In the clinic, the ketogenic diet is mainly used in areas of:
- Reduction of epileptic symptoms
- Treatment of obesity
Regarding epilepsy, it seems that some studies have highlighted the therapeutic potential of ketone bodies in controlling epileptic symptoms in children who do not respond correctly to drug treatment (age less than 10 years of life).
Epilepsy
Epilepsy is a chronic disorder characterized by more or less frequent symptoms associated with involuntary neural discharges. Seizures represent the most frequent neurological alteration in pediatric age but their single onset is NOT epilepsy (see for example febrile convulsions), instead defined by a peculiar clinical history and confirmed by much more specific diagnoses.
The incidence of epilepsy is 50 cases per 100, 000 individuals a year, with a prevalence of manifestations in the first year of life, and 75% within 20 years; males are more involved than females.
Seizures
The epileptic seizure is caused by the abnormal and excessive stress of brain neurons; the relative electrical discharges are caused by the oscillatory alteration (high amplitude) of the cell membrane potential.
Classification
The classification of epilepsy dates back to 1989 and divides the various pathological forms into two groups:
- Partial epilepsies (convulsions of focal origin, or that originate from a precise point of the cerebral cortex)
- Generalized epilepsies (covulsions that originate indistinctly from both cerebral hemispheres)
Both categories can be differentiated according to the age of onset and / or the presence of peculiar clinical pictures (syndromic forms). Furthermore, it is also possible to recognize symptomatic-secondary forms of epilepsy (known causes) from idiopathic-primitive ones (unknown cause) .
Epileptic seizures can be simple or complex based on the subject's state of consciousness and can evolve into genralized and / or complex forms .
Causes
The main causes of epilepsy are three:- occasional
- For chronic, congenital or acquired brain damage
- genetic
Occasional: intracranial infections, metabolic diseases, intoxications, hypertensive encephalopathy, kidney diseases, head trauma, acute brain hypoxia, cerebrovascular accidents.
For chronic, congenital or acquired brain damage: they are secondary to prenatal, perinatal or post-natal damage.
Genetic: hereditary, can cause both idiopathic and symptomatic forms.
Diagnosis
The diagnosis of epilepsy is based on the description of the critical event and the symptomatology, as well as on the electromyographic examination. Subsequently, the neuroradiological tests (TAC and / or RMM) will allow to classify the etiology of the epileptic form.
The most frequent differential diagnosis, especially in subjects that are too young, therefore unable to correctly describe the symptomatology (and in the absence of third parties present), provides for the exclusion of paroxysmal phenomena (exasperation due to a culminating pathological condition) including: psychic causes or affective, gastroesophageal reflux, sleep disturbances, syncopal events, parasomnias, masturbation (remember that these are subjects in the pediatric age) etc.
NB . Misdiagnosis can lead to serious complications due to the continued use of unnecessary drugs for healthy patients, or vice versa, to failed therapy in sick subjects.
Ketogenic diet
The ketogenic diet is a useful food strategy for reducing body weight and fat mass; it is based on the DRASTIC (and excessive) reduction of carbohydrates, with an increase in protein and lipid ration. With a similar system it is possible:
- Prevent insulin spikes (a hormone that, if produced in excess, is responsible for lipogenesis and blocking lipolysis)
- Oxidate as many fats as possible deriving from adipose tissue (sugars are missing in ketogenic, therefore the body is forced to oxidize more fatty acids.
In light of the aforementioned, it would seem that the ketogenic diet is a highly profitable slimming method; however, even this therapy is NOT devoid of negative aspects, on the contrary ... on the contrary! Probably it is the unbalanced and incorrect diet par excellence. Let's see why:
- In a ketogenic, the organism is obliged to perform as much neoglucogenesis as possible; this happens because the lipids (alone) are NOT sufficient to maintain cellular energy metabolism. In fact, the oxidation of fatty acids takes place ONLY in the presence of oxalacetate deriving from carbohydrates, which in this diet should be resynthesized in the liver (starting from the food amino acids and body tissues, and only to a minor extent from the glycerol constituting the triglycerides).
NB . This does not happen for the branched amino acids (leucine, isoleucine and valine), which however are NOT sufficient to significantly reduce the overall neoglucogenesis.
The new production of glucose from amino acids occurs in hepatocytes by deamination and transamination of amino groups (containing nitrogen). These waste products (especially ammonium) cannot simply be expelled, they need further conversion into urea, a process that takes place once again in the liver through the urea cycle . The latter can finally be filtered by the kidneys and expelled with urine. Even for a layman (let alone for a professional) it should be logical that, although these processes may represent normal "metabolic stages" for the organism (they also manifest themselves in conditions of intense exercise) the difference between the workload of liver and renal in conditions of ketogenic diet compared to that of a balanced diet. Ultimately, subjecting the organs to a constant and continuous super-work is NOT a healthy habit!
- The combustion of fatty acids and amino acids to sustain energy metabolism presents a drawback (which in the ketogenic diet paradoxically represents an advantage), or the accumulation of toxic molecules. These, defined ketone bodies or ketones (acetone, acetoacetato and 3-hydroxybutyrate), interact with the organism through systemic INTOSSICATION and DEHYDRATION. Intoxication involves ALL tissues indiscriminately, but those most visibly affected belong to the central nervous system (CNS); without going into details, the excess of these molecules has an inhibitory power on the stimuli of the brain, including FAME; in practice, ketone bodies "stun" the CNS to the point of reducing appetite. The other aspect is related to systemic dehydration; ketone bodies are strongly osmotic molecules and their elimination takes place ESPECIALLY with urine (as well as with breathing and sweating). By filtering the ketones, the kidneys can do nothing but "let go" of a large quantity of water, inevitably reducing the volume and fluidity of the blood plasma, as well as the arterial pressure.
NB . Recall that the organs most fatigued by the ketogenic diet are the kidneys, which in addition to having an exponential workload compared to the norm, directly suffer the toxic effect of all the ketone bodies that must necessarily be filtered.
- The ketogenic diet therefore leads to metabolic ketosis; we recall that, although it is true to define ketone bodies as a "potential" energy substrate of the brain (which in critical conditions is able to partially exploit them), it is equally true that their use is in any case MARGINAL. Finally, we underline that an out-of-control ketogenic diet can also favor severe metabolic acidosis, an extremely dangerous condition that can induce (due to the lowering of blood pH) coma and even death.
Ketogenic diet and epilepsy
It is known that epilepsy is a widespread but difficult to treat neurological disorder; it is estimated that around 20-30% of the affected population has significant difficulties in controlling and managing seizures also through drug therapy.
In epilepsy, the ketogenic diet is USEFUL but must be cycled and NOT applied constantly; the setting takes place at hospital level, after hospitalization, and must be followed by periodic dietary and neurological checks.
It is curious to note that "historically" the diet has been the only known therapy to prevent and control epilepsy (early 1900s). This was later abandoned with the advent of the first drugs and resumed a few decades later by Johns Hopkins University in Baltimore . To date, the Johns Hopkins statistics (on a sample of about 500 patients) report that: in partial infantile and epilepsy resistant to drugs, in 90 days it is possible to notice a halving of the attacks even if at the same time reducing the antiepileptic drug cure . Other studies allow us to appreciate the application of the ketogenic diet on patients with epilepsy; an authoritative pediatric magazine has published that, in another experimental, 16% of children no longer had significant attacks, 32% showed a reduction in attacks of over 90%, and 56% a reduction in attacks of the 50%.
The ketogenic diet is both a valuable aid in the control of epilepsy already treated and an alternative cure in drug-resistant epilepsy. In any case, ketogenic reduces the dosages of specific molecules, improving the psycho-motor and cognitive development of pediatric subjects, in which it is possible to appreciate a certain improvement in attention. The effectiveness of the ketogenic diet is attributable to a reduction in excitability and nervous transmission due to the action of ketone bodies .
Bibliography:
- Pediatric neurology - L. Pavone, M. Ruggieri Elsevier - page 296
- The Ketogenic diet: a treatment for epilepsy - Freeman JM, Kelly MT, Freeman JB - New York, 2006
