Low glycemic index treatment: Implementation and new insights into efficacy

Abstract

SUMMARYDespite the substantial efficacy of the ketogenic diet (KD) in treating refractory epilepsy, use of the KD remains limited because of difficulties in implementation and tolerability. An effective alternative dietary approach is a low glycemic index treatment (LGIT), which liberalizes the extreme carbohydrate restriction of the KD but restricts the type of carbohydrate-containing foods to those that produce relatively small changes in blood glucose. Foods with a "glycemic index" of less than 50 produce less than half the area-under-the-curve elevation of blood glucose compared to a reference food. The LGIT approach produces comparable efficacy to the classic KD, but tolerability is improved and implementation is much simpler. The LGIT appears to be a viable first-line dietary therapy for epilepsy. KEY WORDS: Glycemic index, Low glycemic index treatment, Refractory epilepsy, Dietary therapy.Developed in the 1920s, the classic ketogenic diet (KD) is arguably the most effective treatment available for medically refractory epilepsy. Over the past 80 years, numerous case series of the classic KD, performed largely in children, have shown that up to one-third of patients who initiate the KD experience a dramatic decrease in seizure frequency (Bailey et al., 2005). However, there are several limitations to the availability, implementation, and maintenance of the KD.Traditional implementation of the KD required an initial fast of 24-48 h followed by gradual introduction of the KD over several days during an inpatient hospitalization. Ideally, calculation of the KD is performed by a skilled KD dietitian who educates the child and family in how to implement and maintain the KD, and who also prepares numerous individualized meal plans to meet the child's protein, fat, and carbohydrate goals to 0.1 g precision. Due to several factors, including a relatively limited number of experienced dietitians, difficulty with reimbursement, and the intensity of labor in initiating and maintaining patients on a classic KD, access to this diet remains limited. Even when the KD is available, its restrictiveness often makes it difficult for a child and family to adhere to, and being on

Medium-chain Triglyceride Ketogenic Diet, An Effective Treatment for Drug-resistant Epilepsy and A Comparison with Other Ketogenic Diets

“…All CHO foods' glycemic index are lower than 50. [15,16] This diet needs to be prescribed by a dietitian. Specific meal plans are not typically provided, but recommendations are made depending on food preferences and individual goals.…”

“…Vitamins and minerals are supplemented to meet individual needs. [15,16] The balance of low glycemic CHO in combination with fat results in steady glucose levels. [15,16] The MAD does not need diet prescription.…”

Ketogenic diets, mitochondria, and neurological diseases

“…The LGIT prevents large postprandial increases in blood glucose, resulting in more stable circulating levels of glucose, and in early studies has been shown to provide seizure control in a broad range of patients ( 64,65 ). This diet also allows for a greater intake of carbohydrates ( ‫ف‬ 40-60 g/day), but this is restricted to those foods with a GI of <50 ( 64,65 ). Total caloric intake is determined based on patient's needs, with 20-30% of calories coming from protein and the remaining 60% from fats ( 64 ) ( Fig.…”

“…The rationale for the LGIT was based on the clinical observation that the KD led to a sustained drop in blood glucose levels and on laboratory studies showing decreased seizure susceptibility in epileptic mice induced by CR (63). The LGIT prevents large postprandial increases in blood glucose, resulting in more stable circulating levels of glucose, and in early studies has been shown to provide seizure control in a broad range of patients ( 64,65 ). This diet also allows for a greater intake of carbohydrates ( ‫ف‬ 40-60 g/day), but this is restricted to those foods with a GI of <50 ( 64,65 ).…”

“…This diet also allows for a greater intake of carbohydrates ( ‫ف‬ 40-60 g/day), but this is restricted to those foods with a GI of <50 ( 64,65 ). Total caloric intake is determined based on patient's needs, with 20-30% of calories coming from protein and the remaining 60% from fats ( 64 ) ( Fig. 2 ).…”