NUTRITION MANAGEMENT
KETOGENIC DIET THERAPY: LET THEM EAT FAT! Susan Wood Specialist Dietitian; Ketogenic Therapies, Matthew’s Friends Clinics & Charity Susan works full time for Matthew’s Friends Clinics and Charity as a specialist ketogenic dietitian, treating children and adults with drug resistant epilepsy and adults with brain tumours.
This article gives an insight into three very different adult cases; two with epilepsy, one with a brain tumour, and how ketogenic diet therapy has influenced the quality of their lives. A ketogenic diet (KD) is low in carbohydrate, high in fat and adequate in protein. It triggers a shift in metabolism that mimics the fasted state; leading to increased fat oxidation and ketogenesis. Ketogenic diet therapy (KDT) is widely implemented for children with drugresistant epilepsy and metabolic conditions such as Glut 1 deficiency disorders.1,2 Despite published evidence indicating feasibility, tolerability, and efficacy of KDT in adults similar to that in children, few epilepsy centres worldwide offer these therapies to adults.3 This also means that families
with children requiring KDT around the teenage to adult service transition stage, or those requiring continuation of their existing KDT beyond 18 years, have immense problems accessing services.4,5 The publication of randomised controlled trial evidence, equivalent to that endorsing KDT use in children, would make all the difference to adult service provision, but no such trial is on the horizon at present. In the meantime, around 30% of adults continue to live with drug-resistant epilepsy, enduring poor seizure control and an impaired quality of life.6
What is epilepsy?7 Epilepsy is simply a tendency to have seizures. A seizure happens when there is a sudden burst of intense electrical activity in the brain. This causes a temporary disruption to the way the brain normally works: an epileptic seizure. There are many different types of seizure with the effect dependent on where in the brain the seizure starts, the level of awareness during the seizure and whether the seizure involves movement or not. • A tonic clonic seizure can start in both sides of the brain, or one side of the brain and then spread to affect both sides. During the tonic phase, the person will lose consciousness, their muscles go stiff and, if standing, they will fall to the floor. They may make a sound as air is expelled from the chest, past the vocal chords and may bite down on their tongue, or the inside of their mouth. During the clonic phase, their limbs jerk quickly and rhythmically and they may lose control of their bladder and/or bowels. Breathing may also be affected, causing a blue tinge around their mouth. • An absence seizure results in the person being unconscious for a few seconds. They will suddenly stop doing whatever they are doing but will not fall. They may appear to be daydreaming or ‘switching off’, so sometimes these can be harder to notice. Their eyelids might flutter and there may be some slight jerking movements of their body or limbs. In longer absences, there might be some brief, repeated actions. They are unaware of their surroundings and cannot be brought out of it. Some people have hundreds of absences a day. They often have them in clusters of several, one after another, and they are often worse when they are waking up or drifting off to sleep. Typical absence seizures usually start in childhood or early adulthood. • Myoclonic seizures are sudden, short-lasting jerks that can affect some or all of the body. The jerking can be very mild, like a twitch, or it can be very forceful and may cause the person to throw something they are holding, or make them fall over.
www.NHDmag.com May 2018 - Issue 134
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