Whether or not you need specialty bars and other packaged goods formulated with probiotics is another matter. “Science has not shown that probiotics improve general health,” says Dr. Shira Doron, infectious diseases physician and associate hospital epidemiologist at Tufts Medical Center. “Certain diseases and conditions have been studied, with varying results, some of which suggest that probiotics can mitigate symptoms. If you’re taking a probiotic for a specific condition, it is critically important that you use the same strain, formulation and dose that were shown to be effective in clinical trials; otherwise you cannot assume you will experience the same positive effect,” she explains.
Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable, but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those who 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 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 children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.
Blumenthal was impressed that improving diet and exercise was helpful even in this group that was at risk of developing cognitive problems and potentially even dementia. “This is not necessarily a cure, but there is currently no pharmaceutical intervention for preventing dementia,” he says. “So a starting point of improving lifestyle with exercise and perhaps diet in this group of people can have important implications down the road for their overall wellbeing.”
Becky Duffett is a contributing nutrition editor for Fitbit and a lifestyle writer with a passion for eating well. A former Williams-Sonoma cookbook editor and graduate of San Francisco Cooking School, she’s edited dozens of cookbooks and countless recipes. City living has turned her into a spin addict—but she’d still rather be riding a horse. She lives in the cutest neighborhood in San Francisco, spending weekends at the farmers’ market, trying to read at the bakery, and roasting big dinners for friends.
Wilder's colleague, paediatrician Mynie Gustav Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman's work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour, and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Joseph Barborka, Sr., also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. 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 some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.
Having ready-to-eat snacks and meals-in-minutes on hand sets you up for success. You'll be less likely to hit the drive-through or order a pizza if you can throw together a healthy meal in five or 10 minutes. Here are some essentials to keep on hand: frozen vegetables, whole-grain pasta, reduced-fat cheese, canned tomatoes, canned beans, pre-cooked grilled chicken breast, whole grain tortillas or pitas, and bags of salad greens.