The ketogenic diet used at the Johns Hopkins
Pediatric Epilepsy Center is commonly considered
the standard or classic form of this diet.
The classic ketogenic diet begins
with placing the child on a 24- to 48-hour fast followed
by a stay of several days as a hospital inpatient, so that
his or her body fluids can be measured and possible
side effects monitored.
The reason for the fast is to
force the body to exhaust its glucose supply and begin
burning stored fat for energy. The foods that are given
after the fast are intended to keep the process of fat
burning going by providing slightly fewer calories
than the body needs and providing 80% of those
calories in the form of fat.
Prior to coming to the hospital, the child’s food
records are kept over a three-day period so that the
doctors will know the average daily calorie intake in
order to tailor the special diet to the child’s need for
growth.
The goal is to maintain the child’s body mass
index at the 50th percentile. The amount of protein in
the diet is based on the child’s age, kidney function,
and stress factors.
While the child is in the hospital, the
parents are given a four-day educational program to
help them understand the diet and give them practice
in preparing meals as well as monitoring the child.
The Johns Hopkins schedule for the child’s hospital
stay is as follows:
Sunday (night before admission):
Child begins fasting
at home in the evening.
Day 1 (Monday):
Child is admitted to the hospital;
fasting continues; fluid intake is restricted; and blood
glucose is monitored every 6 hours.
Day 2 (Tuesday):
Child is given ‘‘eggnog’’ for dinner
(1/3 of the maintenance calorie allotment for dinner);
blood glucose checks are discontinued. The parents
are asked to start checking the child’s urine ketone
levels. Ketone levels should be between 80 and 160
mg/dL when the diet is working properly.
Day 3 (Wednesday):
Breakfast and lunch are given as
eggnog (1/3 of the maintenance calorie allotment for
those meals); dinner (more eggnog) is increased to
2/3 maintenance level.
Day 4 (Thursday):
Breakfast and lunch are given at
2/3 maintenance level; dinner is the child’s first full
ketogenic meal (not eggnog).
Day 5 (Friday):
After a full ketogenic breakfast, the
child’s prescriptions are reviewed, follow-up is
arranged, and the child is discharged from the
hospital.
Some hospital programs do not require fasting to
initiate the child’s diet. Follow-ups for most children
take place at three-month intervals, although infants
may be seen monthly.
Children must take multivitamins
and mineral supplements (particularly calcium)
while on the ketogenic diet.
Anticonvulsant medications
are usually continued for the first few months of
the diet, but may be given in lower dosages if the child
responds well to the diet, or even discontinued
altogether.
SAMPLE MENUS.
A typical day’s menu for a child
on the standard 4:1 ratio diet, allowing 1500 calories
per day:
Breakfast:
egg with bacon, made with heavy whipping
cream and butter, plus an apple
Snack:
peanut butter mixed with butter
Lunch:
tuna salad made with celery, mayonnaise,
and heavy whipping cream, served with lettuce
Snack:
keto yogurt (made with heavywhipping cream,
sour cream, strawberries, and artificial sweetener)
Dinner:
cheeseburger with lettuce and green beans
Snack:
keto custard (heavy whipping cream, egg, and
pure unsweetened vanilla flavoring)
The ketogenic diet
is a long-term diet but is not intended for indefinite use
in children. Most children who respond favorably to it
remain on it about two years.
The diet must not be
stopped abruptly, however; most doctors recommend
that parents slowly start to add regular foods to the
child’s menu to see whether the seizures are still
controlled.
