This is the last of a series of blogs written about the ketogenic diet. The first two dealt with a historical background to the diet (http://bit.ly/11Q9HWX) as well as some metabolic considerations (http://bit.ly/1rlsPRJ). This one will deal with how to implement the diet.

In about one third of autistic individuals seizures are refractory to treatment. Lack of response to medications or being treatment refractory is defined as a failure to improve to at least 2 trials properly conducted of anti-epilepsy drug regimens. Seizure onset in treatment refractory cases occurs at an earlier age than in those individuals with controlled seizures. Lack of seizure control has been associated with more motor and language delay, lower IQ, difficulties in daily living, regression and social impairment. It is important to control seizures as prolonged bouts can lead to brain damage and even death. In a certain way seizures beget more seizures by hardwiring the brain in abnormal circuits.

The ketogenic diet is one of the oldest known treatments for epilepsy and one of the most effective; however, it is difficult to implement. The diet is usually started with a period of fasting while the individual is monitored for potential side effects like vomiting and dehydration. Benefits are noted after a few months. If benefits are noted the diet is usually continued for 2 years. During this period of time anticonvulsant medications may be reduced or eliminated. The benefits of the diet remain after the same is discontinued (http://bit.ly/1y6zrZI).

In order to follow the ketogenic diet, you need to establish a mindset. You have to think of the diet as a healthy choice, one that will reduce your risk for heart disease and normalize your triglycerides (note: the main driver for elevated levels of triglycerides is carbohydrate consumption). Remember carbohydrates provide a lot of calories but are poor in nutrients.

There are two phases to a ketogenic diet. The first or induction phase lasts for about one week and is marked by hunger. It takes about one week to deplete the sugar stores from the liver and elsewhere. It is only after this phase that you can become ketogenic.

High fat diets can prevent you from feeling full and may encourage you to overeat. Meat consumption promotes fullness and the ketogenic diet allows only for low levels of proteins. During this initial stage you will have to watch out for dehydration and constipation. Weight loss during this initial phase is due to fluid loss. You need fluid to clear away any excess ketone bodies. Fats do not have fiber. Lack of roughage combined with dehydration promotes constipation.

In order to improve the period of adaptation, do not cut on calories. Try to deplete glycogen stores quickly by doing exercise, this will also prevent constipation. Keep protein levels in check. Once you adapt, you can bring slowly down the total amount of calories. Give it time!

The second phase of the ketogenic diet starts after the first week when nutritional ketosis is established (i.e., a marker that you are burning primarily fats). The limited amount of macronutrient variety and smaller fluctuations in blood glucose and insulin reduce food carvings. Ketones themselves may have an effect on satiety probably associated with changes in free fatty acid levels. People who fall off the ketogenic diet (e.g., decide on a whim to eat one bowl of pasta after establishing ketosis) may experience rebound hunger. In order to go back into the ketogenic diet, they will have to undergo the first week of adaptation.

Rules for the ketogenic diet:

1) Enlist the support of those around you, notably your family members.
2) Do not skip breakfast.
3) Alcohol, sweet tea, and sodas are out.
4) Eat slowly.
5) Take a balanced vitamin/mineral supplement.
6) Exercise
7) Remember to add fiber to your diet, e.g., for carbohydrates think of plant food, they are more filling.
8) Avoid eating meats with nitrates (highly processes meats) every day. Cured meats may predispose you to diabetes.
9) Initially weight yourself on a daily basis (watch out for dehydration). In similar fashion check your urine for ketone bodies.
10) Get help from a nutritionist or dietician (nutritionist is not a legally protected title).
11) Look for self-help groups.

What can you eat?

Oil, eggs, mayonnaise, some sauces (without carbohydrates), some types of cheese (those that do not have carbohydrates), diet coke, crab meat, chicken, ground beef, steak, salmon and always remember: bacon is your friend. Carbohydrates are taken mostly in vegetables, fruits, nuts and seeds, NOT in fructose, grains or tubers. You should avoid gluten and shy away from casein and whey in the ketogenic diet.