the ketogenic diet

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The Ketogenic Diet

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Page 1: The ketogenic diet

The Ketogenic Diet

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Ketogenic diet initially was developed in 1920

in response to the observation that fasting had anti seizure properties.

Ketogenic diet can stimulate metabolic effects of starvation.

Ketogenc diet-High fat and low carbohydrate

Introduction

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It has beneficial effect on variety of metabolic,

Oncologic, neurodegenerative and psychatric disorders with different mechanism of actions.

It also has anti angiogenic effect

Direct and Indirect effects (neurotransmission, ATP production)

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CLASS 1 CLASS 3EPILEPSY PARKINSONS DISEASE

ALZHEIMER DISEASE AMLTRAUMATIC BRAIN INJURY

AUTISM DEPRESSION

Indication

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Epilepsy-mutation in GLUT-1,PDH deficiency DRAVERT SYNDROME: severe myoclonic epilepsy febrile seizuresDOOSE SYNDROME: myoclonic astatic epilepsy

Metabolic defects: PFK deficiency, McArdle diease(glycogenolysis type V)

Indications

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Malignancy : Advanced astrocytoma,Gliomas

Trauma and ischemia: fuel to injured brain and cardio protective effects.

Neurodegenerative diseases: PD,AD calorie restriction itself is protective, ketogenic diet enhance mitochondrial function, improvement in UPDRS

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Ketogenic diet protect against deposition of

amyloid. In AD high carb diet worsens the memory.

Mitochondrial dysfunction is found to be the cause of progression of ALS

Autism: patients on modified Radcliffe diet shown improvement in Childhood autism rating scale(CARS)

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Depression: Ketogenic diet shown

improvement in Porsolt test and behavioural changes.

Migraine , Headache and Narcolepsy

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In ketogenic diet body uses fat as primary

source.

Fat break down in liver-Ketones

In neuronal tissue ketones are used in mitochondria to generate ATP.

Relation between urine ketones and seizure control is imprecise .

Mechanism of action

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Enhancement of GABA function by ketone

bodies and increases the expression of GAD( 65 & 57)

Saturated fatty acid and PUFA has neuro protective effect. Arachidonic acid inhibit voltage gated sodium channels.

Brain metabolizes ketone better under conditions of reduced glucose(calorie restriction)

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DIRECT INDIRECT

KETONE BODIESSUBSTRATE DELIVERY

ENHANCEMENT OF MITOCHONDRIAL FUNCTION

ATP PRODUCTIONDECREASE ROS

NEUROTRANSMISSIONION CHANNELSMITOCHONDRIAL BIOGENISIS

Potential mediators

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16

49

35

ProteinCarbFat

Standard diet

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90

2 8

fatCarbProtein

Ketogenic Diet

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646

30

FatCarbProtein

Modified Atkins diet

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Diet compostion Ketogenic diet Atkins Diet

Fat(% by weight) 80 60

Protein(% by weight) 15 30

Carbs 5 10

Calorie(% of DRA) 75 Not restricted

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Typical ketogenic

diets

Salad with walnuts Bluberry tart

Sausage and cabbage dinner with cream

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Day prior to admission(Sunday): Reduce carb for 24 hr on fasting from evening

Day 1(Monday) On non carb fluids only, fasting continues till dinner(1/3 rd of the calculated maintainance). fluid restriction 60-75 cc/kg BG Q6H, orange juice for glucose

John Hopkins Protocol

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Day 2 (Tuesday)Urine ketones periodicallyDinner increased to 2/3 rd. of maintenance.

Day 3 (Wednesday)Breakfast and lunch given providing 2/3 rd of maintainanceDinner full Ketogenic meal

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Day 4 (Thursday)Full ketogenic diet breakfastEducation completedPrescription for carb free dietChild discharged

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Low level acidosis

Lack of weight gain

Constipation

Diarrhoea and bloating

Side effects

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Significant dyslipidemia

Kidney stones

Hypoalbuminemia

Pancreatitis

Vitamin deficiencies

Less common

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After 2 years of seizure free or no

improvement after 3- 6 months

Dietary factors that worsen seizure:1. Glutamate eg: MSG2. Caffeine3. Alcohol4. betel nuts5. Herbal remedies

Discontinuation

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59 year old male known case of Diabetes, CVA

,HTN came with history of diplopia and blurring of vision.

1 st episode of CVA on 2012 during that time he presented with blurring of vision with pupil dilated right eye and ptosis with left homonymous hemianopia. With no EOM involvement.

No limb weakness, DTR NORMAL.

Case presentation

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At that time provisional diagnosis was mid

brain stroke.

The images MRI Brain showed

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On 2015 jan CVA with slurring of speech and

right facial palsy. At that time CT brain was took

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Patient presented with diplopia

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SUMMARY

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Final diagnosis: CVA-RIGHT OCCIPITAL ,LEFT

PARIETAL(MCA/PCA) RIGHT MEDIAL RECTUS PALSY PARTIAL 3RD NERVE PALSY (RIGHT SIDE) RIGHT FACIAL N UMN PALSY (RECOVERED) T2DM UNCONTROLLED (HBA1C :11) HTN