Ketogenic Diet Indications and Contra-Indications

The ketogenic diet is usually used as an alternative therapy for children with drug-resistant epilepsy but is also occasionally practiced in the management of some other health conditions. It is the first-line treatment for some metabolic disease and an alternative treatment for many other conditions. There are varying levels of evidence to support the use of the diet for these conditions.  

In some circumstances, the ketogenic diet may be harmful to the individual patient and is contraindicated for use.

Children with Drug-Resistant Epilepsy

The ketogenic diet is most commonly indicated for children with epilepsy that have tried and failed treatment with two to three anticonvulsant medications.

This recommendation is based on the probability of success with an alternative anticonvulsant medication after two have failed, which is approximately 10%. As the chance of success is so low, the ketogenic diet is often the preferable option that will offer the most benefit.

The diet may be considered earlier, even before pharmacotherapy in some cases, for particular health conditions, including:

• Dravet syndrome
• Infantile spasms
• Myoclonic-astatic epilepsy
• Tuberous sclerosis complex

Metabolic Diseases

There are also several other health conditions for which the ketogenic diet is recommended as a first-line treatment. These include:

• Pyruvate dehydrogenase (E1) deficiency
• Glucose transporter 1 deficiency syndrome

These congenital metabolic diseases prevent the body’s ability to use carbohydrates as an energy source and, therefore, have a higher dependence on ketone bodies as an energy source.

Other Conditions

Some health professional also claim there is a place for the ketogenic diet in the treatment of various other conditions, such as:

• Autism
• Depression
• Migraine
• Polycystic Ovary Syndrome
• Diabetes mellitus type 2
• Amyotrophic lateral sclerosis
• Alzheimer’s disease
• Parkinson’s disease

Small improvements in these conditions have been noted in some cases, although there is insufficient evidence to recommend them as a therapeutic choice. The diet may also be protective in patients with traumatic brain injury, stroke and cancer.

Contra-indications

The ketogenic diet is contraindicated in patients with the following health conditions:

• Pyruvate carboxylase deficiency
• Porphyria
• Fat metabolism disorders

If an individual is unable to metabolize fatty acids to produce ketone bodies as an energy source, they must rely on carbohydrates as their primary fuel. If they were to follow the ketogenic diet, their body would be forced to consume protein stores to gain energy, eventually leading to ketoacidosis and possible fatal outcomes.

The ketogenic diet is not usually recommended for adults with epilepsy. The National Institute for Health and Clinical Excellence in the UK advises against the use of the diet to manage epilepsy in adults. However, approximately one in three centers that focus on the treatment of epilepsy occasionally recommended the diet for use by adult patients. In some cases, variants of the ketogenic diets with fewer restrictions on carbohydrate intake are considered more beneficial for adolescents and adults.

Although it is not absolutely contraindicated, children with a focal lesion that is likely to be responsible for causing the seizures are likely to benefit more from surgery than implementation of the ketogenic diet.

References

• https://www.ncbi.nlm.nih.gov/pubmed/18823325
• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3707416/
• http://link.springer.com/chapter/10.1007/978-1-59259-808-3_8
• http://link.springer.com/chapter/10.1007%2F978-1-59259-808-3_8#page-1