Worldwide Use of the Ketogenic Diet

Abstract

Summary: Purpose: Over the past decade, the use of the ketogenic diet internationally has increased dramatically. The purpose of this survey was to evaluate the use of the diet worldwide.Methods: With the use of the Internet, e-mail requests for information about international ketogenic diet centers (outside the United States) were made over a 9-month period. Assistance also was obtained from the Child Neurology Society and International League Against Epilepsy. Questions included patient enrollment (total and annually), year the diet was first offered, unique cultural and religious issues in the country, community opinion, and research interests.Results: Successful communication was made with 73 academic centers in 41 countries outside the United States. Sixteen (39%) countries provided information from multiple centers. The median duration offering the diet was 8 years (range, 1-45 years).The average number of patients enrolled to date was 71.6 per country, with 5.4 new patients annually. Common difficulties included avoiding rice intake, tolerating higher fat-to-protein and carbohydrate ratios (e.g., 4:1), finding specific nutritional labels on foods, and handling the growing interest from large populations with limited resources. Nevertheless, cultural and religious issues were generally not limiting; physician and patient acceptance of the diet as an option is high; and most meals were similar among countries. Centers often had great pride in their programs, and international collaborative groups are forming rapidly. A website is now available with updated center information at http://www.neuro.jhmi.edu/Epilepsy/Peds/ketoworldwide.htm Conclusions: Despite occasional difficulties, the ketogenic diet is being used worldwide.

Improving tolerability of the ketogenic diet in patients with abnormal endoscopic findings

“…Even though efficacy and safety have been demonstrated in several studies over the past decade [1][2][3][4], GI intolerability and various other complications have limited its use in many patients [5][6][7][8][9]. A high-fat diet prolongs gastric emptying time and can cause vomiting, especially in patients with gastroesophageal reflux [12].…”

“…The ketogenic diet (KD) has been found to be an important treatment modality for intractable epilepsy in children [1][2][3][4]. Despite its potent antiepileptic efficacy, wide application of the KD for long-term maintenance has been limited in some children by poor tolerability [5][6][7][8].…”

Practical Use of the Ketogenic Diet in Childhood Epilepsy

“…The ketogenic diet has experienced a reemergence in recent years and modern clinical studies have established the treatment as significantly effective . The ketogenic diet is now available in over 45 countries (Kossoff & McGrogan, 2005).…”

“…The positive attitudes of doctors and parents seem to be the most important supporting factor in maintaining the diet. Although the typical ratio of fats to carbohydrates and protein (in terms of grams) is 4:1, lower ratios are used successfully in other parts of the world, such as Asia, where rice is a major dietary staple (Kossoff & McGrogan, 2005). Moreover, breaking with tradition and convincing the physicians and their patients are the most important factors to introduce the diet in Asian countries (Seo & Kim, 2008).…”

Why should modified Atkins diet be encouraged for treating epilepsy in emerging countries?

“…It is not available in many countries as it requires traditionally a 3-4 day hospitaliza-tion with specialized neurologist and dietitian consultation. Though the KD is less expensive than many anticonvulsants, the prices of foods used are relatively high, as even in some developed countries occasional financial difficulties with the diet are reported 11 . On the other hand, calculating a 4:1 ratio ketogenic diet is impossible for an illiterate patient or care giver.…”