THE ROLE OF THE KETOGENIC DIET IN AUTISM OR WHY BACON IS YOUR FRIEND PART 1: HISTORICAL BACKGROUND

Shortly after my grandson was born it became evident that he was suffering from relentless seizures. Although something was definitely wrong to us his primary physicians believed that we were suffering from parental jitters. We had a hard time convincing his physicians to order appropriate tests in order to establish a diagnosis and start him on anticonvulsant medications. As it happens so many times when seizures start early medications proved to no avail. In my grandson’s case they had serious side effects and affected his liver function. Prognosis was bad due to the early onset of the seizures, the type of seizure, their multifocal nature, and lack of response to medications. If seizures weren’t controlled the aberrant connections created by them would only be reinforced and hardwired in his brain. The importance of controlling his seizures instigated a cascade of more and more aggressive interventions ending with high doses of adrenocorticotropic hormone (ACTH) and steroids, -and you guessed it, still more side effects. It was only then that the primary physicians agreed to a trial using the ketogenic diet.

Although the benefits of the ketogenic diet for the treatment of seizures are well established the same is not in the prescribing armamentarium of the majority of specialists. Unfortunately, many of them lack proper understanding about the diet as it is seldom mentioned in medical textbooks and requires knowledge outside of their expertise, e.g. dietary/nutritional guidance. Many of the physicians most adept at handling the diet come from Johns Hopkins Hospital where the diet was introduced to medical practice in the 1920’s and is presently used by the Departments of Neurology and Neurosurgery within a multispecialty Center for the treatment of seizures (http://bit.ly/1DqXJBL).

I have had the opportunity to recommend the ketogenic diet in multiple occasions. In one particular case intractable seizures had led to the recommendation of surgically ablating one whole brain hemisphere (half of the brain) in a young child. Medications had proven to no avail but the ketogenic diet worked miracles. This may help explain why another name for the diet is the Miracle or Magic diet. Indeed, almost half of children with seizures recalcitrant to medications have marked improvements that persist even after discontinuing the diet (Levy et al., 2012).

A good way to get acquainted with the ketogenic diet is by watching the 1997 movie made for TV with Meryl Streep entitled, “First Do No Harm”. I recommend that you watch the movie, specially the credits to the actors at its very end. I bought it from AMAZON for $9.99 and it occupies a place of honor within my DVD collection.

The ketogenic diet is a high-fat, adequate protein and low-carbohydrate diet that was introduced to modern medicine as a way of treating diabetes. Its synonyms, Paleolithic or Inuit diet, indicate its long-standing role in human history. Its probable use was also known in the Bible wherein Marc (ch. 9, vs. 29) talks about a father who brought his son to Jesus because of episodes where his son, ever since childhood, would be thrown down, foamed from the mouth, grinded his teeth, and became rigid. And Jesus said to the disciples, “This kind can come forth by nothing, but by prayer and fasting.” In effect, one of the physiological effects of fasting is ketosis. Fasting when glucose is not available prevents the breaking down of muscle, as a way of obtaining calories, by instead breaking down fat stores. Ketone bodies are produced by the liver and kidney when fatty acids are broken down and used as an energy source for both the heart and the brain. Note: the proper terminology should have been ketone molecules, not bodies.

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Figure: Comparison among different types of diets. You can click on the graphic to make it bigger.

As previously stated synonyms for the ketogenic diet include the Inuit or Paleolithic diet. The Inuits are the indigenous people inhabiting the Artic regions of the globe. They were previously known as Eskimos, an apt Native American word describing their dietary habits: “eaters of raw meat”. In reality neither the Inuit nor the Paleolithic diet are truly ketogenic as the body can generate a significant amount of glycogen from raw meats.

Sometime in the early decades of the 1900’s William Stephenson (Icelandic: Vihjalmur Stefansson), a renowned explorer, organized and directed a number of expeditions to the Canadian Artic region. He reported that he could go one year following the diet of the indigenous people that consisted of solely of meat and fish. The medical establishment thought that such a diet would undoubtedly produce scurvy (no fruits) but apparently such a deficiency is promoted by the intake of carbohydrates. It was only the English explorers who accompanied Stephenson and who opted to keep their European diets with foods they had brought with them (i.e., plenty of carbs, but no availability of berries) the ones that developed scurvy after several months. In order to prove his point, Stephenson allowed himself to be institutionalized for one year in a hospital under medical observation eating a diet consisting primarily of meat. In the end Stephenson was compensated for his effort by the American Meat Institute.

The low carbohydrate diet was popularized in modern times by Robert Atkins, a cardiologist best known for the “Atkins Nutritional Approach”. Robert Atkins was an overweight physician, with a double chin, early in his medical practice. He was looking into diets and found in the medical literature an article about the low carbohydrate diet- just to say he wasn’t the first person to propose the same. He decided to try the diet himself with great success. From that initial point he then proceeded to try it in some of his overweight patients. The results were incredible.

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Figure: Robert Coleman Atkins (1930-2003)

Atkin’s diet proposal challenged the beliefs of the medical establishment- a scientific heresy to many physicians convinced that it was deadly. At the time, scientists adhered to the proposed fat theory of heart disease. The American Medical Association wrote a scathing criticism of the diet. In the 1970’s some of these dietary attempts weren’t nutritionally sound, they caused electrolyte problems and even some deaths. Very low calorie diets intended to achieve significant weigh loss avoiding the disturbances associated with starvation. Ever since well-controlled studies by multiple clinicians proved no side effects.More specifically, cholesterol levels did not go up-rather went down (much better than other diets in comparison studies). Note: Starvation diets have been taken as an alternative to low carbohydrate diets as an attempt to loose weigh. These diets are definitely not the same as the ketogenic diet and may pose serious health problems to high-risk individuals like the elderly, those with chronic disease, pregnant women and children.

In future blogs I will expand on the ketogenic diet, especially how to institute the same and what to expect from it.

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