Substantial early changes in bone and calcium metabolism among adult pharmacoresistant epilepsy patients on a modified Atkins diet

Abstract

Objective:The aim of this study was to investigate whether the modified Atkins diet (MAD), a variant of the ketogenic diet, has an impact on bone-and calcium (Ca) metabolism.Methods: Two groups of adult patients with pharmacoresistant epilepsy were investigated. One, the diet group (n = 53), was treated with MAD for 12 weeks, whereas the other, the reference group (n = 28), stayed on their habitual diet in the same period. All measurements were performed before and after the 12 weeks in both groups. We assessed bone health by measuring parathyroid hormone (PTH), Ca, 25-OH vitamin D (25-OH vit D), 1,25-OH vitamin D (1,25-OH vit D), phosphate, alkaline phosphatase (ALP), and the bone turnover markers procollagen type 1 N-terminal propeptide (P1NP) and C-terminal telopeptide collagen type 1 (CTX-1). In addition, we examined the changes of sex hormones (estradiol, testosterone, luteinizing hormone, follicle-stimulating hormone), sex hormonebinding globulin, and leptin.Results: After 12 weeks of MAD, we found a significant reduction in PTH, Ca, CTX-1, P1NP, 1,25-OH vit D, and leptin. There was a significant increase in 25-OH vit D. These changes were most pronounced among patients <37 years old, and in those patients with the highest body mass index (≥25.8 kg/m²), whereas sex and type of antiseizure medication had no impact on the results. For the reference group, the changes were nonsignificant for all the analyses. In addition, the changes in sex hormones were nonsignificant.Significance: Twelve weeks of MAD treatment leads to significant changes in bone and Ca metabolism, with a possible negative effect on bone health as a result. A reduced level of leptin may be a triggering mechanism. The changes could be important for patients on MAD, and especially relevant for those patients who receive treatment with MAD at an early age before peak bone mass is reached.

A Review of the Multi-Systemic Complications of a Ketogenic Diet in Children and Infants with Epilepsy

“…Young patients on a KD often have osteopenia due to reduced vitamin D and calcium levels, which predisposes patients to pathological fractures [ 75 , 76 , 77 ]. Non-ambulatory patients and patients with a BMI greater than 25 are more susceptible to poor bone health [ 78 ].…”

Stress biomarkers in adult patients with drug‐resistant epilepsy on a modified Atkins diet: A prospective study

“…The reason for the reduction in FCI and increase in CBG may be due to reduced insulin resistance after 12 weeks on MAD. In support of such a claim is the body weight reduction we previously found 20 . However, weight loss was not significantly correlated with CBG, nor with FCI.…”

“…In support of such a claim is the body weight reduction we previously found. 20 However, weight loss was not significantly correlated with CBG, nor with FCI.…”

Ketogenic diets and Ketone suplementation: A strategy for therapeutic intervention

“…It is important to avoid malnutrition and include an adequate intake of macro- and micronutrients. Low-carbohydrate diets are often low in thiamin, vitamin B6, folates, vitamin A, vitamin E, calcium, magnesium, iron or vitamin K. There is a reduced bone- and calcium (Ca) metabolism and a risk for developing hypercalciuria and kidney stones ( 12 ). Urine analysis and urine calcium creatinine ratio should be analyzed during KD.…”