Avocado Rx Good eating can feel like therapy. For some people with chronic health conditions, it actually is. BY LINDSEY FRISBIE, RD, LD
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t’s likely you’ve heard buzzwords like keto and paleo over the past few years. They’ve become somewhat of a cultural phenomenon, popularized in bestselling books and specialty food products. Flashy advertorials featuring celebrities and social media influencers proclaim that going keto changed their lives, helping them to “lose weight and feel more energized!” What often gets lost behind headlines about trendy diets is the medical, or therapeutic, use of such diets to help treat specific health conditions. This is where taking a deeper dive and studying the history and science behind these eating styles is important. Adapting your diet to adhere to ketogenic or paleo principles is not meant for everyone, but many individuals have relied on therapeutic benefits of such diets over the past century in order to be able to live a safe and healthy life. The origins of what we call keto today date back to the early 1920s when Dr. Russell Wilder of the Mayo Clinic coined the term “ketogenic diet.” He was the first to use ketogenic therapy to help treat epilepsy in children. Epilepsy is a neurological condition of the brain resulting in seizures; oftentimes, the cause of the seizures isn’t known, but may be related to genetics, brain injury, illness or abnormal brain development. The “classic” ketogenic diet involves a specially designed high-fat, low-carbohydrate diet that is prescribed by a doctor and monitored closely by a registered dietitian. More specifically, the diet usually has a 4:1 ratio of fat to carbohydrates and protein combined. Approximately 90% of calories come from fat, with 6% from protein and 4% from carbohydrates. For comparison purposes, a standard American diet contains about 45%-65% of calories from carbohydrates. This classic ketogenic diet is still widely used today in children whose seizures have not responded to medication and requires careful measuring and weighing of all food and liquids consumed. Locally, it’s prescribed at the University of 22
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During ketosis, instead of breaking down carbohydrates into glucose for fuel, the liver converts fat into ketone bodies, compounds that are formed when fat in your food or fat stored in your body is broken down. These ketones replace glucose as the body’s primary source of energy. Iowa Stead Family Children’s Hospital, which is home to Iowa’s only Level 4 epilepsy center with state-of-the-art technology and therapies to both diagnose and treat complex cases of epilepsy. Stephanie Borst, MS, RDN, LD, is the primary registered dietitian who oversees pediatric patients on the ketogenic diet at the hospital. Working alongside a team of neurologists, nurses and nurse practitioners, she sees children from infancy to adolescence. “The youngest patients we’ve had to get started on the diet have been between four to five months of age,” said Borst. When asked how long patients typically stay on the diet, she reports, “We do say, at a minimum, to try it for three months. It may take a three-month trial period on the diet so that we can see if it is working for that patient. If it’s working to
help control seizures, then most patients can plan to stay on it for at least two to three years.” Furthermore, “If the diet is working and the patient is not having any side effects, they may stay on it longer than two to three years.” The goal of eating a ketogenic diet—characterized by a high fat and low carbohydrates—is to get the body into a state known as ketosis. Carbohydrates are our body’s primary source of energy. When you eat carb-rich foods, the body breaks them down into individual sugar molecules called glucose. The pancreas then releases insulin, a hormone that allows glucose to enter cells to provide you with energy. Any excess glucose is delivered to the liver and stored as glycogen. When the body is deprived of carbohydrates, insulin secretion is reduced and glycogen stores get depleted. During
