In the clinic, the ketogenic diet is mainly used in areas of:
- Reduction of epileptic symptoms
- Treatment of obesity
Regarding epilepsy, it seems that some studies have highlighted the therapeutic potential of ketone bodies in the control of epileptic symptoms in children who do not respond correctly to drug treatment (age less than 10 years of life).
Epilepsy
Epilepsy is a chronic disorder characterized by a symptomatology of more or less frequent convulsions associated with involuntary neural discharges. ), instead defined by a peculiar clinical history and confirmed by much more specific diagnoses.
The incidence of epilepsy is 50 cases per 100,000 individuals a year, with a prevalence of manifestation in the first year of life, and 75% within 20 years; males are more involved than females.
Seizures
The epileptic seizure is caused by the abnormal and excessive stress of the neurons of the brain; the relative electrical discharges are caused by the oscillatory alteration (high amplitude) of the cell membrane potential.
Classification
The classification of epilepsy dates back to 1989 and divides the various pathological forms into two groups:
- Partial epilepsies (convulsions of focal origin, i.e. that originate from a specific point in the cerebral cortex)
- Generalized epilepsies (covulsions that originate indiscriminately from both cerebral hemispheres)
Both categories can be differentiated on the basis at the age of onset and / or on presence of peculiar clinical pictures (syndromic forms). In addition, it is also possible to recognize forms of epilepsy symptomatic-secondary (known causes) from those idiopathic-primitive (cause unknown).
Epileptic seizures can be simple or complex according to the state of consciousness of the subject and can evolve into generalized and / or complex forms.
Causes
There are three main causes of epilepsy:
- Occasional
- For chronic, congenital or acquired brain damage
- Genetics
Occasional: intracranial infections, metabolic diseases, intoxications, hypertensive encephalopathy, kidney diseases, head injuries, acute cerebral hypoxia, cerebrovascular accidents.
For chronic, congenital or acquired brain damage: are secondary to prenatal, perinatal or postnatal damage.
Genetics: hereditary, they can cause both idiopathic and symptomatic forms.
Diagnosis
The diagnosis of epilepsy is based on the description of the critical event and the symptoms, as well as on the electromyographic examination. Subsequently, the neuroradiological tests (CT and / or RMM) will allow to classify the etiology of the epileptic form.
The most frequent differential diagnosis, especially in subjects that are too young, therefore unable to correctly describe the symptoms (and in the absence of third parties present), involves the exclusion of paroxysmal phenomena (exasperation due to a culminating pathological condition) including: psychic causes or affective, gastroesophageal refluxes, sleep disturbances, syncopal events, parasomnias, masturbation (remember that these are pediatric subjects) etc.
NB. An incorrect diagnosis can cause serious complications attributable to the prolonged use of drugs useless for healthy patients, or vice versa, to the lack of therapy in sick subjects.
Ketogenic diet
The ketogenic diet is a useful food strategy for reducing body weight and fat mass; it is based on the DRASTIC (and excessive) reduction of carbohydrates, with an increase in the protein and lipid ration. With a similar system it is possible:
- Prevent insulin peaks (hormone which, if produced in excess, is responsible for lipogenesis and blocking lipolysis)
- Oxidize as much fats as possible deriving from adipose tissue (sugars are lacking in the ketogenic, therefore the organism is obliged to oxidize more fatty acids.
In light of the above, it would seem that the ketogenic diet is a highly profitable weight loss method; however, even this therapy is NOT free of negative aspects, on the contrary ... quite the contrary! It is probably the unbalanced and incorrect diet par excellence. Let's see why:
- In a ketogenic, the organism is obliged to carry out as much neoglucogenesis as possible; this happens because the lipids (alone) are NOT sufficient to maintain cellular energy metabolisms. In fact, the oxidation of fatty acids occurs ONLY in the presence of resulting oxaloacetate from carbohydrates, which in this diet should be resynthesized in the liver (starting from dietary amino acids and body tissues, and only to a lesser extent from the glycerol constituting the triglycerides).
NB. This does not happen for branched chain amino acids (leucine, isoleucine and valine), which however are NOT sufficient to significantly reduce overall neoglucogenesis.
The ex-novo production of glucose from amino acids takes place in hepatocytes by deamination and transamination of amino groups (containing nitrogen). These waste products (especially ammonium) cannot simply be excreted, they require further conversion into urea, a process that occurs again in the liver via the urea cycle. The latter can finally be filtered by the kidneys and excreted in the urine. Even for a layman (let alone a professional) it should be logical that, although these processes may represent normal "metabolic stages" for the organism (they also occur in conditions of intense exercise) the difference between the hepatic and renal workload in conditions of ketogenic diet compared to that related to a balanced diet IS ABYSSAL. Ultimately, subjecting the organs to constant and continuous overwork is NOT a "healthy habit!
- The combustion of fatty acids and amino acids for the support of energy metabolisms has a drawback (which paradoxically represents an advantage in the ketogenic diet), namely the accumulation of toxic molecules. These, defined ketone bodies or ketones (acetone, acetoacetate and 3-hydroxybutyrate ), interact with the organism through systemic INTOXICATION and DEHYDRATION. The intoxication involves ALL tissues indiscriminately, but those most visibly affected belong to the central nervous system (CNS); without going into details, the excess of these molecules plays an inhibitory power on the stimuli of the brain, including hunger, in practice, the ketone bodies "stun" the CNS to the point of reducing appetite. The other aspect is linked to systemic dehydration; ketone bodies are highly osmotic molecules and their elimination occurs ESPECIALLY with the urine (as well as with breathing and sweating). By filtering the ketones, the kidneys can not help but "leave go "a large amount of water, inevitably reducing the volume and fluidity of the blood plasma, as well as blood pressure.
NB. Remember that the organs most fatigued by the ketogenic diet are the kidneys, which in addition to having an exponential workload compared to the norm, directly undergo the toxic effect of all the ketone bodies that must necessarily be filtered.
- The ketogenic diet therefore leads to metabolic ketosis; remember that, although it is true to define ketone bodies as a "potential" energetic substrate of the brain (which in critical conditions is able to partially exploit them), it is equally true that their use is in any case MARGINAL. Finally, we emphasize that an out of control ketogenic diet can also promote severe metabolic acidosis, an extremely dangerous condition that can lead (due to lowering of blood pH) to coma and even death.
Ketogenic diet and epilepsy
It is known that epilepsy represents a widespread neurological disorder but at the same time difficult to treat; it is estimated that about 20-30% of the affected population have considerable difficulties in controlling and managing seizures, even through drug therapy.
In "epilepsy, the ketogenic diet is USEFUL but must" be cycled and NOT applied constantly; the setting takes place at the hospital level, after admission, and must be followed by periodic dietological and neurological checks.
It is curious to note how "historically" diet has been the only known therapy for preventing and controlling epilepsy (early 1900s). This was later abandoned with the advent of the first drugs and resumed a few decades later by Johns Hopkins University in Baltimore. To date, Johns Hopkins statistics (on a sample of about 500 patients) report that: in "partial and drug-resistant childhood epilepsy, in 90 days it is possible to notice a halving of the attacks, albeit at the same time reducing the antiepileptic drug treatment. Other studies allow to appreciate the application of the ketogenic diet on patients with epilepsy; an authoritative pediatric journal has published that, in another experimental 16% of children no longer had significant attacks, 32% experienced a 90% reduction in attacks, and 56% a 50% reduction in attacks.
The ketogenic diet is both a valuable aid in the control of already treated epilepsy and an alternative cure in drug resistant epilepsy. In any case, ketogenic allows to reduce the dosages of specific molecules, improving the psycho-motor and cognitive development of pediatric subjects, in which it is possible to appreciate a certain improvement in attention capacity. The effectiveness of the ketogenic diet is attributable to a reduction in excitability and nerve transmission thanks to the action of ketone bodies.
Bibliography:
- Pediatric neurology - L. Pavone, M. Ruggieri Elsevier - page 296
- The Ketogenic diet: a treatment for epilepsy - Freeman J.M., Kelly M.T., Freeman J.B. - New York, 2006
