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NREM-sleep Associated Epileptiform Discharges Disappeared Following a Shift toward the Paleolithic Ketogenic Diet in a Child with Extensive Cortical Malformation

DOI:10.12691/ajmcr-3-7-8
Authors:
Zsofia Clemens at International Center for Medical Nutritional Intervention
Zsofia Clemens
  • International Center for Medical Nutritional Intervention
Anna Kelemen
Anna Kelemen
Csaba Csiba-Tóth at Nutrition intervention foundation
Csaba Csiba-Tóth
  • Nutrition intervention foundation
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Purpose: Although the classical ketogenic diet is an effective treatment in childhood epilepsy, it is difficult to maintain on the long term due to side-effects and dislike. Methods: Here we report a case of a child with frequent epileptiform discharges confined to non-rapid-eye-movement (NREM) sleep and extensive cortical malformation. The child was started on a modified version of the classical ketogenic diet we refer to as the paleolithic ketogenic diet. Results: Subsequent follow-up electroencephalograms showed complete normalization of brain electric activity along with cognitive improvement. Neither antiepileptic medication nor vitamin supplements were used. The child strongly adhered to the diet as assessed by regular urinary ketone tests and laboratory work ups. Currently she is on the diet for 17 months. Neither side effects nor clinical signs of nutrient deficiency were observed. Conclusion: We conclude that the paleolithic ketogenic diet was effective, safe and feasible in this case.
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American Journal of Medical Case Reports, 2015, Vol. 3, No. 7, 212-215
Available online at http://pubs.sciepub.com/ajmcr/3/7/8
© Science and Education Publishing
DOI:10.12691/ajmcr-3-7-8
NREM-sleep Associated Epileptiform Discharges
Disappeared Following a Shift toward the Paleolithic
Ketogenic Diet in a Child with Extensive Cortical
Malformation
Zsófia Clemens1,2,*, Anna Kelemen3, Csaba Tóth1
1Paleomedicina Hungary Ltd., Evolutionary Medicine Working Group, Budapest, Hungary
2Neurological Department, University of Pécs, Pécs, Hungary
3Department of Neurology, National Institute of Clinical Neuroscience, Budapest, Hungary
*Corresponding author: clemenszsofia@gmail.com
Received May 30, 2015; Revised June 09, 2015; Accepted June 11, 2015
Abstract Purpose: Although the classical ketogenic diet is an effective treatment in childhood epilepsy, it is
difficult to maintain on the long term due to side-effects and dislike. Methods: Here we report a case of a child with
frequent epileptiform discharges confined to non-rapid-eye-movement (NREM) sleep and extensive cortical
malformation. The child was started on a modified version of the classical ketogenic diet we refer to as the
paleolithic ketogenic diet. Results: Subsequent follow-up electroencephalograms showed complete normalization of
brain electric activity along with cognitive improvement. Neither antiepileptic medication nor vitamin supplements
were used. The child strongly adhered to the diet as assessed by regular urinary ketone tests and laboratory work ups.
Currently she is on the diet for 17 months. Neither side effects nor clinical signs of nutrient deficiency were
observed. Conclusion: We conclude that the paleolithic ketogenic diet was effective, safe and feasible in this case.
Keywords: epilepsy, ketogenic diet, paleolithic diet, non-rapid-eye-movement sleep, interictal epileptiform
discharges
Cite This Article: Zsófia Clemens, Anna Kelemen, and Csaba Tóth, “NREM-sleep Associated Epileptiform
Discharges Disappeared Following a Shift toward the Paleolithic Ketogenic Diet in a Child with Extensive
Cortical Malformation.” American Journal of Medical Case Reports, vol. 3, no. 7 (2015): 212-215. doi:
10.12691/ajmcr-3-7-8.
1. Introduction
The ketogenic diet has been used in the treatment of
epilepsy for 90 years [1]. Several studies, including
randomized controlled studies [2], proved its effectiveness
which compares to that of antiepileptic drugs while
probably confering less side-effects [1]. Current
epileptological practice, however, continue to rely on
antiepileptic drugs and the ketogenic diet is not
recommended as a first-line therapy except for two rare
epilepsy syndromes[3]. Previously it was suggested that
ketosis represent an evolutionary adapted state in humans
[4]. In 1975 gastroenterologist Voegtlin suggested an
animal fat-meat based diet as being evolutionarily adapted
[5]. Recently we reported a case of a child with absence
epilepsy successfully treated with an animal fat-meat
based diet we refer to as the paleolithic ketogenic diet [6].
Here we report a case of a child with developmental delay,
extensive bilateral cortical malformation and frequent
interictal epileptic discharges confined to non-rapid-eye-
movement (NREM) sleep electroencephalogram
(EEG).The child started the paleolithic ketogenic diet
which she strongly adhered to. Follow-up EEGs showed
complete normalization of the EEG along with
improvements in cognition.
2. Case Report
The child was born at full term with no complications
in 2007. A routine ultrasound examination at 10 days old
showed enlarged ventricles of the brain. Her muscles were
spastic and she had difficulties with feeding. A repeated
ultrasund examination at 1 year old showed moderately
enlarged ventricles but no signs of intracranial
hypertension. An MRI examination performed in October
2012 showed extensive bilateral polymicrogyria involving
all brain lobes except for the frontal lobe. The MRI also
indicated septal agenesia and hypogenesis of the corpus
callosum. Additional dismorphic features included
microcephaly, hypertelorism, arched palate and
dysmorphic auricles. Genetic tests for subtelomeric
deletion, Angelman syndrome and congenital
glycosylation disorder were negative. Due to a delay in
motor development she has been receiving movement
therapy. She had a complex cognitive developmental
American Journal of Medical Case Reports 213
delay including attention deficit an inability to speak. She
has also been receiving interventions to improve cognition.
A whole-night EEG performed on 02 Aug 2013 showed
frequent multifocal epileptiform discharges confined to
non-rapid-eye-movement (NREM) sleep (Figure 1).
Interictal epileptic discharges were continuous during
NREM stage 2 and were very frequent during NREM
stage 3 and 4. No epileptiform discharges were seen
during wakefulness. The child had no history of ouvert
seizures. Parents of the child refused antiepileptic
medication and decided to initiate the paleolithic
ketogenic diet. The child shifted from the normal diet
toward the paleolithic ketogenic diet gradually within one
month. In December 2013 multiple fasciotomy was
performed at a foreign clinic to alleviate muscle
contractures. From 01 January 2014 the child was on a full
paleolithic ketogenic diet. The diet mostly consisted of
animal fat, meat, offal with a fat:protein ratio of at least
2:1. Fat and red meats as well as offal from pork and cattle
were encouraged. She was allowed to consume vegetables
to an extent which did not prevent ketosis as regularly
assessed by urinary ketone test. Although we did not
recommend it, she also used coconut flour in small
amounts to make the diet more palatable. No plant oil of
any form were allowed. Artificial sweeteners were
restricted but small amounts of honey was allowed. At
diet initiation we advised against taking vitamin and
mineral supplements and so the child stopped all
supplements she was taking before. Ketosis was regularly
checked by urinary ketone strips which indicated
sustained ketosis. Laboratory check-ups were carried out
five times during the 17 months on the diet. All five
urinary laboratory tests were positive for ketones. Avarage
blood glucose was 3.98 (± 0.42) mmol/l. Blood count,
renal and liver function were normal. Inflammatory
markers, including CRP and fibrinogen, as well as
triglicerides and uric acid remained low. Total cholesterol
and LDL were elevated (Table 1). On 02 February 2014,
four weeks after diet onset, a whole-night sleep EEG was
performed. This showed normal sleep structure and the
absence of clear-cut epileptiform activity. The EEG only
showed infrequent waveforms during NREM sleep that
were sharper in morphology (Figure 2). As before no EEG
abnormalities were seen during wakefulness. Four months
later on 14 Jun 2014 a next whole-night EEG recording
showed normal sleep structure, normal background
activity and the absence of epileptiform activity (Figure 3).
Figure 1. EEG during NREM stage 2 sleep recorded on 02 Aug 2013 while on a normal diet. Note frequent multifocal epileptiform activity
Figure 2. EEG during NREM stage 2 sleep recorded on 02 Feb 2014 four weeks after the onset of the paleolithic ketogenic diet. Normal EEG
214 American Journal of Medical Case Reports
Figure 3. EEG during NREM stage 2 sleep recorded on 14 Jun 2014 six months after the onset of the paleolithic ketogenic diet. Normal EEG
Table 1. Laboratory data while on a normal diet (on 11 November
2013) and on the paleolithic ketogenic diet 13 months later (on 13
December 2014). Note that except for cholesterol and LDL
cholesterol all parameters fall in the normal range while on the
paleolithic ketogenic diet
Normal diet Paleolithic-ketogenic diet
Sodium 140 138 mmol/l
Potassium 4.5 4.7 mmol/l
Calcium 2.58 2.42 mmol/l
Magnesium 0.83 0.9 mmol/l
Carbamide 6.6 3.4 mmol/l
Creatinine 33 23 μmol/l
Glucose 3.9 3.9 mmol/l
HgA1c 5.2 4.8 %
Total cholesterol 6.1 12.3 mmol/l
HDL cholesterol 1.57 1.44 mmol/l
LDL cholesterol 4.23 10.85 mmol/l
Triglyceride 0.49 0.76 mmol/l
Uric acid 168 209 μmol/l
Total protein 77 73 G/l
WBC 5.4 4.9 G/l
RBC 4.8 4.4 T/l
Iron 6.1 17.8 μmol/l
Hemoglobin 124 126 g/l
GOT 30 28 U/l
GPT 13 16 U/l
GGT 11 13 U/l
ALP 220 197 U/l
fibrinogen 3.59 2.44 g/l
CRP 0.3 0.1 mg/l
Abbreviations: HgA1c – glycated hemoglobin, HDL - high density
lipoprotein, LDL – low density lipoprotein, WBC – white blood cell
count, RBC – red blood cell count, GOT – glutamate-oxaloacetate
transaminase, GPT – glutamate-pyruvate transaminase, GGT – gamma-
glutamyl transferase, ALP – alkaline phosphatase, CRP – C-reactive
protein
As reported by the parents adhering to the diet was
relatively easy for the child. Currently she is on the
paleolithic ketogenic diet for 17 months. The parents of
the child are committed to continue the diet. Neither
gastrointestinal nor other side effects emerged. Also, no
clinical signs of vitamin or mineral deficiencies emerged.
Parents of the child gave written informed consent for
publication of this case.
3. Discussion
Sleep, and especially NREM sleep, is critically
involved in a variety of cognitive functions [7,8]. Frequent
epileptic activity during NREM sleep is thought to
deteriorate sleep-related cognitive processing in epileptic
children [9]. Landau-Kleffner syndrome is a form of
epilepsy presenting without seizures but with epileptic
activity over the sylvian region resulting is a loss of
language skills [10]. Our patient, however, may not be
classified as having Landau-Kleffner syndrome given the
more widespread morphological and EEG abnormalities
and the complexity of her developmental delay.
The parents of the child refused antiepileptic
medication and therefore the paleolithic ketogenic diet
was initiated as a stand-alone therapy. Follow up sleep-
EEG performed at four weeks on the diet showed the
absence of clear-cut epileptiform discharges during
NREM sleep. A next sleep-EEG performed at five months
after diet onset showed no epileptiform EEG activity at all.
Parents and caretakers of the child noted improvements in
cognition including learning, concentration, speech
comprehension as well as improvements in vocalization
and motor skills. Parent reports, home monitoring of
urinary ketone as well as laboratory check-ups showed an
excellent adherence to the diet and sustained ketosis. Her
laboratory parameters were normal except for total
cholesterol and LDL cholesterol which were elevated. In
our previous case with absence epilepsy [6] and in another
case of type 1 diabetes [11] on the paleolithic ketogenic
diet these two laboratory measures were also elevated
although not to this extent. Elevation of cholesterol is also
known from studies with the classical ketogenic diet [12].
Yet it is now acknowledged that neither serum nor dietary
cholesterol should be regarded as a risk factor for
cardiovascular disease [13]. Instead, other laboratory
American Journal of Medical Case Reports 215
parameters including C-reactive protein [14] and
fibrinogen [15] have been suggested as better predictors of
cardiovascular disease. Of note, these latter measures were
consistently low in our patient. We speculate that in our
patient elevated cholesterol may reflect ongoing
regenerative processes. Other laboratory parameters
including uric acid and triglycerides were normal like in
our other patients on the paleolithic ketogenic diet
[6,11,16]. Adverse effects known to be associated with the
classical ketogenic diet such as iron-deficiency anemia,
hypomagnesemia, increased frequency of infections and
gastrointestinal side effects [17] did not emerge in our
patient on the paleolithic ketogenic diet despite of the
absence of supplementation. Of note, no such adverse
effects were seen in our previous cases on the paleolithic
ketogenic diet [6,11,16]. It is worth noting that the
complete normalization of the EEG, in terms of
disappearence of interictal epileptiform spikes, seen in our
both epilepsy cases on the paleolithic ketogenic diet is
very rare among patients on the classical ketogenic diet
[18].
At the time of writing this manuscript the patient is on
the diet for 17 months. We believe that the paleolithic
ketogenic diet may be remedial while confering neither
side effects nor deficiencies because it is of full nutritional
value matching the human evolutionary needs [19,20].
Compliance with Ethical Standards
The authors declared no potential conflicts of interest.
The case study was done in accordance with the Helsinki
Declaration of 1975. Informed consent was obtained the
parents of the child. The authors received no financial
support for the research.
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... This is an animal fat-meat based diet similar to that originally proposed and used by gastroenterologist Voegtlin (13). To date we have published eight cases including patients with epilepsy (14,15), type 1 diabetes (16,17), metabolic syndrome (18), Gilbert's syndrome (19), Crohn's disease (20) and soft palate cancer (21) successfully treated with the paleolithic ketogenic diet. Importantly, the classic version of the ketogenic diet is known to be associated with low magnesium levels (22) one of the most well-known side-effects of the classic ketogenic diet. ...
... Importantly, the classic version of the ketogenic diet is known to be associated with low magnesium levels (22) one of the most well-known side-effects of the classic ketogenic diet. Our published cases (14)(15)(16)(17)(18)(19)(20)(21), along with our general experience, however, indicate that magnesium levels are normal on the paleolithic ketogenic diet. In order to quantify this clinical observation we performed a study in which we retrospectively assessed magnesium levels in relation to glycemic parameters in 45 patients with various diseases and five healthy subjects on the paleolithic ketogenic diet. ...
... were low. A similar pattern of laboratory parameters was seen in our previous case studies with the paleolithic ketogenic diet (14)(15)(16)(17)(18)(19)(20)(21) and may be regarded as indicating adequate dietary adherence. ...
The paleolithic ketogenic diet may ensure adequate serum magnesium levels
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Magnesium plays an essential role in several enzymatic reactions. Its deficiency is known to be widespread and has been associated with a variety of pathological conditions characterized by chronic inflammation and/or oxidative stress. The connection between the metabolism of glucose and magnesium at the cell level is wellestablished. We hypothesize that magnesium deficiency in chronic conditions is primarily due to Western type carbohydrate based metabolism. In previous case studies we have shown that magnesium levels are normal on the paleolithic ketogenic diet. Here we assessed magnesium levels in a larger sample (n=50) to address whether the paleolithic ketogenic diet is able to ensure normal blood magnesium levels. Materials and Methods To assess magnesium levels in patients and healthy controls on the paleolithic ketogenic diet in a larger sample, we retrospectively analysed laboratory data obtained from 50 patients/subjects who were following the diet and were also not taking magnesium or other supplements. Correlation calculation was performed between magnesium and glucose levels. Results We found magnesium levels to be in the normal range in all but one patient/subject. There was a significant inverse correlation between glucose and magnesium levels. Discussion Our results indicate that the paleolithic ketogenic diet ensures normal magnesium levels in various pathological conditions as well as in healthy subjects. We believe that the high prevelance of magnesium deficiency reported earlier for a variety of chronic conditions is correlated with carbohydrate-based Western type nutrition rather than that of the chronic condition itself. We discuss underlying mechanisms. Keywords magnesium, paleolithic, ketogenic, glucose, glycated hemoglobin, diabetesn
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... An increasing number of studies, as also reviewed by a recent metaanalysis [15], indicate metabolic benefits of the human evolutionary diet also known as the stone age diet [16] or paleolithic diet [17]. In recent years we have published a series of case studies where type 1 diabetes [18,19], type 2 diabetes [20], epilepsy [21,22], Gilbert's syndrome [23] and Crohn's disease [24] where was successfully treated by the paleolithic ketogenic diet, an animal fat-meat based diet. In our most recent case study we reported on halted progression of soft palate cancer for 20 months in a patient on the paleolithic ketogenic diet [25]. ...
... It is known that plant oils, grains and dairy, among their other possible negative effects, may promote inflammation [17]. On the contrary, the paleolithic ketogenic diet, which is based on animal fat, meat and offal, seems to have an anti-inflammatory effect, as also seen in our other patients on the same diet [18][19][20][21][22][23][24][25]. In addition, while the classical ketogenic diet is known to induce nutrient deficiencies [29], the paleolithic ketogenic diet seems to supply optimal amounts of micronutrients as shown by the absence of deficiency symptoms and the normalization of laboratory parameters including iron, magnesium and vitamin levels, and normal function of the liver, kidney and thyroid gland. ...
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... In an attempt to distinguish this diet from both the classical ketogenic as well as the diet termed paleolithic in a series of clinical studies [18] and books [17], we refer the diet as paleolithic ketogenic. Previously we have published cases of type 1 [19,20], type 2 diabetes [21], epilepsy [22,23], Gilbert's syndrome [24] and Crohn's disease [25] where we successfully applied the diet. Here we present a case with soft palate tumor of myoepithelial origin, an aggressive cancer type, where using the paleolithic ketogenic diet without any conventional treatment modalities resulted in halted progression of the tumor for 20 months, while producing no symptoms or side effects. ...
... The patient showed excellent dietary adherence as also shown by laboratory workups. Her laboratory parameters are similar to that seen in our other patients on the paleolithic ketogenic diet with other diseases [19,20,21,22,23,24,25]. ...
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... Thus far, we have published several case reports of patients who have been successfully treated with the PKD. These include: type 2 (Tóth and Clemens, 2015a) and type 1 diabetes (Tóth and Clemens, 2014;2015b); Crohn's disease (Tóth et al, 2016); Gilbert's syndrome (Tóth and Clemens, 2015c); epilepsy (Clemens et al., 2013(Clemens et al., , 2015; complete reversal of cervical intraepithelial neoplasia (Tóth et al., 2018); halted progression of soft palate cancer (Tóth and Clemens, 2016) and regression of rectal cancer ( (Tóth and Clemens, 2017) Here we present a case report of a patient with glioblastoma multiforme. Initially, the patient had been treated with standard oncotherapy including surgery, radiotherapy and chemotherapy. ...
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... Thus far, we have published several case reports of patients who have been successfully treated with the PKD. These include: type 2 (Tóth and Clemens, 2015a) and type 1 diabetes (Tóth and Clemens, 2014;2015b); Crohn's disease (Tóth et al, 2016); Gilbert's syndrome (Tóth and Clemens, 2015c); epilepsy (Clemens et al., 2013(Clemens et al., , 2015; complete reversal of cervical intraepithelial neoplasia (Tóth et al., 2018); halted progression of soft palate cancer (Tóth and Clemens, 2016) and regression of rectal cancer ( (Tóth and Clemens, 2017) Here we present a case report of a patient with glioblastoma multiforme. Initially, the patient had been treated with standard oncotherapy including surgery, radiotherapy and chemotherapy. ...
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... Erickson et al. [1] recently published a review on the use of the ketogenic diet in cancer. The authors of this reply are clinicians who bring into play an evolutionary approach in the practice of medicine and specifically have been using the paleolithic ketogenic diet in the treatment of chronic diseases since 2011 [2][3][4][5][6][7][8][9]. We have instituted the paleolithic ketogenic diet in approximately 4000 patients, of whom several hundred have been followed up for at least one year, and 60 cancer patients who have been followed up for at least 6 months. ...
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Erickson et al. recently published a review on the use of the ketogenic diet in cancer. The authors of this reply are clinicians who bring into play an evolutionary approach in the practice of medicine and specifically have been using the paleolithic ketogenic diet in the treatment of chronic diseases since 2011. We have instituted the paleolithic ketogenic diet in approximately 4000 patients, of whom several hundred have been followed up for at least one year, and 60 cancer patients who have been followed up for at least 6 months. Previously (prior to 2011) we had been using the classic paleolithic diet, which was useful in the treatment of certain diseases but proved to be ineffective in the treatment of autoimmune diseases and cancer.
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... The authors of the present report are using a diet referred to as the paleolithic ketogenic diet in the treatment of chronic conditions. So far we have published cases of successful treatment of diabetes type 1 [6,7] and type 2 [8], epilepsy [9,10] as well as other conditions [11]. ...
Crohn's disease successfully treated with the paleolithic ketogenic diet
Article
Full-text available
  • Sep 2016
Introduction: Crohn’s disease is regarded as having no curative treatment. Previous reports on dietary therapy of Crohn’s disease indicate no major success. Case Report: Here we report a severe case of Crohn’s disease where we successfully applied the paleolithic ketogenic diet. Dietary therapy resulted in resolution of symptoms, normalized laboratory parameters as well as gradual normalization of bowel inflammation as evidenced by imaging data and normalization of intestinal permeability as shown by the polyethylene glycol (PEG 400) challenge test. The patient was able to discontinue medication within two weeks. Currently, he is on the diet for 15 months and is free of symptoms as well as side effects. Conclusion: We conclude that the paleolithic ketogenic diet was feasible, effective and safe in the present case.
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... Geijer and Ekelund. I am using a low carbohydrate diet, we refer to as the paleolithic ketogenic diet, in the treatment of diverse chronic diseases already for six years [1][2][3][4][5][6]. I have to say that in my practice I did never see a single case where ketoacidosis or metabolic acidosis developed while on the paleolithic ketogenic diet, even though I am familiar with the diagnosis and treatment of these conditions given my 5-years experience in ICU. ...
Comment on ”Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report"
Data
  • Jan 2015
I became curious when I read the title of the case report by drs. Geijer and Ekelund. I am using a low carbohydrate diet, we refer to as the paleolithic ketogenic diet, in the treatment of diverse chronic diseases already for six years [16]. I have to say that in my practice I did never see a single case where ketoacidosis or metabolic acidosis developed while on the paleolithic ketogenic diet, even though I am familiar with the diagnosis and treatment of these conditions given my 5 years experience in ICU. reflected in this report. First, lactation itself does not predispose to ketosis. Whether ketosis develops in a healthy lactating woman only depends on the type of the nutrition. In newborn infants, however, ketosis is achieved within a few hours after birth and they remain so while breastfeeding. There is ample evidence showing that the state of ketosis is not abnormal but physiological at any age. For example, indigenous people of the Arctic following a traditional fatmeat based diet containing little or no carbohydrate are in ketosis through their entire lifespan. Our experience with patients also indicates that even a prolonged full fatmeat diet does neither predispose to ketosis or metabolic acidosis. Given these facts the explanation for the phenomenon described in the report of drs. Geijer and Ekelund lies elsewhere.
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Die Paläoernährung und ihr Stellenwert für die Prävention und Behandlung chronischer Krankheiten
Article
  • Dec 2016
Background: Many concepts try to explain the current rise in the chronic non-communicable diseases. Within the framework of evolutionary medicine there is a common explanation for these diseases in the form of an insufficient adaption to the modern lifestyle, which also reflects in the word “diseases of civilization”. Nutrition plays a key role within this framework. Accordingly, the terms “Paleolithic diet”, “Stone Age diet” or simply “Paleo diet” have been introduced to refer to a diet that tries to mimic human dietary behaviors during the Old Stone Age (Paleolithic) era, which chronologically spans the majority of human existence. Because the Paleo diet is not only becoming more popular among consumers, but also receives increased attention from the international scientific community, the goal of this review is to comprehensively summarize the background, principles and scientific evaluation of the Paleo diet for the German-speaking part. Materials and Methods: Based on anthropological and ethnographic studies, supplemented with physiological insights, a short overview of the evolution of the human diet during the Old Stone Age is given. From these insights the principles of a modern Paleo diet are derived. All clinical studies published to date using a Paleo diet as an intervention have been shortly described and evaluated. Finally, the Paleo diet is discussed within the broader context of a modern evolutionary medicine that primarily aims at preventing the chronic non-communicable diseases. Results: Although only studies with small sample sizes and methodological shortcomings have been published, they nevertheless have consistently shown that a Paleolithic diet is superior to other diets, also those regarded as wholesome. The largest evidence supports a beneficial effect on coronary risk factors, while beneficial effects on autoimmune diseases seem probable. Conclusion: A Paleolithic diet appears suitable for the treatment of coronary diseases, and probably also autoimmune disorders. Compliance to the diet is facilitated by its intuitive analogy to a “species-appropriate” diet.
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Successful treatment of a patient with obesity, type 2 diabetes and hypertension with the paleolithic ketogenic diet
Article
Full-text available
  • Mar 2015
Introduction: Metabolic syndrome is a major public health problem affecting at least 20% of the world’s adult population. Components of the metabolic syndrome include obesity, impaired glucose metabolism, hypertension and altered lipid profile. Currently, medical treatment relies on drugs. A major problem is that patients with long-standing disease are excessively medicated because of an increase in the number of symptoms over time. A few clinical studies indicate that low-carbohydrate diets, including the paleolithic as well as the ketogenic diet, may be beneficial in the treatment of conditions associated with the metabolic syndrome. Case Report: Herein, we present a case of patient with metabolic syndrome successfully treated with the paleolithic ketogenic diet. While on the diet the patient was able to discontinue eight medicines, lost weight, showed a continuous improvement in glucose parameters and her blood pressure normalized. Currently, the patient is on the paleolithic ketogenic diet for 22 months, free of symptoms and side effects. Conclusion: We conclude that the paleolithic ketogenic diet was safe, feasible and effective in the treatment of this patient with metabolic syndrome.
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Type 1 diabetes mellitus successfully managed with the paleolithic ketogenic diet
Article
Full-text available
  • Oct 2014
Introduction: Type 1 diabetes mellitus (T1DM) patients are usually instructed to follow a low fat/high carbohydrate diet. A few studies in literature, however, reported metabolic benefits and sustainability of carbohydrate restricted diets. Case Report: Herein, we present a case of a 19-year-old male with newly diagnosed T1DM. The patient was first put on an insulin regime. Twenty days later, he shifted towards the paleolithic ketogenic diet and was able to discontinue insulin. Strict adherence to the diet resulted in normal glucose levels and a more than three-fold elevation of C-peptide level indicating restored insulin production. Currently, the patient is on the paleolithic ketogenic diet for 6.5 months. He is free of complaints, and no side effects emerged. Conclusion: We conclude that the paleolithic ketogenic diet was effective and safe in the management of this case of newly diagnosed T1DM. Marked increase in C peptide level within two months indicates that the paleolithic ketogenic diet may halt or reverse autoimmune processes destructing pancreatic beta cell function in T1DM.
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How Sleep Activates Epileptic Networks?
Article
Full-text available
  • Jan 2013
. The relationship between sleep and epilepsy has been long ago studied, and several excellent reviews are available. However, recent development in sleep research, the network concept in epilepsy, and the recognition of high frequency oscillations in epilepsy and more new results may put this matter in a new light. Aim . The review address the multifold interrelationships between sleep and epilepsy networks and with networks of cognitive functions. Material and Methods . The work is a conceptual update of the available clinical data and relevant studies. Results and Conclusions . Studies exploring dynamic microstructure of sleep have found important gating mechanisms for epileptic activation. As a general rule interictal epileptic manifestations seem to be linked to the slow oscillations of sleep and especially to the reactive delta bouts characterized by A1 subtype in the CAP system. Important link between epilepsy and sleep is the interference of epileptiform discharges with the plastic functions in NREM sleep. This is the main reason of cognitive impairment in different forms of early epileptic encephalopathies affecting the brain in a special developmental window. The impairment of cognitive functions via sleep is present especially in epileptic networks involving the thalamocortical system and the hippocampocortical memory encoding system.
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Childhood Absence Epilepsy Successfully Treated with the Paleolithic Ketogenic Diet
Article
Full-text available
  • Sep 2013
Introduction Childhood absence epilepsy is an epilepsy syndrome responding relatively well to the ketogenic diet with one-third of patients becoming seizure-free. Less restrictive variants of the classical ketogenic diet, however, have been shown to confer similar benefits. Beneficial effects of high fat, low-carbohydrate diets are often explained in evolutionary terms. However, the paleolithic diet itself which advocates a return to the human evolutionary diet has not yet been studied in epilepsy. Results Here, we present a case of a 7-year-old child with absence epilepsy successfully treated with the paleolithic ketogenic diet alone. In addition to seizure freedom achieved within 6 weeks, developmental and behavioral improvements were noted. The child remained seizure-free when subsequently shifted toward a paleolithic diet. Conclusion It is concluded that the paleolithic ketogenic diet was effective, safe and feasible in the treatment of this case of childhood absence epilepsy.
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Ketogenic diet and other dietary treatments for epilepsy
Article
Full-text available
  • Mar 2013
Background: The ketogenic diet, being high in fat and low in carbohydrates, has been suggested to reduce seizure frequency. It is currently used mainly for children who continue to have seizures despite treatment with antiepileptic drugs. Recently there has been interest in less restrictive ketogenic diets including the Atkins diet and the use of these diets has extended into adult practice. Objectives: To review the evidence from randomised controlled trials regarding the effects of ketogenic and similar diets. Search methods: We searched the Cochrane Epilepsy Group's Specialised Register (June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2 of 4), MEDLINE (1948 to May week 4, 2011) and EMBASE (1980 to March 2003). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. Selection criteria: Studies of ketogenic diets and similar diets for people with epilepsy. Data collection and analysis: Three review authors independently applied pre‐defined criteria to extract data and also assessed study quality. Main results: We identified four randomised controlled trials which generated five publications. These included Kossoff 2007, Bergqvist 2005, Seo 2007, Neal 2008 and Neal 2009. All trials applied the intention‐to‐treat analysis with varied randomisation method. The four studies recruited a total of 289 children and adolescents and no adults. Meta‐analysis could not be conducted due to heterogeneity of the studies. Seven prospective studies and four retrospective studies were also identified. Authors' conclusions: Our review update included data from four new randomised studies of the ketogenic diet. Although none were blinded, some were of good quality. These studies suggest that in children, the ketogenic diet results in short to medium term benefits in seizure control, the effects of which are comparable to modern antiepileptic drugs. However, one study of long term outcome reports a high attrition rate for the diet. This would suggest that many children find the diet difficult to tolerate. The main reasons for drop‐outs in the included studies included gastrointestinal side effects and dislike for the diet. We found just three studies on the use of the diet in adults and none of these were randomised. There has been less research involving other diets. We found one randomised study of reasonable quality of the Atkins diet. This study showed similar benefits in seizure control with a less restrictive diet. For those with medically intractable epilepsy or those in whom surgery is unsuitable, a ketogenic diet could improve seizure control, but tolerability is poor. One observational study suggested that the Atkins diet may have a similar effect on seizure control, but this requires more investigation.
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Can Children With Hyperlipidemia Receive Ketogenic Diet for Medication-Resistant Epilepsy?
Article
Full-text available
  • Feb 2013
The very-high-fat ketogenic diet can worsen lipid levels in children with pre-existing hyperlipidemia by increasing serum lipoproteins and reducing antiatherogenic high-density lipoproteins. A retrospective chart review of 160 children treated with the ketogenic diet from September 2000 to May 2011 was performed. Twelve children with pre-existing hyperlipidemia were identified. Lipid levels including total cholesterol, low-density lipoprotein, triglycerides, high-density lipoprotein, and total cholesterol/high-density lipoprotein were measured pre-diet and at 3, 6, and 12 months of treatment. During treatment, there was a significant reduction in mean total cholesterol, low-density lipoprotein, and total cholesterol/high-density lipoprotein. Total cholesterol and low-density lipoprotein were normalized in 8 and 7 children at 6 months; and 9 and 9 children at 12 months respectively. At 6 and 12 months, tot cholesterol/HDL ratio was normalized in 5 and 7 children respectively. Diet modifications were made to achieve healthy lipid levels. By extrapolating the data, it suggests lipid levels can be controlled in children and adults with ketogenic diet treatment.
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Carbohydrate restriction in patients with advanced cancer: A protocol to assess safety and feasibility with an accompanying hypothesis
Article
  • Jan 2008
Dietary carbohydrate restriction provokes systemic metabolic and cell signaling effects including down-regulation of insulin, insulin-like growth factors, fatty acid synthase, and other enzymatic and signaling targets. These effects as well as increased availability of fatty acids and ketone bodies may plausibly inhibit aggressive glycolytic cancers. We have designed a 28-day clinical trial diet of very low carbohydrate intake under nutritionist guidance to test the safety and feasibility in patients with advanced glucose-dependent solid cancers, determined by a positive baseline positron emission tomography (PET) scan using 18-fluorodeoxyglucose to demonstrate glucose avidity. Changes in a follow-up PET scan at study's end permit a surrogate measure of efficacy.
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Ketogenic diet and other dietary treatments for epilepsy
Article
  • Mar 2012
Background: The ketogenic diet, being high in fat and low in carbohydrates, has been suggested to reduce seizure frequency. It is currently used mainly for children who continue to have seizures despite treatment with antiepileptic drugs. Recently there has been interest in less restrictive ketogenic diets including the Atkins diet and the use of these diets has extended into adult practice. Objectives: To review the evidence from randomised controlled trials regarding the effects of ketogenic and similar diets. Search methods: We searched the Cochrane Epilepsy Group's Specialised Register (June 2011), the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2 of 4), MEDLINE (1948 to May week 4, 2011) and EMBASE (1980 to March 2003). No language restrictions were imposed. We checked the reference lists of retrieved studies for additional reports of relevant studies. Selection criteria: Studies of ketogenic diets and similar diets for people with epilepsy. Data collection and analysis: Three review authors independently applied pre-defined criteria to extract data and also assessed study quality. Main results: We identified four randomised controlled trials which generated five publications.These included Kossoff 2007, Bergqvist 2005, Seo 2007, Neal 2008 and Neal 2009. All trials applied the intention-to-treat analysis with varied randomisation method. The four studies recruited a total of 289 children and adolescents and no adults. Meta-analysis could not be conducted due to heterogeneity of the studies. Seven prospective studies and four retrospective studies were also identified. Authors' conclusions: Our review update included data from four new randomised studies of the ketogenic diet. Although none were blinded, some were of good quality. These studies suggest that in children, the ketogenic diet results in short to medium term benefits in seizure control, the effects of which are comparable to modern antiepileptic drugs. However, one study of long term outcome reports a high attrition rate for the diet. This would suggest that many children find the diet difficult to tolerate. The main reasons for drop-outs in the included studies included gastrointestinal side effects and dislike for the diet.We found just three studies on the use of the diet in adults and none of these were randomised. There has been less research involving other diets. We found one randomised study of reasonable quality of the Atkins diet. This study showed similar benefits in seizure control with a less restrictive diet.For those with medically intractable epilepsy or those in whom surgery is unsuitable, a ketogenic diet could improve seizure control, but tolerability is poor. One observational study suggested that the Atkins diet may have a similar effect on seizure control, but this requires more investigation.
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International consensus statement on clinical implementation of the ketogenic diet: Agreement, flexibility, and controversy
Article
  • Nov 2008
The ketogenic diet (KD) is an established, effective nonpharmacologic treatment for intractable childhood epilepsy. The KD is provided differently throughout the world, with occasionally significant variations in its administration. There exists a need for more standardized protocols and management recommendations for clinical and research use. In December 2006, the Charlie Foundation commissioned a panel comprised of 26 pediatric epileptologists and dietitians with particular expertise in using the KD. This group was convened to create a consensus statement regarding the clinical management of the KD; the consensus statement has also been endorsed by the Child Neurology Society. Members were asked to write sections based on clinical interests and the full document was subsequently reviewed and approved by the entire group. Recommendations were made regarding evaluation of children before starting the diet, specifically in regards to ideal patient selection, pre-KD counseling and testing, and choice of specific dietary therapy (ketogenic or less restrictive alternative diets). In addition, there was information provided regarding diet implementation (need for fasting and admission), supplementation, follow-up management (frequency of visits as well as diet and laboratory evaluations while receiving the diet), adverse event monitoring, and timing and method of eventual KD discontinuation. This group effort highlights recommendations based on best evidence, including areas of agreement and controversy, unanswered questions, and future research.
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Dietary Cholesterol: from physiology to cardiovascular risk
Article
Dietary cholesterol comes exclusively from animal sources, thus it is naturally present in our diet and tissues. It is an important component of cell membranes and a precursor of bile acids, steroid hormones and vitamin D. Contrary to phytosterols (originated from plants), cholesterol is synthesised in the human body in order to maintain a stable pool when dietary intake is low. Given the necessity for cholesterol, very effective intestinal uptake mechanisms and enterohepatic bile acid and cholesterol reabsorption cycles exist; conversely, phytosterols are poorly absorbed and, indeed, rapidly excreted. Dietary cholesterol content does not significantly influence plasma cholesterol values, which are regulated by different genetic and nutritional factors that influence cholesterol absorption or synthesis. Some subjects are hyper-absorbers and others are hyper-responders, which implies new therapeutic issues. Epidemiological data do not support a link between dietary cholesterol and CVD. Recent biological data concerning the effect of dietary cholesterol on LDL receptor-related protein may explain the complexity of the effect of cholesterol on CVD risk.
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