659:(patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free. At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.
480:, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.
1381:(MCTs) are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate, leading to more food choices and larger portion sizes. The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil. Consuming that quantity of MCT oil caused abdominal cramps, diarrhoea, and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant. The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by
1394:
achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (about 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.
1118:
1146:, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil, or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas, and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower, and green beans are all equivalent. Fresh, canned, or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic
1135:
started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or
1510:
321:
1088:
three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure-free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.
1526:
1580:). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.
1429:
1007:" restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not "eggnog"). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.
579:, which had continued to offer the therapy. Under the diet, Charlie's epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research. A multicentre prospective study began in 1994; the results were presented to the American Epilepsy Society in 1996 and were published in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV drama film,
674:
of diets or ways of introducing them to make them more tolerable. In the largest trial of the ketogenic diet with a non-diet control, nearly 38% of the children and young people had half or fewer seizures with the diet compared to 6% with the group not assigned to the diet. Two large trials of the
Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.
553:
into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
1542:
40:
526:
1463:
must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory, so calculating macronutrients such as fat, protein and carbohydrates can be difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.
5038:
5068:
699:
5058:
877:, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone. About one in 20 children on the ketogenic diet develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as
1018:(which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common, but disappear within two weeks. The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar, and handling illness. The level of parental education and commitment required is higher than with medication.
1782:
5048:
1768:
1658:, but cannot do this by using fatty acids. Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the
105:. Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists after discontinuing the diet. Some evidence shows that adults with epilepsy may benefit from the diet and that a less strict regimen, such as a modified
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fat content. Although it is also a high-fat diet (with approximately 60% calories from fat), the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day. However, the types of carbohydrates consumed are restricted to those that have a
1708:, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet. This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.
1134:
require more food energy than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be
1087:
About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether. Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or
1041:
After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are
983:
The Johns
Hopkins Hospital protocol for initiating the classic ketogenic diet has been widely adopted. It involves a consultation with the patient and their caregivers and, later, a short hospital admission. Because of the risk of complications during ketogenic diet initiation, most centres begin the
974:
Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging
673:
systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures. Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types
552:
devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated
1462:
In theory, there are no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people
1419:
Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre's experience with 76 children up to the year 2009)
1410:
levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet, which occurs because the absorption of the limited carbohydrates is slowed by the high
1397:
The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients. While the strength of evidence is low for the modified Atkins, it has been known to show seizure freedom in some infants. Few adverse effects have been reported,
1129:
for each child. Age, weight, activity levels, culture, and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child's age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet).
392:
in the intestines, was discharged into the bloodstream. He recommended a fast lasting 18 to 25 days to allow this toxin to dissipate. Conklin probably treated hundreds of epilepsy patients with his "water diet" and boasted of a 90% cure rate in children, falling to 50% in adults. Later analysis
1032:
For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the
677:
A systematic review in 2018 looked at 16 studies on the ketogenic diet in adults. It concluded that the treatment was becoming more popular for that group of patients, that the efficacy in adults was similar to children, and the side effects relatively mild. However, many patients gave up the diet,
364:
The first modern study of fasting as a treatment for epilepsy was in France in 1911. Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with
311:
to treat epilepsy. Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs. Most individuals with epilepsy can successfully control their seizures with medication. However, 25–30% fail to achieve such control despite trying a number of different drugs.
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lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary
1614:
There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for
1393:
First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns
Hopkins Hospital modified the Atkins diet by removing the aim of
412:
convention. He had seen
Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite having studied the patients for only a short time. Further studies in the 1920s indicated that seizures generally returned after the fast.
2633:
Kossoff EH, Zupec-Kania BA, Auvin S, Ballaban-Gil KR, Christina
Bergqvist AG, Blackford R, Buchhalter JR, Caraballo RH, Cross JH, Dahlin MG, Donner EJ, Guzel O, Jehle RS, Klepper J, Kang HC, Lambrechts DA, Liu YMC, Nathan JK, Nordli DR Jr, Pfeifer HH, Rho JM, Scheffer IE, Sharma S, Stafstrom CE,
630:
Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a
1479:
do not eat root vegetables. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in
1091:
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and
760:
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several
1483:
In many developing countries, the ketogenic diet is expensive because dairy fats and meat are more expensive than grain, fruit, and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a
588:
By 2007, the ketogenic diet was available from around 75 centres in 45 countries, and less restrictive variants, such as the modified Atkins diet, were in use, particularly among older children and adults. The ketogenic diet was also under investigation for the treatment of a wide variety of
889:) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone. The stones are treatable and do not justify discontinuation of the diet. Around half of clinics give oral
597:
The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients. Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been
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containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an
1466:
In Asia, the traditional diet includes rice and noodles as the main source of energy, making their elimination difficult. Therefore, the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: for instance, Hindus
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seen more frequently, with the initial visit held after just two to four weeks. A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital
643:, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet's restrictions. Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.
736:
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%. The diet is recommended earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include
1692:, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the
841:, holistic, or all-natural treatment. As with any serious medical therapy, it may result in complications, although these are generally less severe and less frequent than with anticonvulsant medication or surgery. Common but easily treatable short-term side effects include
473:) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.
1444:
powdered formula, such as KetoCal, into a liquid feed. Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula. Some studies have found this liquid feed to be more efficacious and associated with lower total
1454:
artificially sweetened vanilla flavour and is suitable for tube or oral feeding. Other formula products include KetoVolve and
Ketonia. Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.
816:
The ketogenic diet is usually initiated in combination with the patient's existing anticonvulsant regimen, though patients may be weaned off anticonvulsants if the diet is successful. There is some evidence of synergistic benefits when the diet is combined with the
1639:). Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.
598:
ineffective. Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug. Adolescents and adults may also benefit from the diet, though compliance with oral diet (vs tube fed) remains a problem.
897:
to all ketogenic diet patients, with some evidence that this reduces the incidence of stone formation. However, this has not been tested in a prospective controlled trial. Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:
788:, which prevent the body from using carbohydrates as fuel, leading to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication. However, it is absolutely
1002:
The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal. On admission, only calorie- and caffeine-free fluids are allowed until dinner, which consists of
861:
by around 30%. This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and if persistent, by lowering the ketogenic ratio. Supplements are necessary to counter the dietary deficiency of many
136:
to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective
1398:
though cholesterol is increased and the diet has not been studied long term. Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favorably with the traditional ketogenic diet.
728:
treatment and the modified Atkins diet—are more appropriate for adolescents and adults, mainly due to better adherence. A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and others who are
804:. Persons with a disorder of fatty acid oxidation are unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their bodies would consume their own protein stores for fuel, leading to
2301:
Cai QY, Zhou ZJ, Luo R, Gan J, Li SP, Mu DZ, Wan CM. Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies. World J Pediatr. 2017 Dec;13(6):528–536.
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are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect. This is performed using ketone test strips containing
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patients to achieve an improvement is longer (two weeks), but the long-term seizure reduction rates are unaffected. Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.
1724:) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.
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30–50% for anticonvulsant therapy. Of those who have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an
702:
Experts on the ketogenic diet recommend it be strongly considered for children with uncontrolled epilepsy who have tried and failed two anticonvulsant drugs; most children who start the ketogenic diet have failed at least three times this
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Musa-Veloso K, Cunnane SC. Measuring and interpreting ketosis and fatty acid profiles in patients on a high-fat ketogenic diet. In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004. pp. 129–141.
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are more likely to become seizure-free with surgery than with the ketogenic diet. About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. The two less restrictive dietary variants—the low
3319:
Kossoff E. Is there a role for the ketogenic diet beyond childhood? In: Freeman J, Veggiotti P, Lanzi G, Tagliabue A, Perucca E. The ketogenic diet: from molecular mechanisms to clinical effects. Epilepsy Res. 2006 Feb;68(2):145–180.
170:, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.
1711:
Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants
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accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.
666:. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients. It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.
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levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight. Loss of seizure-control may come from unexpected sources. Even "sugar-free" food can contain carbohydrates such as
540:(MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides). MCTs are more efficiently absorbed and are rapidly transported to the liver via the
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Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet – 1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358–1363.
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Zupec-Kania B, Werner RR, Zupanc ML. Clinical Use of the
Ketogenic Diet – The Dietitian's Role. In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004. pp. 63–81.
512:
in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time, restricted to difficult cases such as
417:, the parent of one of Conklin's successful patients and a wealthy New York corporate lawyer, gave his brother John Elias Howland a gift of $ 5,000 to study "the ketosis of starvation". As professor of paediatrics at
141:
medications. This classic ketogenic diet contains a 4:1 ketogenic ratio or ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and
619:, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a
571:. The two-year-old had epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to
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drugs have failed to control it. About 60% of patients achieve control of their epilepsy with the first drug they use, whereas around 30% do not achieve control with drugs. When drugs fail, other options include
2000:
Ketogenic "eggnog" is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg,
2005:
and vanilla flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1). The eggnog may also be cooked to make a custard, or frozen to make ice
1703:
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely,
606:
Early studies reported high success rates; in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a
349:. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis. In the same collection, the author of
263:
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Muzykewicz DA, Lyczkowski DA, Memon N, Conant KD, Pfeifer HH, Thiele EA. Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia. 2009 May;50(5):1118–1126.
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and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet or the low-glycaemic index treatment diet, because they find the difficulties too great.
615:) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from
1642:
On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through
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Kossoff EH, Freeman JM. The ketogenic diet – the physician's perspective. In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004. pp. 53–61.
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Temkin O. The falling sickness: a history of epilepsy from the Greeks to the beginnings of modern neurology. 2nd ed. Baltimore: Johns
Hopkins University Press; 1971. pp. 33, 57, 66–67, 71, 78.
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1029:, hypoglycaemia, and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size, but alter the ketogenic ratio from 2:1 to 4:1.
623:(the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as
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Thiele EA, Turner Z, Vaccarezza MM, van der Louw EJTM, Veggiotti P, Wheless JW, Wirrell EC; Charlie
Foundation; Matthew's Friends; Practice Committee of the Child Neurology Society.
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Porta N, Vallée L, Lecointe C, Bouchaert E, Staels B, Bordet R, Auvin S. Fenofibrate, a peroxisome proliferator-activated receptor-alpha agonist, exerts anticonvulsive properties.
3176:. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean LJH, Stephens K, Amemiya A, editors. GeneReviews. Seattle (WA): University of Washington, Seattle; 1993–2018. 2002 Jul 30 .
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Bergqvist AGC. Indications and
Contraindications of the Ketogenic diet. In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004. pp. 53–61.
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Henderson CB, Filloux FM, Alder SC, Lyon JL, Caplin DA. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol. 2006 Mar;21(3):193–198.
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and calcium with vitamin D. A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises three small meals and three small snacks:
971:
who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.
1615:
inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.
1104:). Such children may remain on the diet longer than average, and children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.
662:
It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as
4559:
548:. The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971,
1484:
reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.
1472:
278:(spread widely throughout the brain and leading to a loss of consciousness). Epilepsy can occur for a variety of reasons; some forms have been classified into epileptic
2785:
Hemingway C, Freeman JM, Pillas DJ, Pyzik PL. The ketogenic diet: a 3- to 6-year follow-up of 150 children enrolled prospectively. Pediatrics. 2001 Oct;108(4):898–905.
3141:
Mastriani KS, Williams VC, Hulsey TC, Wheless JW, Maria BL. Evidence-based versus reported epilepsy management practices. J Child Neurol. 2008 Feb 15;23(5):507–514.
3090:
999:
is obtained and the parameters of the diet selected: the ketogenic ratio of fat to combined protein and carbohydrate, the calorie requirements and the fluid intake.
2348:
3592:
2392:, Marie A. La lutte contre l'epilepsie par la desintoxication et par la reeducation alimentaire. Rev Ther med-Chirurg. 1911; 78: 8–13. As cited by Bailey (2005).
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shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an
2111:
2076:
2636:
Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group
1079:. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.
2260:
Stafstrom CE. An introduction to seizures and epilepsy. In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004.
927:
Many institutions traditionally restricted the water intake of patients on the diet to 80% of normal daily needs; this practice is no longer encouraged.
388:, began to treat his epilepsy patients by recommending fasting. Conklin conjectured that epileptic seizures were caused when a toxin, secreted from the
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number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment
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2722:
2148:
381:
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describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink. The royal physician
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201:. The foundation sponsored a research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.
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3399:
2813:
461:), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet. Dr.
4988:
177:, whose son's severe epilepsy was effectively controlled by the diet, created the Charlie Foundation for Ketogenic Therapies to further promote
3734:
3524:
3496:
3292:
404:
claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent
97:, the latter passing into the brain and replacing glucose as an energy source. An elevated level of ketone bodies in the blood (a state called
4012:
3860:
Broom GM, et al. The ketogenic diet as a potential treatment and prevention strategy for Alzheimer's disease. Nutrition. 2019 Apr;60:118–121.
3614:
3348:
2770:
1623:
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include
469:, built on this research and coined the term "ketogenic diet" to describe a diet that produced a high level of ketone bodies in the blood (
31:
1139:
must be subtracted from this allowance. The total daily amount of fat, protein, and carbohydrate is then evenly divided across the meals.
2872:
3677:
2188:
Zupec-Kania BA, Spellman E. An overview of the ketogenic diet for pediatric epilepsy. Nutr Clin Pract. 2008 Dec–2009 Jan;23(6):589–596.
1596:
2927:
30:
This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see
3976:
3441:
Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group.
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2522:
3194:
2638:
801:
781:
3808:
3773:
3110:
2485:. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 Jun;7(6):500–506.
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followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the
1046:
and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.
1468:
2670:
Husari KS, Cervenka MC. The ketogenic diet all grown up-Ketogenic diet therapies for adults. Epilepsy Res. 2020 May;162:106319.
5105:
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Kossoff EH, Zupec-Kania BA, Rho JM. Ketogenic diets: an update for child neurologists. J Child Neurol. 2009 Aug;24(8):979–988.
793:
3693:
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2934:. National Institute for Health and Care Excellence (NICE). Published January 2012. Updated February 2016. Cited March 2018.
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must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient's age: a
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for various reasons, and the quality of evidence was inferior to studies on children. Health issues include high levels of
4433:
3883:
Römer M, et al. The use of ketogenic diets in cancer patients: a systematic review. Clin Exp Med. 2021 Nov;21(4):501–536.
3087:
2345:
1737:
878:
572:
213:
1732:
The ketogenic diet has been studied for potential therapeutic use in various neurological disorders other than epilepsy:
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2219:
1584:
913:
Hypocitraturia: the urine has an abnormally low concentration of citrate, which normally helps to dissolve free calcium.
874:
777:
409:
3580:
3169:
514:
4998:
4978:
4110:
2450:
Huttenlocher PR, Wilbourn AJ, Signore JM. Medium-chain triglycerides as a therapy for intractable childhood epilepsy.
1142:
A computer program such as KetoCalculator may be used to help generate recipes. The meals often have four components:
632:
624:
266:, or both, leading to temporary disruption of normal brain function. This might affect, for example, the muscles, the
3253:
Bergqvist AG. Long-term monitoring of the ketogenic diet: Do's and Don'ts. Epilepsy Res. 2011 Aug 18;100(3):261–266.
2426:
1420:
also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.
869:
Long-term use of the ketogenic diet in children increases the risk of slowed or stunted growth, bone fractures, and
585:, starring Meryl Streep, in which a young boy's intractable epilepsy is successfully treated by the ketogenic diet.
307:
dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of
282:, most of which begin in childhood. Epilepsy is considered refractory (not yielding to treatment) when two or three
5008:
4493:
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Bailey EE, Pfeifer HH, Thiele EA. The use of diet in the treatment of epilepsy. Epilepsy Behav. 2005 Feb;6(1):4–8.
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750:
746:
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of Conklin's case records showed 20% of his patients achieved freedom from seizures and 50% had some improvement.
2277:
de Boer HM, Mula M, Sander JW. The global burden and stigma of epilepsy. Epilepsy Behav. 2008 May;12(4):540–546.
2108:
1055:, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).
948:
537:
529:
155:
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Guideline 81, Diagnosis and management of epilepsies in children and young people. A national clinical guideline
2773: – JHMI Office of Communications and Public Affairs. Updated 7 December 1998. Cited 6 March 2008.
1025:
clinics rather than requiring a stay in hospital. Often, no initial fast is used (fasting increases the risk of
365:
the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication,
4983:
3037:
Kossoff EH, McGrogan JR, Freeman JM. Benefits of an all-liquid ketogenic diet. Epilepsia. 2004 Sep;45(9):1163.
2073:
2041:
Freeman JM, Kossoff EH, Hartman AL. The ketogenic diet: one decade later. Pediatrics. 2007 Mar;119(3):535–543.
1666:
1604:
1515:
620:
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1659:
251:, affecting around 50 million people worldwide. It is diagnosed in a person having recurrent, unprovoked
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For this group, and for children in particular, the diet has once again found a role in epilepsy management.
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818:
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708:
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292:
151:
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in Scotland, England, and Wales and reimbursed by nearly all US insurance companies. Children with a focal
4993:
4423:
4235:
2983:
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The ketogenic diet is indicated as an adjunctive (additional) treatment in children and young people with
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576:
438:
418:
385:
221:
209:
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Kim DY, Rho JM. The ketogenic diet and epilepsy. Curr Opin Clin Nutr Metab Care. 2008 Mar;11(2):113–120.
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4901:
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Optimal management of seizures associated with tuberous sclerosis complex: current and emerging options.
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Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies
1643:
1608:
964:
541:
477:
357:
declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."
338:
205:
59:
3003:
2355:(PDF). In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004.
146:, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts,
3915:
Grimes DR, O'Riordan E (November 2023). "Starving cancer and other dangerous dietary misconceptions".
4931:
4906:
4539:
4438:
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3004:
Decreased relative efficacy of the ketogenic diet for children with surgically approachable epilepsy.
1441:
1297:
1093:
988:
858:
462:
129:
122:
114:
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4936:
4403:
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1849:
612:
581:
304:
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189:
62:
dietary therapy that in conventional medicine is used mainly to treat hard-to-control (refractory)
5067:
1933:
of 9 and 4 kcal/g for fat and combined carbohydrate and water respectively. The equation is:
1432:
Measuring KetoCal – a powdered formula for administering the classic ketogenic diet
951:
that involves participants from various disciplines. Team members include a registered paediatric
719:(a single point of brain abnormality causing the epilepsy) who would make suitable candidates for
320:
4871:
4577:
4346:
4318:
4250:
4186:
3708:
Kossoff EH, McGrogan JR. Worldwide use of the ketogenic diet. Epilepsia. 2005 Feb;46(2):280–289.
1624:
1569:
1159:
1136:
1101:
1026:
773:
549:
508:(Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of
497:
414:
333:
332:
treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the
178:
3345:
389:
1756:. As of 2022 there is no clinical evidence that a ketogenic diet is effective to treat cancer.
1525:
5095:
4941:
4896:
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3972:
3957:
3932:
3899:
3868:
3844:
3816:
3789:
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3717:
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3563:
3536:
3508:
3476:
3459:
3411:
3376:
3329:
3304:
3262:
3232:
3206:
3177:
3150:
3126:
3070:
3046:
3022:
2959:
2935:
2905:
2888:
2869:
2853:
2828:
2794:
2762:
2737:
2679:
2654:
2595:
2538:
2494:
2463:
2410:
2373:
2356:
2311:
2286:
2261:
2235:
2197:
2164:
2126:
2092:
2050:
1557:
907:
890:
712:
655:
and followed-up by a report published in 2001. As with most studies of the ketogenic diet, no
489:
426:
373:
366:
143:
102:
5051:
4891:
4798:
4582:
4514:
4478:
4473:
4468:
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4418:
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4359:
4240:
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4201:
4165:
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3924:
3892:
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3836:
3781:
3738:
3709:
3635:
3584:
3555:
3528:
3500:
3451:
3403:
3368:
3321:
3296:
3254:
3198:
3142:
3118:
3038:
3014:
2924:
2880:
2845:
2821:
2786:
2754:
2730:
2671:
2646:
2587:
2530:
2486:
2455:
2402:
2389:
2303:
2278:
2227:
2189:
2156:
2119:
2084:
2042:
1565:
1531:
1382:
960:
906:) occurs due to increased bone demineralisation with acidosis. Bones are mainly composed of
789:
754:
742:
720:
651:
A study with an intent-to-treat prospective design was published in 1998 by a team from the
545:
509:
377:
288:
256:
194:
78:
2519:
1696:
to remain stable in the face of increased energy demand during a seizure, and may confer a
1021:
Variations on the Johns Hopkins protocol are common. The initiation can be performed using
931:
In adolescents and adults, common side effects reported include weight loss, constipation,
361:
believed an "attenuating diet" might afford a cure in mild cases and be helpful in others.
4634:
4602:
4519:
4448:
4443:
4298:
4265:
4209:
4070:
4002:
3812:
3777:
3665:
3621:
3447:
3352:
3173:
3114:
3094:
3010:
2990:
2931:
2876:
2817:
2726:
2642:
2526:
2433:
2352:
2223:
2152:
2115:
2080:
1773:
1697:
1655:
1611:(such as a neurotransmitter). These channels are another target for anticonvulsant drugs.
1450:
1412:
1321:
1179:
996:
894:
785:
738:
725:
561:
The ketogenic diet achieved national media exposure in the US in October 1994, when NBC's
86:
2635:
1838:
in this article refers to going without food while maintaining calorie-free fluid intake.
3896:
3785:
3554:
Kossoff EH, Dorward JL. The modified Atkins diet. Epilepsia. 2008 Nov;49 Suppl 8:37–41.
3107:
1564:. The propagation of this impulse from one neuron to another is typically controlled by
1117:
5041:
5003:
4726:
4587:
4336:
4331:
4047:
3805:
3770:
3742:
3497:
Discontinuing the ketogenic diet in seizure-free children: recurrence and risk factors.
1930:
1753:
1721:
1685:
1147:
992:
903:
854:
616:
329:
283:
225:
204:
Possible therapeutic uses for the ketogenic diet have been studied for many additional
138:
3928:
2490:
1572:
between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by
1014:
are checked several times daily and the patient is monitored for signs of symptomatic
567:
television programme reported the case of Charlie Abrahams, son of Hollywood producer
5089:
4716:
4676:
4666:
4612:
4529:
4413:
4293:
4288:
4275:
4191:
3997:
3840:
3713:
3639:
3559:
3532:
3504:
3455:
3407:
3325:
3258:
3042:
2734:
2675:
2160:
1795:
1717:
1663:
1636:
1632:
1588:
1561:
1500:
1407:
1155:
1052:
863:
850:
826:
663:
656:
493:
458:
405:
271:
94:
5061:
4039:
1962:. For example, a 4:1 diet derives 90% of calories from fat. The inverse equation is
17:
4458:
4408:
4303:
4074:
2088:
1689:
1670:
1647:
1541:
1437:
1175:
1064:
936:
932:
870:
842:
805:
730:
608:
568:
562:
501:
450:
422:
354:
198:
182:
174:
159:
110:
67:
3435:
Kossoff EH, Zupec-Kania BA, Amark PE, Ballaban-Gil KR, Bergqvist AG, Blackford R,
3018:
1121:
The ratio of calorific contributions from food components of four diets, by weight
496:(1912), the ketogenic diet was widely used and studied. This changed in 1938 when
3372:
910:. The phosphate reacts with the acid, and the calcium is excreted by the kidneys.
488:
During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative
5071:
4830:
4554:
4544:
4380:
4135:
2534:
2406:
2282:
1787:
1745:
1705:
1600:
1446:
1428:
1315:
1011:
956:
687:
683:
640:
466:
217:
167:
133:
106:
3888:
2825:
166:. A variant of the classic diet known as the MCT ketogenic diet uses a form of
4926:
4916:
4806:
4782:
4741:
4711:
4696:
4661:
4643:
4549:
4483:
3865:
3202:
3166:
2307:
1763:
1651:
1358:
1163:
1131:
1022:
968:
886:
882:
822:
765:
and clinical practice. One major factor may be the lack of adequately trained
698:
90:
3658:
3300:
3146:
2591:
2216:
2193:
2123:
1905:
reduction is defined here to mean a 50–90% decrease in seizure frequency. An
5018:
4911:
4853:
4848:
4843:
4838:
4769:
4736:
4691:
4681:
4620:
4597:
4592:
4534:
4524:
4488:
4125:
4105:
2849:
2758:
2514:
Vining EP, Freeman JM, Ballaban-Gil K, Camfield CS, Camfield PR, Holmes GL,
2002:
1713:
1662:. However, the liver can use long-chain fatty acids to synthesise the three
1583:
The nerve impulse is characterised by a great influx of sodium ions through
1577:
1406:
The low glycemic index treatment (LGIT) is an attempt to achieve the stable
1171:
1126:
1047:
1043:
952:
917:
838:
797:
766:
505:
470:
421:, John E. Howland used the money to fund research undertaken by neurologist
397:
240:
163:
44:
3936:
3903:
3872:
3848:
3793:
3749:
3721:
3647:
3588:
3567:
3540:
3512:
3463:
3415:
3380:
3333:
3308:
3266:
3210:
3181:
3154:
3130:
3050:
3026:
2892:
2857:
2832:
2798:
2790:
2741:
2683:
2658:
2599:
2498:
2459:
2414:
2315:
2290:
2239:
2201:
2168:
2130:
2096:
2054:
2046:
1058:
A short-lived increase in seizure frequency may occur during illness or if
525:
3820:
2766:
2542:
2467:
4946:
4881:
4876:
4774:
4746:
4671:
4656:
4569:
4280:
4160:
3735:
The modified Atkins diet: a potential treatment for developing countries.
1097:
1076:
1068:
963:
who is familiar with childhood epilepsy. Additional help may come from a
846:
635:
has changed. In older protocols, the diet was initiated with a prolonged
442:
279:
244:
236:
118:
63:
2231:
1603:
is governed by a "gate" which is opened by either a voltage change or a
1576:, or GABA) or they can excite the neuron into firing (primarily done by
132:
provides just enough protein for body growth and repair, and sufficient
5013:
4973:
4863:
4761:
4721:
4701:
4686:
4651:
4255:
4145:
4130:
4100:
4095:
3122:
2884:
2650:
1818:
1674:
1547:
1476:
1167:
1015:
636:
454:
308:
252:
98:
74:
55:
1781:
921:
380:, popularised the use of fasting to restore health. His disciple, the
39:
4921:
4886:
4822:
4814:
4751:
4731:
4706:
4115:
4016:
3954:
The Ketogenic Diet: A Treatment for Children and Others with Epilepsy
3696:. Keto News. Epilepsy.com. Updated July 2009. Cited 29 November 2009.
3579:
Treadwell, Jonathan R.; Wu, Mingche; Tsou, Amy Y. (25 October 2022).
2481:
Neal EG, Chaffe H, Schwartz RH, Lawson MS, Edwards N, Fitzsimmons G,
1741:
1693:
1072:
1059:
1004:
716:
259:
248:
4027:
1377:
Normal dietary fat contains mostly long-chain triglycerides (LCTs).
3394:
Kossoff EH, Laux LC, Blackford R, Morrison PF, Pyzik PL, Hamdy RM,
324:
A news report of Dr Hugh Conklin's "water diet" treatment from 1922
4021:
1650:(the energy-producing parts of the cell). Humans can convert some
1480:
America and Europe. However, they appear to be just as effective.
1427:
1143:
1116:
697:
524:
358:
319:
267:
147:
82:
81:. However, if only a little carbohydrate remains in the diet, the
38:
3293:
Kidney stones and the ketogenic diet: risk factors and prevention
2993:(PDF). Pract Gastroenterol. 2006 Jun;29(6):53, 56, 58, 61–62, 64.
825:, and that the diet may be less successful in children receiving
772:
Because the ketogenic diet alters the body's metabolism, it is a
4951:
4308:
4260:
4120:
77:, which is then transported around the body and is important in
4043:
2072:
Martin-McGill KJ, Jackson CF, Bresnahan R, Levy RG, Cooper PN.
1158:
and only contains tiny portions of fresh fruit and vegetables,
66:
in children. The diet forces the body to burn fats rather than
3525:
KetoCalculator: a web-based calculator for the ketogenic diet.
3583:(Report). Agency for Healthcare Research and Quality (AHRQ).
2811:
Ketogenic diets: evidence for short- and long-term efficacy.
1100:
shows focal abnormalities (for example, as in children with
400:
in mainstream practice. In 1916, a Dr McMurray wrote to the
3624:. Epilepsy Foundation. 22 August 2013. Cited 31 March 2018.
2984:
The ketogenic and Atkins diets: recipes for seizure control
150:, and butter. Most dietary fat is made of molecules called
2520:
A multicenter study of the efficacy of the ketogenic diet.
1294:
4 g strawberries (about half of one small strawberry)
3400:
When do seizures usually improve with the ketogenic diet?
2868:
Liu H, Yang Y, Wang Y, Tang H, Zhang F, Zhang Y, Zhao Y.
2217:
Ketogenic diets, mitochondria, and neurological diseases.
959:
who is experienced in offering the ketogenic diet; and a
769:
who are needed to administer a ketogenic diet programme.
3806:
Fasting: the history, pathophysiology and complications.
3197:(PDF). Curr Neurol Neurosci Rep. 2006 Jul;6(4):332–340.
3969:
The Ketogenic Bible: The Authoritative Guide to Ketosis
3291:
Sampath A, Kossoff EH, Furth SL, Pyzik PL, Vining EP.
2427:
Do ketogenic diets work for adults with epilepsy? Yes!
1440:
can also be given a ketogenic diet. Parents make up a
984:
diet under close medical supervision in the hospital.
3992:, from the Harvard University School of Public Health
2958:(PDF). Edinburgh: Royal College of Physicians; 2005.
1925:
can be converted to the portion of calories from fat
4034:
Epilepsy.com: Dietary Therapies & Ketogenic News
3804:
Kerndt PR, Naughton JL, Driscoll CE, Loxterkamp DA.
3117:
Neuropsychiatr Dis Treat. 2014 Oct 23;10:2021–2030.
2083:
Cochrane Database Syst Rev. 2018 Nov 7;11:CD001903.
1681:
substitute for blood glucose as a source of energy.
1162:
cereals, and calcium-rich foods. In particular, the
408:
Henry Rawle Geyelin reported his experiences to the
270:, consciousness, or a combination. A seizure can be
4964:
4862:
4760:
4642:
4633:
4611:
4568:
4502:
4394:
4373:
4345:
4317:
4274:
4223:
4200:
4174:
4153:
4144:
3097:
Guardian. 2008 Aug 15;Sect. Health & wellbeing.
2446:
2444:
2442:
920:from dissolving, leading to crystals that act as a
109:, is similarly effective. Side effects may include
73:Normally, carbohydrates in food are converted into
3226:
3224:
3222:
3220:
3218:
3002:Stainman RS, Turner Z, Rubenstein JE, Kossoff EH.
2184:
2182:
2180:
2178:
2176:
2146:Medium-chain triglyceride (MCT) ketogenic therapy.
2068:
2066:
2064:
2062:
445:. He reported that three water-soluble compounds,
2436:epilepsy.com. 2007, March. Cited 24 October 2009.
955:who coordinates the diet programme; a paediatric
761:possible explanations exist for this gap between
611:of patients recently treated by the physician (a
3733:Kossoff EH, Dorward JL, Molinero MR, Holden KR.
3249:
3247:
3245:
2781:
2779:
2714:
2712:
2582:
2580:
2578:
2576:
2574:
2572:
2570:
1877:De venae sect. adv. Erasistrateos Romae degentes
4036:, information and regular research news updates
3550:
3548:
3491:
3489:
3431:
3429:
3427:
3425:
3423:
3390:
3388:
3295:(PDF). J Child Neurol. 2007 Apr;22(4):375–378.
3065:
3063:
3061:
3059:
2710:
2708:
2706:
2704:
2702:
2700:
2698:
2696:
2694:
2692:
2629:
2627:
2568:
2566:
2564:
2562:
2560:
2558:
2556:
2554:
2552:
2550:
2256:
2254:
2252:
2250:
2248:
1222:9 g slice of apple (about 5% of one apple)
3952:Freeman JM, Kossoff EH, Freeman JB, Kelly MT.
3769:Hartman AL, Gasior M, Vining EP, Rogawski MA.
3765:
3763:
3761:
3759:
3757:
3704:
3702:
3287:
3285:
3283:
3281:
3279:
3277:
3275:
3167:Glucose Transporter Type 1 Deficiency Syndrome
2625:
2623:
2621:
2619:
2617:
2615:
2613:
2611:
2609:
2607:
2340:
2338:
2336:
2334:
2332:
2330:
2328:
2326:
2324:
274:(confined to a specific part of the brain) or
4055:
3688:
3686:
2978:
2976:
2974:
2972:
2954:Scottish Intercollegiate Guidelines Network.
2510:
2508:
2506:
2037:
2035:
2033:
2031:
2029:
2027:
2025:
2023:
2021:
8:
3771:The neuropharmacology of the ketogenic diet.
3668:. Nutricia North America. Cited 8 June 2018.
2645:. Epilepsia Open. 2018 May 21;3(2):175–192.
2074:Ketogenic diets for drug-resistant epilepsy.
1130:Highly active children or those with muscle
181:. Publicity included an appearance on NBC's
3990:Diet Review: Ketogenic Diet for Weight Loss
2477:
2475:
1821:as a unit of measure (4.1868 kJ), and
792:in the treatment of other diseases such as
4639:
4150:
4062:
4048:
4040:
3402:(PDF). Epilepsia. 2008 Feb;49(2):329–333.
3195:State of the ketogenic diet(s) in epilepsy
2820:Neurotherapeutics. 2009 Apr;6(2):406–414.
2211:
2209:
1677:. These ketone bodies enter the brain and
1449:than a solid ketogenic diet. KetoCal is a
987:At the initial consultation, patients are
158:(MCTs)—made from fatty acids with shorter
3971:. 1st ed. Victory Belt Publishing; 2017.
2879:. Epilepsia Open. 2018 Feb 19;3(1):9–17.
2140:
2138:
786:glucose transporter 1 deficiency syndrome
396:Conklin's fasting therapy was adopted by
4006:) is being considered for deletion. See
3780:Pediatr Neurol. 2007 May;36(5):281–292.
2529:Arch Neurol. 1998 Nov;55(11):1433–1437.
2346:History and origin of the ketogenic diet
2226:J Lipid Res. 2014 Nov;55(11):2211–2228.
1184:
4030:, a US charity and information resource
4024:, a UK charity and information resource
3680:. Solace Nutrition. Cited 17 June 2013.
2950:
2948:
2920:
2918:
2720:Clinical aspects of the ketogenic diet.
2017:
1917:
1915:
1806:
837:The ketogenic diet is not considered a
3527:Epilepsia. 2008 Nov;49 Suppl 8:14–16.
2155:Epilepsia. 2008 Nov;49 Suppl 8:33–36.
1556:The brain is composed of a network of
1125:The ketogenic diet is calculated by a
782:pyruvate dehydrogenase (E1) deficiency
3815:West J Med. 1982 Nov;137(5):379–399.
3737:Epilepsia. 2008 Sep;49(9):1646–1647.
1354:25 g of 36% heavy whipping cream
1330:38 g of 36% heavy whipping cream
1288:18 g of 36% heavy whipping cream
1267:36 g of 36% heavy whipping cream
1216:37 g of 36% heavy whipping cream
101:) eventually lowers the frequency of
27:High-fat dietary therapy for epilepsy
7:
5047:
2925:Epilepsies: diagnosis and management
1627:(high levels of acid in the blood),
1477:strict vegetarians of the Jain faith
1364:Pure, unsweetened vanilla flavouring
1336:11 g green beans (one spoonful)
1213:11 g bacon (about half a slice)
1154:The classic ketogenic diet is not a
916:The urine has a low pH, which stops
855:Raised levels of lipids in the blood
342:, covers the disease; it dates from
32:Very low-carbohydrate ketogenic diet
4989:Fruits & Veggies – More Matters
3786:10.1016/j.pediatrneurol.2007.02.008
3694:The Ketogenic Diet ... in a bottle?
3499:Epilepsia. 2007 Jan;48(1):187–190.
3495:Martinez CC, Pyzik PL, Kossoff EH.
3450:Epilepsia. 2009 Feb;50(2):304–317.
2118:Biomed J. 2013 Jan–Feb;36(1):2–8.
1333:10 g lettuce (one medium leaf)
802:genetic disorders of fat metabolism
3743:10.1111/j.1528-1167.2008.01580_6.x
3581:Management of Infantile Epilepsies
1834:Unless otherwise stated, the term
1471:not to be killed and eaten, Islam
1270:15 g lettuce (one large leaf)
853:if an initial fast is undertaken.
476:Wilder's colleague, paediatrician
441:reviewed the research on diet and
128:The original therapeutic diet for
25:
4010:to help reach a consensus. ›
3956:. 4th ed. New York: Demos; 2007.
3088:The diet that can treat epilepsy.
3013:Seizure. 2007 Oct;16(7):615–619.
2729:Epilepsia. 2007 Jan;48(1):31–42.
1654:into glucose by a process called
1416:dietary therapy for adolescents.
1210:28 g egg (about half an egg)
857:affect up to 60% of children and
808:, and eventually coma and death.
694:Indications and contraindications
5066:
5056:
5046:
5037:
5036:
3841:10.1111/j.1528-1167.2008.01901.x
3714:10.1111/j.0013-9580.2005.42704.x
3640:10.1111/j.1528-1167.2008.01959.x
3595:from the original on 5 July 2023
3560:10.1111/j.1528-1167.2008.01831.x
3533:10.1111/j.1528-1167.2008.01824.x
3505:10.1111/j.1528-1167.2006.00911.x
3456:10.1111/j.1528-1167.2008.01765.x
3408:10.1111/j.1528-1167.2007.01417.x
3326:10.1016/j.eplepsyres.2005.10.003
3259:10.1016/j.eplepsyres.2011.05.020
3043:10.1111/j.0013-9580.2004.18504.x
2735:10.1111/j.1528-1167.2007.00914.x
2676:10.1016/j.eplepsyres.2020.106319
2161:10.1111/j.1528-1167.2008.01830.x
1780:
1766:
1595:), which is mediated by another
1540:
1524:
1508:
1348:(serving size: 1.2 ounces)
1282:(serving size: 1.3 ounces)
967:who works with the family and a
3165:Wang D, Pascual JM, De Vivo D.
2109:Dietary therapies for epilepsy.
1909:reduction is a 90–99% decrease.
1684:The ketone bodies are possibly
1436:Infants and patients fed via a
1234:(serving size: 0.5 ounce)
859:cholesterol levels may increase
794:pyruvate carboxylase deficiency
589:disorders other than epilepsy.
2089:10.1002/14651858.CD001903.pub4
1825:stands for "energy" from food.
1:
3929:10.1016/S1470-2045(23)00483-7
3019:10.1016/j.seizure.2007.04.010
2491:10.1016/S1474-4422(08)70092-9
2454:. 1971 Nov;21(11):1097–1103.
1738:amyotrophic lateral sclerosis
1558:neurons that transmit signals
1186:Sample meal plan for one day
902:Excess calcium in the urine (
879:carbonic anhydrase inhibitors
873:. The diet reduces levels of
778:congenital metabolic diseases
711:. It is approved by national
343:
214:amyotrophic lateral sclerosis
3615:Low glycemic index treatment
3373:10.1097/MCO.0b013e3282f44c06
3346:Epilepsy's Big, Fat Miracle.
1469:consider cows sacred animals
1402:Low glycemic index treatment
924:for calcium stone formation.
875:insulin-like growth factor 1
410:American Medical Association
384:Dr. Hugh William Conklin of
173:In 1994, Hollywood producer
4999:Latin American Diet Pyramid
4979:Dairy Council of California
4434:Gluten-free and casein-free
3678:KetoVOLVE: 4:1 Ratio Powder
3659:KetoCal Product Information
2535:10.1001/archneur.55.11.1433
2407:10.1016/j.yebeh.2004.10.006
2283:10.1016/j.yebeh.2007.12.019
1473:forbids consumption of pork
1451:nutritionally complete food
484:Anticonvulsants and decline
5122:
5009:Mediterranean Diet Pyramid
4464:Low-fiber/low-residue diet
3889:10.1007/s10238-021-00710-2
3835:. 2009 Apr;50(4):943–948.
2826:10.1016/j.nurt.2009.01.005
2215:Gano LB, Patel M, Rho JM.
1728:Other medical applications
1379:Medium-chain triglycerides
751:tuberous sclerosis complex
747:myoclonic-astatic epilepsy
538:medium-chain triglycerides
376:, an American exponent of
295:, and the ketogenic diet.
239:is one of the most common
156:medium-chain triglycerides
29:
5075:Health and fitness portal
5032:
4081:
3866:10.1016/j.nut.2018.10.003
3203:10.1007/s11910-006-0027-6
3172:30 September 2016 at the
2308:10.1007/s12519-017-0053-2
1599:. The flow through these
949:medical nutrition therapy
776:in children with certain
639:, designed to lose 5–10%
530:Medium-chain triglyceride
369:, which dulled the mind.
208:, some of which include:
4355:Bodybuilding supplements
4008:templates for discussion
3446:13 February 2018 at the
3301:10.1177/0883073807301926
3147:10.1177/0883073807309785
2989:11 December 2019 at the
2641:20 November 2022 at the
2592:10.1177/0883073809337162
2194:10.1177/0884533608326138
2124:10.4103/2319-4170.107152
2079:20 November 2020 at the
1568:, though there are also
1324:(half a slice of cheese)
991:for conditions that may
947:The ketogenic diet is a
753:and for children fed by
625:intent-to-treat analysis
402:New York Medical Journal
303:The ketogenic diet is a
195:made-for-television film
152:long-chain triglycerides
54:is a high-fat, adequate-
5024:Vegetarian Diet Pyramid
4327:Ovo-lacto vegetarianism
3811:27 October 2017 at the
3193:Huffman J, Kossoff EH.
3113:10 January 2020 at the
2875:31 January 2020 at the
2850:10.2310/7010.2006.00044
2759:10.1542/peds.102.6.1358
2718:Hartman AL, Vining EP.
1424:Prescribed formulations
709:drug-resistant epilepsy
680:low-density lipoprotein
515:Lennox–Gastaut syndrome
457:(known collectively as
293:vagus nerve stimulation
5106:Low-carbohydrate diets
4994:Healthy eating pyramid
4540:Time Restricted Eating
4424:Fluid restriction diet
4028:The Charlie Foundation
3589:10.23970/ahrqepccer252
2982:Turner Z, Kossoff EH.
2791:10.1542/peds.108.4.898
2725:13 August 2017 at the
2460:10.1212/wnl.21.11.1097
2151:22 August 2017 at the
2047:10.1542/peds.2006-2447
1433:
1309:Cheeseburger (no bun)
1240:6 g peanut butter
1122:
1010:When in the hospital,
819:vagus nerve stimulator
704:
653:Johns Hopkins Hospital
577:Johns Hopkins Hospital
533:
498:H. Houston Merritt Jr.
492:(discovered 1857) and
439:Rollin Turner Woodyatt
419:Johns Hopkins Hospital
386:Battle Creek, Michigan
325:
206:neurological disorders
79:fueling brain function
47:
45:ketone bodies in urine
4494:Specific carbohydrate
4386:Very-low-calorie diet
3620:27 April 2018 at the
2930:22 April 2019 at the
2432:27 April 2018 at the
2107:Kossoff EH, Wang HS.
1850:On the Sacred Disease
1431:
1357:9 g egg (half a
1120:
1048:Urinary ketone levels
965:medical social worker
701:
542:hepatic portal system
528:
478:Mynie Gustav Peterman
382:osteopathic physician
339:On the Sacred Disease
323:
42:
4439:Intermittent fasting
3967:Lowery R, Wilson J.
3664:12 June 2018 at the
3351:1 April 2018 at the
3093:1 April 2018 at the
2816:1 April 2018 at the
2809:Kossoff EH, Rho JM.
2525:25 July 2011 at the
1931:Atwater coefficients
1921:The ketogenic ratio
1644:fatty-acid oxidation
1316:minced (ground) beef
1298:artificial sweetener
1291:17 g sour cream
1261:30 g mayonnaise
1144:heavy whipping cream
1094:electroencephalogram
995:the diet. A dietary
517:, declined further.
463:Russell Morse Wilder
18:Modified Atkins diet
4404:Calorie restriction
3776:1 June 2018 at the
3009:21 May 2020 at the
2351:5 June 2011 at the
2232:10.1194/jlr.R048975
2222:19 May 2019 at the
2114:1 June 2018 at the
1890:De victu attenuante
1750:Parkinson's disease
1734:Alzheimer's disease
1660:blood–brain barrier
1629:electrolyte changes
1574:γ-aminobutyric acid
1570:electrical pathways
1488:Mechanism of action
1383:insurance companies
1258:28 g tuna fish
1232:Peanut butter ball
1187:
713:clinical guidelines
613:retrospective study
582:...First Do No Harm
255:. These occur when
222:Parkinson's disease
210:Alzheimer's disease
190:...First Do No Harm
162:than LCTs—are more
130:paediatric epilepsy
4319:Semi-vegetarianism
3613:Pfeifer, Heidi H.
3356:The New York Times
3123:10.2147/NDT.S51789
3106:Wang S, Fallah A.
2885:10.1002/epi4.12098
2651:10.1002/epi4.12225
1866:, VII, 46; vol. 5.
1605:chemical messenger
1434:
1185:
1123:
1102:tuberous sclerosis
774:first-line therapy
705:
621:prospective cohort
550:Peter Huttenlocher
534:
532:(MCT) oil emulsion
425:and his assistant
415:Charles P. Howland
372:Around this time,
334:Hippocratic Corpus
326:
305:mainstream medical
264:hypersynchronously
262:fire excessively,
117:, growth slowing,
103:epileptic seizures
48:
5083:
5082:
4960:
4959:
4629:
4628:
4202:Sustainable diets
4022:Matthew's Friends
3923:(11): 1177–1178.
1853:, ch. 18; vol. 6.
1813:In this article,
1802:Explanatory notes
1667:β-hydroxybutyrate
1625:systemic acidosis
1597:potassium channel
1593:refractory period
1566:neurotransmitters
1516:β-hydroxybutyrate
1493:Seizure pathology
1370:
1369:
908:calcium phosphate
891:potassium citrate
821:or with the drug
800:, and other rare
447:β-hydroxybutyrate
427:William G. Lennox
374:Bernarr Macfadden
367:potassium bromide
154:(LCTs). However,
16:(Redirected from
5113:
5070:
5060:
5050:
5049:
5040:
5039:
4640:
4474:Monotrophic diet
4454:Low-carbohydrate
4419:Elimination diet
4365:Therapeutic food
4360:Meal replacement
4347:Supplement diets
4215:Planetary health
4151:
4087:
4064:
4057:
4050:
4041:
3941:
3940:
3912:
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3881:
3875:
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2687:
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2584:
2545:
2512:
2501:
2479:
2470:
2448:
2437:
2423:
2417:
2399:
2393:
2387:
2381:
2370:
2364:
2342:
2319:
2299:
2293:
2275:
2269:
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2213:
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2007:
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1992:
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1987:
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1979:
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1960:
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1879:, c. 8; vol. 11.
1873:
1867:
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1845:
1839:
1832:
1826:
1811:
1790:
1785:
1784:
1776:
1771:
1770:
1769:
1587:in the neuron's
1544:
1532:acetoacetic acid
1528:
1512:
1438:gastrostomy tube
1327:26 g butter
1277:Afternoon snack
1264:10 g celery
1219:23 g butter
1188:
961:registered nurse
935:, and in women,
755:gastrostomy tube
743:infantile spasms
546:lymphatic system
544:rather than the
510:sodium valproate
378:physical culture
348:
345:
289:epilepsy surgery
243:disorders after
115:high cholesterol
60:low-carbohydrate
21:
5121:
5120:
5116:
5115:
5114:
5112:
5111:
5110:
5086:
5085:
5084:
5079:
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4858:
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4802:
4794:
4786:
4778:
4756:
4625:
4607:
4564:
4498:
4396:
4390:
4374:Non-solid diets
4369:
4341:
4313:
4299:Milk substitute
4278:
4270:
4224:Religious diets
4219:
4196:
4170:
4140:
4085:
4077:
4071:Human nutrition
4068:
4011:
3986:
3949:
3947:Further reading
3944:
3914:
3913:
3909:
3882:
3878:
3859:
3855:
3830:
3826:
3813:Wayback Machine
3803:
3799:
3778:Wayback Machine
3768:
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3666:Wayback Machine
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3622:Wayback Machine
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3608:
3598:
3596:
3578:
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3573:
3553:
3546:
3523:Zupec-Kania B.
3522:
3518:
3494:
3487:
3473:
3469:
3448:Wayback Machine
3434:
3421:
3393:
3386:
3366:
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3353:Wayback Machine
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3339:
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3188:
3174:Wayback Machine
3164:
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3115:Wayback Machine
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3095:Wayback Machine
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3011:Wayback Machine
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2877:Wayback Machine
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2818:Wayback Machine
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2727:Wayback Machine
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2224:Wayback Machine
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2116:Wayback Machine
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2081:Wayback Machine
2071:
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2019:
2015:
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1999:
1995:
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1971:
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1779:
1774:Medicine portal
1772:
1767:
1765:
1762:
1754:sleep disorders
1730:
1722:benzodiazepines
1698:neuroprotective
1656:gluconeogenesis
1621:
1619:Seizure control
1560:by propagating
1554:
1553:
1552:
1551:
1550:
1545:
1536:
1535:
1534:
1529:
1520:
1519:
1518:
1513:
1504:
1503:
1495:
1490:
1460:
1426:
1413:glycaemic index
1404:
1391:
1389:Modified Atkins
1375:
1322:American cheese
1243:9 g butter
1205:Egg with bacon
1115:
1110:
1085:
1083:Discontinuation
1039:
981:
945:
835:
833:Adverse effects
814:
790:contraindicated
739:Dravet syndrome
726:glycaemic index
696:
649:
604:
595:
573:John M. Freeman
559:
523:
486:
435:
406:endocrinologist
390:Peyer's patches
346:
318:
301:
234:
226:sleep disorders
35:
28:
23:
22:
15:
12:
11:
5:
5119:
5117:
5109:
5108:
5103:
5101:High-fat diets
5098:
5088:
5087:
5081:
5080:
5078:
5077:
5064:
5054:
5044:
5033:
5030:
5029:
5027:
5026:
5021:
5016:
5011:
5006:
5004:French paradox
5001:
4996:
4991:
4986:
4981:
4976:
4970:
4968:
4962:
4961:
4958:
4957:
4955:
4954:
4949:
4944:
4939:
4934:
4929:
4924:
4919:
4914:
4909:
4904:
4899:
4894:
4889:
4884:
4879:
4874:
4868:
4866:
4860:
4859:
4857:
4856:
4851:
4846:
4841:
4836:
4832:
4828:
4824:
4820:
4816:
4812:
4808:
4804:
4800:
4796:
4792:
4788:
4784:
4780:
4776:
4772:
4766:
4764:
4758:
4757:
4755:
4754:
4749:
4744:
4739:
4734:
4729:
4727:Selenocysteine
4724:
4719:
4714:
4709:
4704:
4699:
4694:
4689:
4684:
4679:
4674:
4669:
4664:
4659:
4654:
4648:
4646:
4637:
4631:
4630:
4627:
4626:
4624:
4623:
4617:
4615:
4609:
4608:
4606:
4605:
4600:
4595:
4590:
4588:Master Cleanse
4585:
4580:
4574:
4572:
4566:
4565:
4563:
4562:
4557:
4552:
4547:
4542:
4537:
4532:
4527:
4522:
4517:
4512:
4506:
4504:
4500:
4499:
4497:
4496:
4491:
4486:
4481:
4476:
4471:
4466:
4461:
4456:
4451:
4446:
4441:
4436:
4431:
4426:
4421:
4416:
4411:
4406:
4400:
4398:
4392:
4391:
4389:
4388:
4383:
4377:
4375:
4371:
4370:
4368:
4367:
4362:
4357:
4351:
4349:
4343:
4342:
4340:
4339:
4334:
4329:
4323:
4321:
4315:
4314:
4312:
4311:
4306:
4301:
4296:
4291:
4285:
4283:
4272:
4271:
4269:
4268:
4263:
4258:
4253:
4248:
4243:
4238:
4233:
4227:
4225:
4221:
4220:
4218:
4217:
4212:
4206:
4204:
4198:
4197:
4195:
4194:
4189:
4184:
4178:
4176:
4175:Regional diets
4172:
4171:
4169:
4168:
4163:
4157:
4155:
4148:
4142:
4141:
4139:
4138:
4133:
4128:
4123:
4118:
4113:
4108:
4103:
4098:
4093:
4088:
4082:
4079:
4078:
4069:
4067:
4066:
4059:
4052:
4044:
4038:
4037:
4031:
4025:
4019:
4013:Ketogenic diet
3995:
3993:
3985:
3984:External links
3982:
3981:
3980:
3977:978-1628601046
3965:
3948:
3945:
3943:
3942:
3907:
3876:
3853:
3824:
3797:
3753:
3726:
3698:
3682:
3670:
3651:
3626:
3606:
3571:
3544:
3516:
3485:
3467:
3419:
3384:
3360:
3358:. 2010 Nov 17.
3344:Vogelstein F.
3337:
3312:
3271:
3241:
3214:
3186:
3158:
3134:
3099:
3079:
3055:
3030:
2995:
2968:
2944:
2940:978-1473117907
2914:
2897:
2861:
2837:
2802:
2775:
2745:
2688:
2663:
2603:
2546:
2502:
2471:
2438:
2418:
2394:
2382:
2365:
2320:
2294:
2270:
2244:
2205:
2172:
2134:
2100:
2058:
2016:
2014:
2011:
2009:
2008:
1993:
1911:
1894:
1881:
1868:
1855:
1840:
1827:
1805:
1803:
1800:
1799:
1798:
1792:
1791:
1777:
1761:
1758:
1729:
1726:
1686:anticonvulsant
1646:in the cell's
1620:
1617:
1562:nerve impulses
1546:
1539:
1538:
1537:
1530:
1523:
1522:
1521:
1514:
1507:
1506:
1505:
1499:
1498:
1497:
1496:
1494:
1491:
1489:
1486:
1459:
1456:
1425:
1422:
1403:
1400:
1390:
1387:
1374:
1371:
1368:
1367:
1366:
1365:
1362:
1355:
1350:
1344:
1343:Evening snack
1340:
1339:
1338:
1337:
1334:
1331:
1328:
1325:
1318:
1310:
1307:
1303:
1302:
1301:
1300:
1295:
1292:
1289:
1284:
1278:
1274:
1273:
1272:
1271:
1268:
1265:
1262:
1259:
1254:
1251:
1247:
1246:
1245:
1244:
1241:
1236:
1230:
1229:Morning snack
1226:
1225:
1224:
1223:
1220:
1217:
1214:
1211:
1206:
1203:
1199:
1198:
1195:
1192:
1114:
1111:
1109:
1106:
1084:
1081:
1038:
1035:
1012:glucose levels
993:contraindicate
980:
977:
944:
943:Implementation
941:
929:
928:
925:
914:
911:
904:hypercalciuria
864:micronutrients
834:
831:
813:
810:
695:
692:
648:
645:
617:selection bias
603:
600:
594:
591:
558:
555:
536:In the 1960s,
522:
519:
485:
482:
434:
431:
330:ancient Greece
328:Physicians of
317:
314:
300:
297:
284:anticonvulsant
233:
230:
139:anticonvulsant
52:ketogenic diet
26:
24:
14:
13:
10:
9:
6:
4:
3:
2:
5118:
5107:
5104:
5102:
5099:
5097:
5094:
5093:
5091:
5076:
5073:
5069:
5065:
5063:
5059:
5055:
5053:
5045:
5043:
5035:
5034:
5031:
5025:
5022:
5020:
5017:
5015:
5012:
5010:
5007:
5005:
5002:
5000:
4997:
4995:
4992:
4990:
4987:
4985:
4982:
4980:
4977:
4975:
4972:
4971:
4969:
4963:
4953:
4950:
4948:
4945:
4943:
4940:
4938:
4935:
4933:
4930:
4928:
4925:
4923:
4920:
4918:
4915:
4913:
4910:
4908:
4905:
4903:
4900:
4898:
4895:
4893:
4890:
4888:
4885:
4883:
4880:
4878:
4875:
4873:
4870:
4869:
4867:
4865:
4861:
4855:
4852:
4850:
4847:
4845:
4842:
4840:
4837:
4835:
4829:
4827:
4821:
4819:
4813:
4811:
4805:
4803:
4797:
4795:
4789:
4787:
4781:
4779:
4773:
4771:
4768:
4767:
4765:
4763:
4759:
4753:
4750:
4748:
4745:
4743:
4740:
4738:
4735:
4733:
4730:
4728:
4725:
4723:
4720:
4718:
4717:Phenylalanine
4715:
4713:
4710:
4708:
4705:
4703:
4700:
4698:
4695:
4693:
4690:
4688:
4685:
4683:
4680:
4678:
4677:Glutamic acid
4675:
4673:
4670:
4668:
4667:Aspartic acid
4665:
4663:
4660:
4658:
4655:
4653:
4650:
4649:
4647:
4645:
4641:
4638:
4636:
4632:
4622:
4619:
4618:
4616:
4614:
4613:List of diets
4610:
4604:
4601:
4599:
4596:
4594:
4591:
4589:
4586:
4584:
4581:
4579:
4576:
4575:
4573:
4571:
4567:
4561:
4560:U.S. military
4558:
4556:
4553:
4551:
4548:
4546:
4543:
4541:
4538:
4536:
4533:
4531:
4528:
4526:
4523:
4521:
4518:
4516:
4513:
4511:
4508:
4507:
4505:
4501:
4495:
4492:
4490:
4487:
4485:
4482:
4480:
4477:
4475:
4472:
4470:
4467:
4465:
4462:
4460:
4457:
4455:
4452:
4450:
4447:
4445:
4442:
4440:
4437:
4435:
4432:
4430:
4427:
4425:
4422:
4420:
4417:
4415:
4414:Diabetic diet
4412:
4410:
4407:
4405:
4402:
4401:
4399:
4393:
4387:
4384:
4382:
4379:
4378:
4376:
4372:
4366:
4363:
4361:
4358:
4356:
4353:
4352:
4350:
4348:
4344:
4338:
4335:
4333:
4330:
4328:
4325:
4324:
4322:
4320:
4316:
4310:
4307:
4305:
4302:
4300:
4297:
4295:
4294:Meat analogue
4292:
4290:
4289:Fruitarianism
4287:
4286:
4284:
4282:
4277:
4276:Vegetarianism
4273:
4267:
4264:
4262:
4259:
4257:
4254:
4252:
4249:
4247:
4244:
4242:
4239:
4237:
4234:
4232:
4229:
4228:
4226:
4222:
4216:
4213:
4211:
4208:
4207:
4205:
4203:
4199:
4193:
4190:
4188:
4187:Mediterranean
4185:
4183:
4180:
4179:
4177:
4173:
4167:
4164:
4162:
4159:
4158:
4156:
4152:
4149:
4147:
4143:
4137:
4134:
4132:
4129:
4127:
4124:
4122:
4119:
4117:
4114:
4112:
4109:
4107:
4104:
4102:
4099:
4097:
4094:
4092:
4089:
4086:Main articles
4084:
4083:
4080:
4076:
4075:healthy diets
4072:
4065:
4060:
4058:
4053:
4051:
4046:
4045:
4042:
4035:
4032:
4029:
4026:
4023:
4020:
4018:
4014:
4009:
4005:
4004:
3999:
3994:
3991:
3988:
3987:
3983:
3978:
3974:
3970:
3966:
3963:
3959:
3955:
3951:
3950:
3946:
3938:
3934:
3930:
3926:
3922:
3918:
3911:
3908:
3905:
3901:
3898:
3894:
3890:
3886:
3880:
3877:
3874:
3870:
3867:
3863:
3857:
3854:
3850:
3846:
3842:
3838:
3834:
3828:
3825:
3822:
3818:
3814:
3810:
3807:
3801:
3798:
3795:
3791:
3787:
3783:
3779:
3775:
3772:
3766:
3764:
3762:
3760:
3758:
3754:
3751:
3747:
3744:
3740:
3736:
3730:
3727:
3723:
3719:
3715:
3711:
3705:
3703:
3699:
3695:
3689:
3687:
3683:
3679:
3674:
3671:
3667:
3663:
3660:
3655:
3652:
3649:
3645:
3641:
3637:
3630:
3627:
3623:
3619:
3616:
3610:
3607:
3594:
3590:
3586:
3582:
3575:
3572:
3569:
3565:
3561:
3557:
3551:
3549:
3545:
3542:
3538:
3534:
3530:
3526:
3520:
3517:
3514:
3510:
3506:
3502:
3498:
3492:
3490:
3486:
3482:
3478:
3471:
3468:
3465:
3461:
3457:
3453:
3449:
3445:
3442:
3438:
3432:
3430:
3428:
3426:
3424:
3420:
3417:
3413:
3409:
3405:
3401:
3397:
3391:
3389:
3385:
3382:
3378:
3374:
3370:
3364:
3361:
3357:
3354:
3350:
3347:
3341:
3338:
3335:
3331:
3327:
3323:
3316:
3313:
3310:
3306:
3302:
3298:
3294:
3288:
3286:
3284:
3282:
3280:
3278:
3276:
3272:
3268:
3264:
3260:
3256:
3250:
3248:
3246:
3242:
3238:
3234:
3227:
3225:
3223:
3221:
3219:
3215:
3212:
3208:
3204:
3200:
3196:
3190:
3187:
3183:
3179:
3175:
3171:
3168:
3162:
3159:
3156:
3152:
3148:
3144:
3138:
3135:
3132:
3128:
3124:
3120:
3116:
3112:
3109:
3103:
3100:
3096:
3092:
3089:
3083:
3080:
3076:
3072:
3066:
3064:
3062:
3060:
3056:
3052:
3048:
3044:
3040:
3034:
3031:
3028:
3024:
3020:
3016:
3012:
3008:
3005:
2999:
2996:
2992:
2988:
2985:
2979:
2977:
2975:
2973:
2969:
2965:
2961:
2957:
2951:
2949:
2945:
2941:
2937:
2933:
2929:
2926:
2921:
2919:
2915:
2911:
2907:
2901:
2898:
2894:
2890:
2886:
2882:
2878:
2874:
2871:
2865:
2862:
2859:
2855:
2851:
2847:
2841:
2838:
2834:
2830:
2827:
2823:
2819:
2815:
2812:
2806:
2803:
2800:
2796:
2792:
2788:
2782:
2780:
2776:
2772:
2768:
2764:
2760:
2756:
2749:
2746:
2743:
2739:
2736:
2732:
2728:
2724:
2721:
2715:
2713:
2711:
2709:
2707:
2705:
2703:
2701:
2699:
2697:
2695:
2693:
2689:
2685:
2681:
2677:
2673:
2667:
2664:
2660:
2656:
2652:
2648:
2644:
2640:
2637:
2630:
2628:
2626:
2624:
2622:
2620:
2618:
2616:
2614:
2612:
2610:
2608:
2604:
2601:
2597:
2593:
2589:
2583:
2581:
2579:
2577:
2575:
2573:
2571:
2569:
2567:
2565:
2563:
2561:
2559:
2557:
2555:
2553:
2551:
2547:
2544:
2540:
2536:
2532:
2528:
2524:
2521:
2517:
2511:
2509:
2507:
2503:
2500:
2496:
2492:
2488:
2484:
2478:
2476:
2472:
2469:
2465:
2461:
2457:
2453:
2447:
2445:
2443:
2439:
2435:
2431:
2428:
2422:
2419:
2416:
2412:
2408:
2404:
2398:
2395:
2391:
2386:
2383:
2379:
2375:
2369:
2366:
2362:
2358:
2354:
2350:
2347:
2341:
2339:
2337:
2335:
2333:
2331:
2329:
2327:
2325:
2321:
2317:
2313:
2309:
2305:
2298:
2295:
2292:
2288:
2284:
2280:
2274:
2271:
2267:
2263:
2257:
2255:
2253:
2251:
2249:
2245:
2241:
2237:
2233:
2229:
2225:
2221:
2218:
2212:
2210:
2206:
2203:
2199:
2195:
2191:
2185:
2183:
2181:
2179:
2177:
2173:
2170:
2166:
2162:
2158:
2154:
2150:
2147:
2141:
2139:
2135:
2132:
2128:
2125:
2121:
2117:
2113:
2110:
2104:
2101:
2098:
2094:
2090:
2086:
2082:
2078:
2075:
2069:
2067:
2065:
2063:
2059:
2056:
2052:
2048:
2044:
2038:
2036:
2034:
2032:
2030:
2028:
2026:
2024:
2022:
2018:
2012:
2004:
1997:
1994:
1984:
1975:
1966:
1955:
1946:
1937:
1932:
1918:
1916:
1912:
1908:
1904:
1898:
1895:
1891:
1885:
1882:
1878:
1872:
1869:
1865:
1862:Hippocrates,
1859:
1856:
1852:
1851:
1847:Hippocrates,
1844:
1841:
1837:
1831:
1828:
1824:
1820:
1816:
1810:
1807:
1801:
1797:
1796:List of diets
1794:
1793:
1789:
1783:
1778:
1775:
1764:
1759:
1757:
1755:
1751:
1747:
1743:
1739:
1735:
1727:
1725:
1723:
1719:
1718:levetiracetam
1715:
1709:
1707:
1701:
1699:
1695:
1691:
1690:animal models
1687:
1682:
1680:
1676:
1672:
1668:
1665:
1664:ketone bodies
1661:
1657:
1653:
1649:
1645:
1640:
1638:
1637:blood glucose
1634:
1633:hypoglycaemia
1630:
1626:
1618:
1616:
1612:
1610:
1606:
1602:
1598:
1594:
1590:
1589:cell membrane
1586:
1581:
1579:
1575:
1571:
1567:
1563:
1559:
1549:
1543:
1533:
1527:
1517:
1511:
1502:
1501:Ketone bodies
1492:
1487:
1485:
1481:
1478:
1474:
1470:
1464:
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1455:
1452:
1448:
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1430:
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1409:
1408:blood glucose
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1386:
1384:
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1363:
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1352:
1351:
1349:
1346:Keto custard
1345:
1342:
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1323:
1319:
1317:
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1196:
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1177:
1173:
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1157:
1156:balanced diet
1152:
1149:
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1107:
1105:
1103:
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1053:nitroprusside
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872:
871:kidney stones
867:
865:
860:
856:
852:
851:hypoglycaemia
848:
844:
840:
832:
830:
828:
827:phenobarbital
824:
820:
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685:
682:, high total
681:
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664:meta-analysis
660:
658:
657:control group
654:
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494:phenobarbital
491:
483:
481:
479:
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459:ketone bodies
456:
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191:
186:
185:
180:
176:
171:
169:
165:
161:
160:carbon chains
157:
153:
149:
145:
140:
135:
131:
126:
124:
123:kidney stones
120:
116:
112:
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96:
95:ketone bodies
92:
88:
84:
80:
76:
71:
69:
68:carbohydrates
65:
61:
57:
53:
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41:
37:
33:
19:
5072:Food portal,
4984:Food pyramid
4965:Nutritional
4409:Cardiac diet
4397:restrictions
4381:Liquid diets
4001:
3968:
3953:
3920:
3917:Lancet Oncol
3916:
3910:
3879:
3856:
3832:
3827:
3800:
3729:
3692:Kossoff EH.
3673:
3654:
3629:
3609:
3599:30 September
3597:. Retrieved
3574:
3519:
3470:
3436:
3395:
3363:
3355:
3340:
3315:
3189:
3161:
3137:
3102:
3086:Spendiff S.
3082:
3033:
2998:
2900:
2864:
2840:
2805:
2748:
2666:
2515:
2482:
2451:
2425:Kossoff EH.
2421:
2397:
2385:
2368:
2344:Wheless JW.
2297:
2273:
2103:
1996:
1982:
1973:
1964:
1953:
1944:
1935:
1906:
1902:
1897:
1889:
1884:
1876:
1871:
1863:
1858:
1848:
1843:
1835:
1830:
1822:
1814:
1809:
1744:, headache,
1731:
1710:
1702:
1683:
1678:
1671:acetoacetate
1648:mitochondria
1641:
1622:
1613:
1601:ion channels
1582:
1555:
1482:
1465:
1461:
1435:
1418:
1405:
1396:
1392:
1376:
1347:
1281:
1280:Keto yogurt
1233:
1197:Ingredients
1176:multivitamin
1153:
1141:
1124:
1090:
1086:
1065:maltodextrin
1057:
1040:
1031:
1020:
1009:
1001:
986:
982:
973:
946:
937:dysmenorrhea
933:dyslipidemia
930:
893:supplements
868:
845:, low-grade
843:constipation
836:
815:
812:Interactions
806:ketoacidosis
771:
759:
735:
706:
676:
668:
661:
650:
629:
605:
602:Trial design
596:
587:
580:
569:Jim Abrahams
563:
560:
535:
502:Tracy Putnam
487:
475:
451:acetoacetate
436:
423:Stanley Cobb
401:
398:neurologists
395:
371:
363:
355:Erasistratus
350:
337:
327:
302:
241:neurological
235:
216:, headache,
203:
199:Meryl Streep
188:
187:program and
183:
179:diet therapy
175:Jim Abrahams
172:
127:
111:constipation
72:
51:
49:
43:Testing for
36:
4644:Amino acids
4583:Macrobiotic
4555:Raw foodism
4545:Liquid diet
4515:Cotton ball
4510:Entomophagy
4503:Other diets
4469:Low-protein
4429:Gluten-free
4337:Pollotarian
4332:Pescetarian
4166:Plant-based
4154:Basic types
4136:Staple food
3996:‹ The
2771:Lay summary
1817:stands for
1788:Food portal
1746:neurotrauma
1706:fenofibrate
1652:amino acids
1607:known as a
1447:cholesterol
1253:Tuna salad
1137:supplements
1037:Maintenance
957:neurologist
895:empirically
688:weight loss
684:cholesterol
641:body weight
504:discovered
467:Mayo Clinic
276:generalised
218:neurotrauma
168:coconut oil
107:Atkins diet
91:fatty acids
5090:Categories
4927:Phosphorus
4917:Molybdenum
4742:Tryptophan
4712:Methionine
4697:Isoleucine
4662:Asparagine
4550:Ninja diet
4484:Renal diet
4449:Low-FODMAP
4444:Low-sodium
4210:Low carbon
3962:1932603182
3481:1588292959
3237:1588292959
3075:1588292959
2964:1899893245
2910:1588292959
2378:0801848490
2361:1588292959
2266:1588292959
2013:References
1929:using the
1442:prescribed
1359:tablespoon
1320:10 g
1314:22 g
1202:Breakfast
1194:Menu idea
1164:B vitamins
1132:spasticity
1023:outpatient
979:Initiation
969:pharmacist
887:zonisamide
883:topiramate
823:zonisamide
767:dietitians
193:(1997), a
144:vegetables
5019:MyPyramid
4932:Potassium
4912:Manganese
4907:Magnesium
4854:Vitamin K
4849:Vitamin E
4844:Vitamin D
4839:Vitamin C
4831:Vitamin B
4823:Vitamin B
4815:Vitamin B
4807:Vitamin B
4799:Vitamin B
4791:Vitamin B
4783:Vitamin B
4775:Vitamin B
4770:Vitamin A
4737:Threonine
4692:Histidine
4682:Glutamine
4635:Nutrition
4621:Diet food
4603:Slow-Carb
4598:Superfood
4593:Junk food
4578:Cambridge
4570:Fad diets
4489:Soft diet
4395:Specific
4304:Raw vegan
4261:Rastafari
4236:Christian
4126:Nutrition
4106:Dietitian
3833:Epilepsia
2452:Neurology
2003:saccharin
1907:excellent
1864:Epidemics
1752:(PD) and
1714:valproate
1679:partially
1578:glutamate
1458:Worldwide
1172:vitamin D
1160:fortified
1127:dietitian
1044:dietitian
953:dietitian
918:uric acid
798:porphyria
506:phenytoin
471:ketonemia
465:, at the
437:In 1921,
351:Epidemics
280:syndromes
197:starring
164:ketogenic
85:converts
5096:Epilepsy
5062:Cookbook
5042:Category
4947:Vanadium
4937:Selenium
4882:Chromium
4877:Chlorine
4864:Minerals
4762:Vitamins
4747:Tyrosine
4672:Cysteine
4657:Arginine
4281:veganism
4231:Buddhist
4192:Atlantic
4161:Omnivore
3998:template
3937:37922928
3904:33813635
3873:30554068
3849:19054409
3809:Archived
3794:17509459
3774:Archived
3750:18782218
3722:15679509
3662:Archived
3648:19220406
3618:Archived
3593:Archived
3568:19049584
3541:19049577
3513:17241227
3464:18823325
3444:Archived
3416:18028405
3381:18301085
3349:Archived
3334:16523530
3309:17621514
3267:21855296
3211:16822355
3182:20301603
3170:Archived
3155:18281618
3131:25364257
3111:Archived
3091:Archived
3051:15329084
3027:17544706
3007:Archived
2987:Archived
2928:Archived
2893:29588983
2873:Archived
2858:16901419
2833:19332337
2814:Archived
2799:11581442
2742:17241206
2723:Archived
2684:32199222
2659:29881797
2639:Archived
2600:19535814
2523:Archived
2499:18456557
2430:Archived
2415:15652725
2390:Guelpa G
2349:Archived
2316:28702868
2291:18280210
2240:24847102
2220:Archived
2202:19033218
2169:19049583
2149:Archived
2144:Liu YM.
2131:23515147
2112:Archived
2097:30403286
2077:Archived
2055:17332207
1823:calories
1819:calories
1760:See also
1748:, pain,
1700:effect.
1585:channels
1180:minerals
1108:Variants
1098:MRI scan
1077:fructose
1069:sorbitol
1027:acidosis
989:screened
847:acidosis
780:such as
763:evidence
731:tube-fed
671:Cochrane
647:Outcomes
633:protocol
593:Efficacy
564:Dateline
521:MCT diet
490:bromides
443:diabetes
257:cortical
253:seizures
245:migraine
237:Epilepsy
232:Epilepsy
220:, pain,
184:Dateline
134:calories
119:acidosis
64:epilepsy
5052:Commons
5014:MyPlate
4974:5 A Day
4872:Calcium
4722:Proline
4702:Leucine
4687:Glycine
4652:Alanine
4459:Low-fat
4246:Islamic
4182:Western
4146:Dieting
4131:Obesity
4101:Cuisine
4096:Dieting
4000:below (
3897:8505380
3821:6758355
2767:9832569
2543:9823827
2468:5166216
1988:
1981:9 (1 -
1969:
1959:
1940:
1892:, c. 1.
1888:Galen,
1875:Galen,
1836:fasting
1740:(ALS),
1694:neurons
1675:acetone
1548:acetone
1373:MCT oil
1306:Dinner
1168:calcium
1113:Classic
1016:ketosis
997:history
721:surgery
703:number.
557:Revival
455:acetone
316:Fasting
309:fasting
299:History
260:neurons
99:ketosis
75:glucose
56:protein
4967:advice
4942:Sodium
4922:Nickel
4897:Iodine
4892:Copper
4887:Cobalt
4752:Valine
4732:Serine
4707:Lysine
4256:Jewish
4116:Leptin
4111:Hunger
4017:Curlie
4003:Curlie
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1742:autism
1736:(AD),
1609:ligand
1475:, and
1250:Lunch
1170:, and
1075:, and
1073:starch
1060:ketone
1005:eggnog
849:, and
839:benign
717:lesion
686:, and
609:cohort
453:, and
268:senses
249:stroke
224:, and
121:, and
4530:Inuit
4241:Hindu
3437:et al
3396:et al
2516:et al
2483:et al
1688:; in
1635:(low
1191:Meal
1178:with
1148:scale
922:nidus
359:Galen
272:focal
148:cream
89:into
83:liver
4952:Zinc
4902:Iron
4535:MIND
4525:DASH
4520:Pica
4309:Tofu
4279:and
4266:Sikh
4251:Jain
4121:Meal
4091:Diet
4073:and
3973:ISBN
3958:ISBN
3933:PMID
3900:PMID
3869:PMID
3845:PMID
3817:PMID
3790:PMID
3746:PMID
3718:PMID
3644:PMID
3601:2023
3564:PMID
3537:PMID
3509:PMID
3477:ISBN
3460:PMID
3412:PMID
3377:PMID
3330:PMID
3305:PMID
3263:PMID
3233:ISBN
3207:PMID
3178:PMID
3151:PMID
3127:PMID
3071:ISBN
3047:PMID
3023:PMID
2960:ISBN
2936:ISBN
2906:ISBN
2889:PMID
2854:PMID
2829:PMID
2795:PMID
2763:PMID
2738:PMID
2680:PMID
2655:PMID
2596:PMID
2539:PMID
2495:PMID
2464:PMID
2411:PMID
2374:ISBN
2357:ISBN
2312:PMID
2287:PMID
2262:ISBN
2236:PMID
2198:PMID
2165:PMID
2127:PMID
2093:PMID
2051:PMID
1903:good
1815:kcal
1720:and
1673:and
1631:and
784:and
637:fast
500:and
433:Diet
247:and
93:and
50:The
4479:NPO
4015:at
3925:doi
3893:PMC
3885:doi
3862:doi
3837:doi
3782:doi
3739:doi
3710:doi
3636:doi
3585:doi
3556:doi
3529:doi
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3369:doi
3322:doi
3297:doi
3255:doi
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3119:doi
3039:doi
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2881:doi
2846:doi
2822:doi
2787:doi
2755:doi
2731:doi
2672:doi
2647:doi
2588:doi
2531:doi
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2456:doi
2403:doi
2304:doi
2279:doi
2228:doi
2190:doi
2157:doi
2120:doi
2085:doi
2043:doi
1956:+ 4
627:).
575:at
87:fat
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