Jane Riebold, M.S., R.D. ’15, is a newly-minted alumna of the Graduate Programs in Human Nutrition in the OHSU School of Medicine. Jane will be attending the prestigious Boston Children’s Hospital Pediatric Clinical Nutrition Fellowship to complete further training in nutritional treatments for childhood disease. Below, she shares a brief guide to the different types of dietary therapy for epilepsy.
There are about 750,000 children in the United States who are living with epilepsy, a brain disorder that causes seizures. While antiepileptic drugs exist, dietary treatments for epilepsy can effectively reduce seizure frequency and severity for some children. Dietary treatment may also give some children good seizure control with a reduced dosage or number of antiepileptic drugs. Dietary therapies for epilepsy are very high in fat and low in carbohydrate, and should only be followed under the supervision of a pediatric neurologist and dietitian. The low-glycemic index diet, the modified Atkins diet and the classic ketogenic diet are three different therapeutic diets that a pediatric neurologist and dietitian may discuss as options for your child.
The low-glycemic index diet is the least restrictive type of dietary therapy for epilepsy. Successful low-glycemic index diet therapy requires parents to be able to track the amount of carbohydrate (and what kinds of foods) their child eats each day. Parents must limit the grams of carbohydrate contained in their child’s food to about 40-60 grams per day, or as instructed by the dietitian. Foods with a low glycemic index (≤50) are preferred. Glycemic index measures the amount that a certain food raises a person’s blood sugar when compared to pure glucose, which has a glycemic index of 100. For example, a small apple has a glycemic index of 40 and contains about 15 grams of carbohydrate.
The modified Atkins diet is more restrictive than the low-glycemic index diet because fewer grams of carbohydrate are allowed per day. During modified Atkins therapy, parents will limit the grams of carbohydrate contained in their child’s food to about 10-20 grams per day as instructed by the dietitian. Any type of food containing carbohydrate is allowed if the grams of carbohydrate in the food fit within the daily allowance, and fats and protein are again encouraged. Modified Atkins is less restrictive than the classic ketogenic diet because parents must be able to track the amount of carbohydrate that their child eats each day but do not need to track their child’s intake of fat or protein.
The classic ketogenic diet is the strictest form of dietary therapy for epilepsy. The ketogenic diet is prescribed as a ratio of the grams of fat a child eats in a day compared to the total grams of protein and carbohydrate that a child eats in a day. The classic ketogenic diet typically provides 3-4 grams of fat for every 1 gram of protein and carbohydrate combined (for comparison, a modified Atkins diet could also be described as an approximate 1:1 ratio). While following the classic ketogenic diet, 87-90 percent of the energy that a child consumes from food each day is derived from fat. The classic ketogenic diet requires parents to track the amount of protein and fat, along with carbohydrate, that their child consumes each day. Accuracy is so important that all foods must be weighed on a gram scale before they are eaten so that the amount of fat, protein, and carbohydrate they contain can be correctly calculated. This can be very challenging and time consuming for parents, particularly if their child is a picky eater. A dietitian works closely with every child on this diet to provide recipes, educate the family, and ensure that all of the child’s nutritional needs are being met.
The ketogenic diet team at Doernbecher Children’s Hospital currently includes Carter Wray, M.D., assistant professor of pediatrics, OHSU School of Medicine; Andrea Frank, MSN, CPNP, instructor of pediatrics, OHSU School of Medicine; Audrey Easttum, RD, LD; and Megan Fuetterer, RDN, LDN, CPT.