Ketogenic diet - Wikipedia
The ketogenic diet is a low carb, moderate protein, and high fat diet which what's the difference between the ketogenic diet and just eating normally. When you lower your carb intake, glucose levels, along with blood sugar . This means that 70% of your calories will come from fats, 25% from protein, and 5% from carbs. PDF | The accumulation of 5-keto-d-fructose (5KF) by Gluconobacter cerinus cells were grown in the presence of specifically labeled d-glucose and d-fructose . In comparison with glucose, the ketone bodies are actually a very good respiratory fuel. Keywords: low-carbohydrate diets, ketogenic diets, ketogenesis, ketosis diets limit carbohydrates to 10 to 20 g/d, which is one fifth of the minimum fructose 1,6-biphosphatase, and glucose 6-phosphatase and also.
On the ketogenic diet, their body would consume its own protein stores for fuel, leading to ketoacidosisand eventually coma and death. There is some evidence of synergistic benefits when the diet is combined with the vagus nerve stimulator or with the drug zonisamideand that the diet may be less successful in children receiving phenobarbital. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health.
Many factors may be involved such as acidosis and suppressed growth hormone. A class of anticonvulsants known as carbonic anhydrase inhibitors topiramatezonisamide are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.
Bones are mainly composed of calcium phosphate. The phosphate reacts with the acid, and the calcium is excreted by the kidneys. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy.
Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant.
Some people terminate the diet or switch to a less demanding diet, like the modified Atkins diet MAD or the low-glycaemic index treatment LGIT diet, because they find the difficulties too great. A dietary history is obtained and the parameters of the diet selected: The following breakfast and lunch are similar, and on the second day, the "eggnog" dinner is increased to two-thirds of a typical meal's caloric content.
By the third day, dinner contains the full calorie quota and is a standard ketogenic meal not "eggnog".
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After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient's current medicines are changed to carbohydrate-free formulations.
Lack of energy and lethargy are common but disappear within two weeks. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital.
Often there is no initial fast fasting increases the risk of acidosis and hypoglycaemia and weight loss.
Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size but alter the ketogenic ratio from 2: If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer two weeks but the long-term seizure reduction rates are unaffected.
These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks. This fine-tuning is typically done over the telephone with the hospital dietitian  and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.
The diet may be modified if seizure frequency remains high, or the child is losing weight. Even "sugar-free" food can contain carbohydrates such as maltodextrinsorbitolstarch and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.
This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions. When the diet is required to treat certain metabolic diseases, the duration will be longer.
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The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial. The length of time until recurrence is highly variable but averages two years. Of those that have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet.
Recurrence is more likely if, despite seizure freedom, an electroencephalogram EEG shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure.
Recurrence is also likely if an MRI scan shows focal abnormalities for example, as in children with tuberous sclerosis.
Such children may remain on the diet longer than average, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely. Age, weight, activity levels, culture and food preferences all affect the meal plan. Highly active children or those with muscle spasticity require more calories than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein.
This is typically 4: The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio.
Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein and carbohydrate is then evenly divided across the meals. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes.
For example, cooked broccoli, Brussels sprouts, cauliflower and green beans are all equivalent. Fresh, canned or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.
In particular, the B vitaminscalcium and vitamin D must be artificially supplemented.
What is the relationship between D-glucose and D-fructose?
This is achieved by taking two sugar-free supplements designed for the patient's age: Medium-chain triglycerides are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised.
Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,  leading to more food choices and larger portion sizes. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.
The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet MAD places no limit on calories or protein, and the lower overall ketogenic ratio approximately 1: The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet.
Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,  which occurs because the absorption of the limited carbohydrates is slowed by the high fat content. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support.
Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents. The data coming from one centre's experience with 76 children up to the year also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.
Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed. It is used to administer the 4: The formula is available in both 3: However, fasting and dietary changes are affected by religious and cultural issues.
A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal.
In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In addition, fructose transfer activity increases with dietary fructose intake.
Fructose malabsorption Several studies have measured the intestinal absorption of fructose using the hydrogen breath test. When fructose is not absorbed in the small intestine, it is transported into the large intestine, where it is fermented by the colonic flora.
Hydrogen is produced during the fermentation process and dissolves into the blood of the portal vein. This hydrogen is transported to the lungs, where it is exchanged across the lungs and is measurable by the hydrogen breath test. The colonic flora also produces carbon dioxide, short-chain fatty acidsorganic acids, and trace gases in the presence of unabsorbed fructose. Uptake of fructose by the liver is not regulated by insulin.
However, insulin is capable of increasing the abundance and functional activity of GLUT5 in skeletal muscle cells. Fructolysis The initial catabolism of fructose is sometimes referred to as fructolysisin analogy with glycolysisthe catabolism of glucose. In fructolysis, the enzyme fructokinase initially produces fructose 1-phosphatewhich is split by aldolase B to produce the trioses dihydroxyacetone phosphate DHAP and glyceraldehyde .
Unlike glycolysisin fructolysis the triose glyceraldehyde lacks a phosphate group.
A third enzyme, triokinaseis therefore required to phosphorylate glyceraldehyde, producing glyceraldehyde 3-phosphate. The resulting trioses are identical to those obtained in glycolysis and can enter the gluconeogenic pathway for glucose or glycogen synthesis, or be further catabolized through the lower glycolytic pathway to pyruvate. Metabolism of fructose to DHAP and glyceraldehyde[ edit ] The first step in the metabolism of fructose is the phosphorylation of fructose to fructose 1-phosphate by fructokinase, thus trapping fructose for metabolism in the liver.
Fructose 1-phosphate then undergoes hydrolysis by aldolase B to form DHAP and glyceraldehydes; DHAP can either be isomerized to glyceraldehyde 3-phosphate by triosephosphate isomerase or undergo reduction to glycerol 3-phosphate by glycerol 3-phosphate dehydrogenase.
The glyceraldehyde produced may also be converted to glyceraldehyde 3-phosphate by glyceraldehyde kinase or further converted to glycerol 3-phosphate by glycerol 3-phosphate dehydrogenase. The metabolism of fructose at this point yields intermediates in the gluconeogenic pathway leading to glycogen synthesis as well as fatty acid and triglyceride synthesis.