The ketogenic diet from a nutritional point of view
Ketogenic nutrition therapy (KET) has been used since 1921 for various forms of epilepsy as a therapy option, which has the same status as drug therapy. The adjustment to a ketogenic diet takes place in a neurological clinic after checking blood values and genetics as well as a preliminary discussion and is always implemented under the supervision of a neuropediatrician (children) or neurologist (adults) and under the guidance of a nutritionist. The aim of the setting is to adjust the patient to a stable ketosis in order to improve the seizure situation.
If the patient does not have a seizure reduction of at least 50% after a maximum of three months, KET is discontinued. A ketogenic nutrition therapy is measured by the ketogenic quotient (KQ): Fat divided by protein + carbohydrates. From this, it can be seen that a KET is not a low carb diet, which has a higher protein content. The focus of a Ketogenic Nutrition Therapy is on a high fat diet, which should be protein balanced and low in carbohydrates. Protein can reduce ketosis to the same extent as carbohydrates (via gluconeogenesis) and is therefore used balanced, i.e. the guidelines of the DGE observed - but not given as a saturation supplement!
From a large number of studies it is known today that a high intake of animal products causes diseases. The exception is animal products from grass-fed pasture (not organic!). However, such animal products are very expensive and difficult to obtain. Only about 0.7% of German agriculture is used in this form. Today the "planetary health diet" is recommended by the WHO and should also be implemented in a KET. For this, the consumption of animal products should be reduced (max. 300 g meat or 200 g fish per week or 250 g cheese per day. A vegan diet is also recommended here). Nuts and legumes serve as a daily source of protein. Soy in particular - with its high-quality amino acid profile and low carbohydrate content - is an excellent substitute for animal protein. Soy planted for human consumption is not grown in Latin America, but in the EU, and is not genetically modified. Soy from the rainforests is used to feed animals (e.g. in factory farming as well as fish in aquaculture).
Peas or lupine can also be used well as a substitute for animal protein. Dairy products are generally not particularly suitable for a low-carbohydrate diet. This is mainly due to the sometimes quite high carbohydrate content. For example, one milk (3.5% fat) contains 4.9 g of carbohydrates, yogurt 4.1 g of carbohydrates, and cream 3.4 g of carbohydrates per 100 g. When calculating the ketogenic quotient (KQ), it becomes clear that if high-carbohydrate dairy products are used, either more fat must be used or protein intake must be reduced. Both are avoidable if carbohydrate-free dairy alternatives are used in the diet. Unsweetened soy drink or unsweetened soy yogurt, each with 0 g of carbohydrates, are ideally suited for KET and the supply of high-quality protein and meet the WHO recommendations. At the same time, the carbohydrates now saved can be used for healthy carbohydrate intake: Vegetables, cereals, salads and low-KH fruits, which additionally contribute to the supply of vitamins and minerals, phytochemicals and fiber.
The choice of fatty acids also plays an important role in ketosis. C8 increases ketone body formation and C10 has a seizure-reducing effect. Both are MCT fats and should be incorporated into each meal between 0.5 g to 1 g per kg of body weight, depending on age. It should be noted that MCT fats must always be slowly incorporated into the diet (slowly creep dose into the diet) to avoid gastrointestinal discomfort. There are good therapy suggestions for this at Kanso. The omega-3 fatty acid, DHA, plays an important role in neurological events. Fish, which is often cited as a source of omega-3 fatty acids, is no longer a preferred source today due to the high levels of heavy metals in wild-caught marine fish. Fish from aquaculture have very low levels of omega-3 fatty acids due to feeding on soy meal and meat waste, as fish also require omega-3 from plankton and algae as a food source. For the daily DHA requirement, algae oil (e.g. Norsan oil vegan) is therefore recommended. Vegetable fats should generally be preferred (planetary health diet). Foods such as cream, butter and mascarpone no longer need to be used as a source of fat. Vegetable alternatives such as Creme Vega from Dr. Oetker or Cuisine from Alpro have a higher KQ and a better fatty acid pattern and are therefore optimal for use in a healthy KET!
Ketogenic diet therapy can be used very well as a therapeutic option for epilepsy - even for years without side effects such as hypercholesterolemia, uric acid elevation, micronutrient deficiencies, and constipation. An "egg-meat diet" is not recommended for this purpose. Those who implement the guidelines of a modern "planetary health diet" can maintain a healthy KET.
