Mackenzie C. Cervenka - The Ketogenic and Modified Atkins Diets: Treatments for Epilepsy and Other Disorders

The Ketogenic and Modified Atkins Diets

The Ketogenic and Modified Atkins Diets

Treatments for Epilepsy and Other Disorders

SIXTH EDITION

E RIC H. K OSSOFF , MD

Z AHAVA T URNER , RD, CS P, LDN

S ARAH D OERRER , CPNP

M ACKENZIE C. C ERVENKA , MD

B OBBIE J. H ENRY , RD, LDN

Visit our website at www.demoshealth.com

ISBN: 978-1-936303-94-6

e-book ISBN: 9781617052675

Acquisitions Editor: Beth Barry

Compositor: diacriTech

2016 by Kossoff, Turner, Doerrer, Cervenka, Henry.

Demos Health is an imprint of Springer Publishing Company, LLC.

All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medical information provided by Demos Health, in the absence of a visit with a health care professional, must be considered as an educational service only. This book is not designed to replace a physicians independent judgment about the appropriateness or risks of a procedure or therapy for a given patient. Our purpose is to provide you with information that will help you make your own health care decisions.

The information and opinions provided here are believed to be accurate and sound, based on the best judgment available to the authors, editors, and publisher, but readers who fail to consult appropriate health authorities assume the risk of injuries. The publisher is not responsible for errors or omissions. The editors and publisher welcome any reader to report to the publisher any discrepancies or inaccuracies noticed.

Library of Congress Cataloging-in-Publication Data

Names: Kossoff, Eric, author. | Turner, Zahava, author. | Doerrer, Sarah, author. | Cervenka, Mackenzie C., author. | Henry, Bobbie J., author.

Title: The ketogenic and modified Atkins diets : treatments for epilepsy and other disorders / Eric H. Kossoff, MD, Zahava Turner, RD, CSP, LDN, Sarah Doerrer, CPNP, Mackenzie C. Cervenka, MD, Bobbie J. Henry, RD, LDN.

Other titles: Ketogenic diets.

Description: Sixth edition. | New York, New York : Demos Medical Publishing, LLC, [2016] | Revision of: Ketogenic diets. c2010. | Includes bibliographical references and index.

Identifiers: LCCN 2015051252 | ISBN 9781936303946 | ISBN 9781617052675 (ebook)

Subjects: LCSH: Epilepsy in childrenDiet therapy. | Ketogenic diet. | MESH: Epilepsydiet therapy.

Classification: LCC RJ496.E6 K47 2016 | DDC 618.92/8530654dc23 LC record available at http://lccn.loc.gov/2015051252

Printed in the United States of America by McNaughton & Gunn.

16 17 18 19 20 5 4 3 2 1

Important Note to Readers

This book introduces the ketogenic diet to physicians, dietitians, patients, and parents of children with difficult-to-control seizures who might benefit from the treatment. This book is not intended to be an instruction manual. A book cannot take into account the specific needs of any individual patient. As with any course of treatment for epilepsy, a decision to try the ketogenic diet must be the result of a dialogue between patients (or parents) and a neurologist.

If you are reading this book, we assume that you are familiar with the basic descriptions of epilepsy and what they mean. This is not a book about seizures or epilepsy. This is about one form of treatment for epilepsydietary therapy.

This book is dedicated to the memory of Dr. John Freeman

In 2014, the world lost one of the biggest advocates, researchers, and believers in the ketogenic diet, my personal mentor, Dr. John Freeman. Dr. Freeman took over the ketogenic diet service at Johns Hopkins Hospital shortly after moving to Baltimore from San Francisco in the 1980s. The diet was being used, but only sporadically (and as a last resort). Dr. Freeman kept the flame alive as many other people have said over the years, writing articles, seeing children from all over the United States, and never letting the diet be forgotten at national meetings like the American Epilepsy Society. He would often be in line for the microphone at a lecture on epilepsy and would ask, What about the ketogenic diet here? Through his research and partnership with Jim Abrahams and The Charlie Foundation, the diet has truly become mainstream epilepsy care.

I had the amazing fortune about being in the right place at the right time when I was a child neurology fellow in 1999 and ran into John in the hallways of the Childrens Center at Johns Hopkins one morning. It was the first day of ketogenic diet admission week, and John asked me to interrupt my rounds to follow him to the hospital floor. He asked me to meet a family from the Midwest who had traveled with their five-year-old daughter to Johns Hopkins to start the diet. He (purposefully) didnt give me any more history! I went into the room, introduced myself, and saw she was wearing a helmet and having drop seizures nearly every 5 minutes in front of me. It was difficult to watch. Afterwards I asked John what was going to happen and he told me she was fasting to start the diet. I had not heard much at all about the ketogenic diet previously and was skeptical about its likelihood of benefit. Dr. Freeman said, Come back in 4 days and meet me here. Four days later, the same girl was seizure-free, her helmet was gone, and one of her anticonvulsants was gone. In retrospect, I believe she probably had Doose syndrome. I was flabbergasted, shocked, and hooked.

At that moment, I decided to focus on the ketogenic diet for research, my epilepsy fellowship, and later my neurology career. Dr. Freeman mentored and guided me through all of this, showing me how to implement the diet and investigate it scientifically. I was thrilled to eventually assume the leadership of the Johns Hopkins Ketogenic Diet team in 2005 when he retired and become an author of this book starting with the fourth edition.

Most importantly, I learned from John about just how unique and amazing this treatment can be. Using foods to combat epilepsy is incredible and he never grew tired of this. The ability for parents and patients to have some control over an inherently uncontrollable condition was not lost on him, and how powerful that control could be. At national and international conferences, he was always excited, enthusiastic, and full of ideas. I know for sure that Dr. Freeman was amazingly proud of just how far the use of the ketogenic diet has come, and equally thrilled to see it being used for adults and patients with cancer, both of which were personal interests of his. I will always hear his voice whenever I read some of the articles and chapters hes written, and his love and passion that transcended what is typical for a normal physician. Dietary therapy, this book, and my life would not have been as successful without him.