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Our scientific dogma says that the latest research is the closest to the truth; yet as soon as new research comes out, it will be obsolete. This paradigm always ignores context. For example, for the past 15 years it has become assumed truth that a low fat diet is a healthy diet.
The same people who thirty years ago used to urge us to eat plenty of meat and cheese, shifted to encourage us towards vegetables and low fat salad dressings. And the tide is turning once again: there is a great deal of emphasis on the importance of good fats and essential fatty acids, most notably the Omega 3 kind. My point here is that it is foolish to establish absolute and narrow rules, especially about single ingredients in diets. Context counts.
A low fat diet is good for people who have eaten lots of meat and cheese and fat during their lives; it will help them re-balance and return to a more healthful equilibrium. On the other hand, a low fat diet is bad for people who have been eating raw food, fruit and vegetables for most of their lives. Not only that, a high fat diet is good for people with neurological disorders, particularly seizures. Seizures are not uncommon among young children, especially those who have been vaccinated.
Seizure disorder, or epilepsy, is "an abnormality of the electric potentials or waves produced in the normal brain." We fluctuate between the normal 9-to-14 alpha waves per second of the waking state and the 3-to-6 per second delta waves of the sleeping state. In epilepsy these waves go out of step, and an electro-encephalograph will indicate abnormal firings of the brain's neurons.
Symptoms include grand mal seizures, with loss of consciousness and contraction and relaxation of all muscle groups, lasting a few minutes; petit mal seizures, which involve limited convulsions or temporary alteration of consciousness, sometimes extremely subtle; and psychomotor epilepsy, which consists of uncontrolled and unpremeditated behavior. In addition, related neurological disorders include severe headaches, absence seizures or staring episodes, dizzy spells, or impaired memory. Many of these conditions, incidentally, are common in criminals and juvenile delinquents1.
It is a fact little known by the general public that dietary modification can help seizure disorders. For example, the medical community has long been aware that fasting improves and even eliminates seizures. In the early 1920's, R.M. Wilder introduced a diet intended to mimic the physiological effects of fasting. This diet consists of high amounts of fat (as much as 80% of calories) and low amounts of protein and carbohydrate (no more than 20% of calories total)2.
Like fasting, it provokes ketosis, the production of certain acids called ketone bodies which, in the absence of dietary carbohydrates, will be metabolized instead of glucose as fuel for the brain3; for this reason it was named the ketogenic diet (KD). Ketosis is demonstrated by testing the urine with dip-and-read sticks available in most drugstores.
From early on, the KD showed clinical effectiveness in suppressing and avoiding seizures. I had not heard about this until late 1994, when I read something about the ketogenic diet in a publication. When I discussed it in one of my classes, Carol Ellis, MD, a physician with an interest in alternative medicine, mentioned that she had studied the KD as a seizure controlling technique in medical school twenty five years earlier! Unfortunately, as it requires a great deal of effort to follow, and as even a small amount of extra carbohydrate can bring on seizures again within 3 1/2 hours, the KD was eventually neglected in favor of anticonvulsant drugs.
With the recent recognition that diet impacts health, interest in the ketogenic diet has returned. Johns Hopkins Medical Center has used it with great success to treat intractable seizures. In one review of 58 cases, seizure control improved in 67% of patients, and 75% of these improved patients continued the diet for at least 18 months. Sixty_four percent had AEDs (anti-epileptic drugs) reduced, 36% became more alert, and 23% had improved behavior . In St Louis Children's Hospital it was found that 50% of patients on the KD, ranging in age from seven months to 38 years, had become free of seizures, and another 20 to 30% had experienced considerable improvement in control of their seizure5.
A version of the KD developed in Booth Hall Children's Hospital in Manchester, Great Britain, requires that 50-70% of the calories be given as medium-chain triglycerides (MCT), a type of oil, plus 11% as other fats, plus 10% protein and 19% carbohydrate, a more palatable combination. The MCT oil is recommended for frying, grilling and in baked foods; it is also given as part of an emulsion to be sipped throughout meals, consisting of 200 ml MCT oil, 200 ml water, a teaspoon of powdered gelatin, and skim milk.
At first, this diet may provoke temporary abdominal pain, vomiting, or diarrhea, but rarely any other adverse effects; when effective, it may permit the reduction of anticonvulsant drugs without a return of the seizures. In a paper published in the October 2001 journal Pediatrics, a follow-up study of children with epilepsy found that "Of the original 150 patient cohort, 20 (13%) were seizure-free and an additional 21 (14%) had a 90% to 99% decrease in their seizures. Twenty-nine were free of medications, and 28 were on only 1 medication; 15 remained on the diet."6
Some researchers speculate that the high fat intake helps repair the myelin sheath around the nerves, a structure that is damaged in such widely disparate conditions as multiple sclerosis and adreno-leuko-dystrophy (the illness shown in the movie "Lorenzo's Oil"). Children with seizures need to remain very strictly on the diet, with not even the slightest deviation towards carbohydrates, for about two years. After that time they can slowly widen their food intake somewhat.
At a time when low fat is the defining factor for "healthy" eating, I find it deliciously ironic that a high-fat diet could help with such a difficult problem as intractable seizures, and that it has been shown to be effective where drugs have failed. As someone once said, all food can be medicine, and all food can be poison; the secret is in using the right food at the right time. And there, my dear friends, lies the rub, and the reason for the many different prescriptions and recommendations in the dietary marketplace. It is essential that we keep an open mind.
How does one plan such a high fat diet? Following my inclination to use only real foods (not manufactured fats), I like what I found in a study from India. It includes the following daily foods used in the KD:
- butter and ghee (clarified butter) (6 oz)
- eggs (2)
- bread and chapati bread, (2 pieces)
- whole milk (10 oz)
- meat or dal (bean sauce) (2 oz)
- mixed vegetables (8 oz)
- orange (1).7
These foods could be divided as follows
- Breakfast: 1 egg fried in 1/2 oz butter, one slice toast with 1/2 oz butter, 4 oz whole milk.
- Snack: 1 orange.
- Lunch: 4 oz mixed vegetables sautéed in 1 oz. butter, 1 oz meat with 1 oz melted butter.
- Snack: 4 oz whole milk, 1 slice bread with 1/2 oz melted butter.
- Dinner: 4 oz mixed vegetables sautéed in 1 oz butter, 1 oz bean sauce with 1 oz ghee, 1 egg fried with 1/2 oz butter.
1 Lewis, Dorothy O., et al, "Neuropsychiatric, Psychoeducational, and Family Characteristics of Fourteen Juveniles Condemned to Death in the United States." American Journal of Psychiatry, May 1988;145:5, 584-89.
2 Withrow, C.D., "The Ketogenic Diet: Mechanism of Anticonvulsant Action," in Antiepileptic Drugs: Mechanisms of Action, edited by G.H. Glaser, J.K. Penry, and D.M. Woodbury. Raven Press, New York: 1980.
3 Dodson, WE; Prensky, AL; DeVivom DC; Goldring, S; and Dodge, PR, "Management of seizure disorders: Selected aspects. Part II." The Journal of Pediatrics, November 1976, Vol. 89, No. 5, pp.695-703.
4 Kinsman SL; Vining EP; Quaskey SA; Mellits D; Freeman JM "Efficacy of the ketogenic diet for intractable seizure disorders: review of 58 cases." Pediatric Epilepsy Center, Kennedy Krieger Institute, Baltimore, MD 21205. Epilepsia 1992 Nov_Dec;33(6):1132_6.
5 Gordon, Neil, "Medium-Chain Triglycerides in a Ketogenic Diet." Develop. Med. Child Neurol., 1977,19,535-544.
6 Hemingway C, Freeman JM, Pillas DJ, Pyzik PL. The ketogenic diet: a 3- to 6-year follow-up of 150 children enrolled prospectively. Pediatrics. 2001 Oct;108(4):898-905.
7 Janaki, S., et al, "A Clinical Electroencephalographic Correlation of Seizures on a Ketogenic Diet." Indian Journal of Medical Research, 7 July 1976.