The ketogenic diet contains a high ratio of fat to carbohydrate plus protein. Most of the calories are provided as fats, using butter and heavy cream. Seizure control is greatest when the diet contains a ratio of fat calories to protein/carbohydrate calories of 3 or 4:1. A typical meal might consist of a very small portion of meat, fish, poultry, or cheese, a slightly larger portion of fruit, additional fat served as butter or mayonnaise, and a serving of heavy (whipping type) cream. It doesn’t sound very palatable, does it? It is this perception of the diet as unappealing that has interfered with its more frequent use.
When your child is severely handicapped by seizures and massive amounts of medication, what do you have to lose by trying the diet? Not much! What do you have to gain? If it works, a lot. If it doesn’t, you’ve lost very little other than the time invested in learning how to prepare the diet. If your child is seizure-free and less drugged, then the rigors of the diet are worthwhile. If the child’s seizures continue after one to three months on the diet or if the diet is poorly tolerated, then the diet can be discontinued and the child returned to medication.
The diet is initiated with several days of starvation and limited fluid intake. The child should be carefully observed during this time for signs of hypoglycemia (low blood sugar)—paleness, sweatiness, unresponsiveness, or seizures. When the child is very ketotic (has a lot of ketones in the urine) and has lost about 10 percent of his body weight, one-third of the diet is begun. The diet is increased over the first two to three days. We usually do this in the hospital since this allows us to instruct the parents in diet preparation. Menus can be selected to fit the child’s food preferences. It is surprising how much variety an innovative parent can introduce into this restricted diet.