treatment of childhood epilepsy, the long-term effects of the KD on brain development are not clear. The objective of this study was to examine the long-term effects of the KD on visual-spatial memory, activity level, and emotionality in immature rats after status epilepticus (SE). Weanling rats were subjected to lithium/ pilocarpine-induced SE or saline injections and were then randomized to either the KD or regular rat diet, both fed ad libitum. One month later, rats were evaluated for visual-spatial memory in the water maze, activity level in the open field test, and emotionality with the handling test. Spontaneous recurrent seizures were measured using videotaping, and seizure susceptibility was tested with flurothyl inhalation. Brains were weighed and examined for mossy fiber sprouting and cell loss. Although rats treated with the KD were active and seemed healthy, their weight gain was substantially lower than that in rats that received regular rat diet. The KD reduced the number of spontaneous seizures but had no discernible effect on flurothyl seizure susceptibility. KDfed rats, with or without SE, had significantly impaired visualspatial learning and memory compared with rats that were fed regular diet. The KD had minimal effects on activity level and emotionality. Rats that were treated with the KD had significantly impaired brain growth. No differences in pathology scores between the KD and regular diet groups were seen after SE. Despite reducing the number of spontaneous seizures after SE, the KD resulted in severe impairment in visual-spatial memory and decreased brain growth, with no effect on mossy fiber sprouting. This study raises concerns about the long-term effects of the KD on brain development. The ketogenic diet (KD) is a high-fat, low-carbohydrate, and low-protein diet that is now widely used to treat epilepsy (1-4). Although the diet has not undergone the rigorous evaluation process required for marketing of antiepileptic drugs, there is now a considerable body of evidence indicating that the KD is efficacious in the treatment of epilepsy (1,2,5,6).Despite the use of the KD over several decades, the long-term effects of the KD on cognition are not yet known. Anecdotal reports suggest improvements in alertness, cognitive function, and behavior (2), although impairments in patients have also been reported (7). In a prospective study on the effects of the KD, Pulsifer et al. (8) found that developmental quotients in children on the diet improved after 1 y. One of the difficulties in evaluating cognitive effects of the KD in children is that the diet is rarely continued in children who do not respond with a reduction in seizure frequency (5, 9). The improvement in cognitive function therefore may represent the effects of reduced seizures, a positive cognitive effect of the diet, or a combination of these facto...

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Epilepsy and the Ketogenic Diet: Assessment of Ketosis in Children Using Breath Acetone

Cited by 21 publications

References 19 publications

Breath Ethanol and Acetone as Indicators of Serum Glucose Levels: An Initial Report

Breath Ethanol and Acetone as Indicators of Serum Glucose Levels: An Initial Report

The Neuropharmacology of the Ketogenic Diet

Detrimental Effects of the Ketogenic Diet on Cognitive Function in Rats

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