“The ketogenic diet has been known for decades and has its place in the modern treatment of epilepsy, and according to world data, it gives the best results if it is applied in the age range between 1 and 10 years. It is a mandatory condition that the start of this treatment be in hospital conditions under medical supervision", stressed Dr. Radka Tincheva, head of the Clinic for Endocrinology, Diabetes and Genetics at the hospital "Prof. I. Mitev" in Sofia.
Prof. Tincheva, there has been a lot of talk lately about the ketogenic diet as a treatment option for epilepsy. What's your opinion?
- It's really a treatment, even though it's called a diet. True, some brave ladies also use it to lose weight, but I hope they know that they should do it under medical supervision. Many parents are already familiar with the ketogenic diet, it was introduced in Bulgaria precisely at their insistence.
Why did we start applying it?! Well, no nutritionist in our country wanted to deal with her for the simple reason that there is no specialist, as there are in all university hospitals in Europe, dealing with this difficult speci alty, with this dietary treatment. This is no ordinary diet, this is life-saving treatment. We started working on it because children with epilepsy come to us, regardless of the fact that we are a genetic clinic, but also with metabolic syndrome. And it turned out that the ketogenic diet was very useful for them. We qualify on the fly, which makes our job even more difficult. Specialists in clinical genetics can be counted on the fingers of one hand in Bulgaria, and it is right that we should be supported before the Ministry of He alth, before the He alth Fund, before the he alth institutions - to allocate a place for a nutritionist in our hospital, even for half a staff.
Since when was the ketogenic diet known?
- It has been known since biblical times. Applied to children since 1921, it is used to treat certain types of reflex epilepsy according to a special protocol. It requires treatment to be conducted in a hospital setting.
What does this diet contain?
- Contains a minimal amount of protein and carbohydrates at the expense of a high fat content. The aim is to use fat as a primary energy source with low carbohydrate intake. When there is starvation, there are not enough carbohydrates, fatty acids do not cross the blood-brain barrier, ketogenic bodies are formed, which do cross the brain barrier. This diet is based precisely on the role of these ketogenic bodies. Unfortunately, it has not yet been clarified exactly how these bodies act on epileptic foci and suppress their activity.
Can it be applied to all children with epilepsy?
- Recently, there are many indications in which this diet is applied, but it is believed to have the best effect in refractory epilepsies, in a genetic enzyme disease, in glucose transporter enzyme deficiency. It is contraindicated in certain metabolic diseases, where there is a danger that these ketogenic bodies will harm the child, rather than help him.
Can any parent decide to implement the diet in a home setting?
- No, he can't just make up his mind and start applying it at home. This is an extremely difficult, heavy diet. It must be started in a hospital setting. Urine tests for sugar and ketones are done, preceded by a short period of complete fasting. We receive the child in the afternoon, he is starving from evening to morning.
Gradually loaded with fat -
the diet is difficult for children to tolerate, very fatty, parents' understanding and cooperation is required.
The stay in the hospital is usually 4 days, we also do the impossible to train the parents and the child to get used to the requirements of the diet, which then, according to the rules, can be continued at home. But they remain under observation, and if no result is achieved, the child must again stay in the clinic until progress is made. It is important to know that the ketogenic diet is essentially a type of treatment, absolutely equivalent to medication, and it should be carried out strictly under the control of a specialist.
Are carbohydrates and proteins not taken at all?
- No, of course. We balance the diet so that the body receives a sufficient amount of carbohydrates and proteins so that the child can grow normally - both in height and weight, and have normal development. Otherwise, "instead of writing on his eyebrows, we will take out his eyes." We also monitor for possible loss of muscle mass, as well as weight. With the intake of so much fat, we are careful not to give a basis for the development of atherosclerosis. There is a danger of calcium deficiency, of water-soluble vitamins - everything missing is additionally imported. I'll just mention that there were many parents who were willing to phone us to explain or email them the ketogenic diet. No, it doesn't work like that, this diet is a treatment like medicine.
Apparently there are quite a few biochemical disorders, but still the ketogenic diet is a cure…
- Nausea, vomiting, constipation, dehydration, cardiopathy, pancreatitis appear - many biochemical disorders that we periodically monitor. Therefore, we are asking the jeeps to take care of these children with research, because not all of them can come to Sofia, and it is not necessary. Over time, these complications may occur, although we do our best to overcome them. But you know, as Prof. Litvinenko said,
in medicine there is no 100% guarantee
Its mechanism of action is not known, but we are pleased that we now have patients who are only on a diet, do not take medication and do not have seizures.
How many patients are you currently treating?
- 4 children, 2 more we started now, a month ago. All are on four anticonvulsants, but the effect of their treatment is not satisfactory. Pediatric neurologists, Prof. Bozhinova, Prof. Litvinenko, after trying all the treatment combinations, refer them to us, the parents cannot decide to apply the ketogenic diet to them themselves. In over 90% of children there is a reduction in seizures.
The fund for the treatment of children in the first 6 months paid for the special food. Since the beginning of this year, the Ketokal food has been reimbursed by the He alth Insurance Fund after 6 months of use and a proven positive effect.
It is no longer necessary for parents to spend money and take their children to a clinic in Thessaloniki - because only there, until the beginning of 2012, when we started working with her, was the ketogenic diet applied.
I will only mention the results achieved by one child. He is 8 years old, started the diet on January 13, 2012, before that he had 2-3 attacks a day. After the 16th month from the start of the diet, all medications were stopped, the child is currently in first grade. He has normal neuropsychological and physical development, which satisfies us. This child has been on the ketogenic diet for the longest time so far. At some point we will stop her too - when there are no seizures for a longer period of time.
Does it work on patients over 18?
- I'm not convinced that the ketogenic diet will work after childhood. Everywhere in the literature it is written that it is applied to children between 1 and 10 years of age. Unfortunately, not all refractory epilepsies, especially focal ones, have a positive effect from this diet. There must be results from the diet, not just guesswork - medicine without evidence cannot. But the good effect achieved in our patients is a fact.
