TMC PULSE

t m c » p u l s e | m a r c h 2 0 1 8 16 Fighting Epilepsy with Fat Today's popular ketogenic diet is actually a century-old treatment plan for epileptic children B y A l e x a n d r a B e c k e r T he plastic container held cooked carrots and un-melted butter chopped into pieces. The ratio of fat and carbohydrates had to be perfect. For more than seven years, everything Kristin Ybarra has put into her mouth has been measured and monitored to ensure her body burned fat instead of glucose for energy. Since starting the diet, her hours-long, noncon- vulsive seizures, which rendered her blank and unresponsive, had completely disappeared. Originally developed in the early 1900s as a treatment for epilepsy, the ketogenic diet is high in fat and low in carbohydrates, which forces the liver to convert fat into fatty acids and ketone bodies as a replacement for glucose as its primary energy source. Typically, carbohydrates are converted into glucose, which is the body's preferred form of energy, but in their absence, ketone bodies will do. This produces a state known as ketosis, and for reasons not completely understood, it leads to a reduction in seizures. "Although the diet has been around for at least nine decades, and there has been a lot of research done, we still don't really know the exact mechanism for why the diet works for treating epilepsy," said Rebecca J. Schultz, Ph.D., RN, pediatric nurse practitioner at Texas Children's Hospital Epilepsy Center. "In some way, we know that since it does have an effect on seizures, it alters the excitability of the nerve cells." Some research suggests the ketogenic diet impacts potas- sium ion channels, which are cell membrane pathways that generate electrical signals in cells. Ketosis has also been shown to lower insulin levels and help train the body to become exceedingly efficient at burning fat. Add to that the absence of carbohydrates—including all processed foods—and it's no wonder the diet has recently been touted by celebrities and social media influ- encers as a tool for dramatic weight loss. But using it to trim down is not without controversy, and Schultz emphasized the importance of med- ical supervision due to potentially harmful side effects. "So many people come to me because they want off 'those poisonous medicines,' and to be on something they perceive as natural," Schultz said, referring to patients who want to replace their epilepsy medication with the diet exclusively. "One of my responses to them is, 'Wait a minute, think about this. What is natural about a high-fat diet? It can be harmful. You can die from this diet if it's not properly administered, or if you happen to have some underlying metabolic problem. When I talk about being high in fat for the strict ketogenic diet, we're talking 90 percent of the calories are coming from fat. It's a huge change in the way you're eating.'" Pressing the reset button According to the Centers for Disease Control and Prevention, nearly 470,000 children in the U.S. have epilepsy. Approximately 70 percent of those patients can be managed with medication, said Dave Clarke, M.D., who recently joined Texas Children's Hospital as director of clinical epilepsy and pediatric neurology and devel- opmental neuroscience. But the remaining 30 percent? "We need everything in our arsenal," Clarke said. One approach is the ketogenic diet. "It has multiple benefits, inde- pendent of just treating seizures," Clarke said. "It sometimes helps The portions are smaller because this diet is high in fat, so it's calorically dense. Fat has more calories per gram than carbohydrates, so although the meal looks small, it's the same number of calories and you get full. — REBECCA J. SCHULTZ, PH.D., RN Pediatric nurse practitioner at Texas Children's Hospital Epilepsy Center Sarah Ybarra sits with her daughter, Kristin, during an appointment at Texas Children's Hospital.

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