Jefferson Health

Getting Started on the Ketogenic Diet

Normally our bodies run on energy stored from glucose, which is provided from food. When we go without food for one to three days, our bodies use all of our stored glucose, and the brain and body switch to burn fat for energy stores. The ketogenic diet, which is a diet high in fat and low in carbohydrates, keeps the body burning fat instead of burning glucose.

The diet was originally discovered because patients with epilepsy were found to have a remarkable reduction in their seizures when they were ill and not eating. So, it was noted that during times of starvation, the seizures improved. The ketogenic diet actually tricks the body into thinking that it is starving.

During the ketogenic diet, 80 percent of calories are from fat; very little comes from carbohydrates and protein. Each meal has about four times as much fat as protein or carbohydrates, a 4:1 ratio. Some centers restrict the amount of liquid at each meal; however, at Thomas Jefferson University Hospitals, fluids are not restricted.

The diet has been found in studies to reduce seizures by at least 50 percent in 50 percent of adult patients. In our studies, some patients have an even greater reduction of seizures (up to 90 percent).

Ketogenic Diet Requirements

If you are interested in the ketogenic diet, you will need some blood studies and a screening EKG to monitor your heart. You will also need to meet with our outpatient nutritionist. People usually require two outpatient visits for education regarding the diet.

We require that patients commit to a three-month trial period of the ketogenic diet.

Once you have decided to try the diet, you are admitted to the Hospital. This is to begin the starvation. During the first two days of the hospitalization, you are given fluids but no meals. Once your body has completed burning all the glucose stores, you will begin to see that your body has high levels of ketones in your blood (ketosis). The ketones are checked simply with the urine dipstick.

After reaching ketosis, you will begin a partial diet in the Hospital, and if you are tolerating the diet after your first full meal, you are discharged home.

A Typical Meal

Here is a sample meal plan that will give you a general idea of what kinds of foods are on the diet. The meal plan serves small amounts of fruits or vegetables (carbohydrates) and meat, fish or chicken (protein) with a lot of fat such as cream, butter, eggs or mayonnaise. No sugar is given in the diet.

Breakfast: Scrambled eggs with butter, diluted cream and orange juice.

Lunch: Spaghetti squash with butter and Parmesan cheese, lettuce leaf with mayonnaise and orange diet soda mixed with whipped cream.

Dinner: Hot dog slices with sugar-free ketchup, asparagus with butter, chopped lettuce with mayonnaise and sugar-free vanilla cream popsicle.

The exact amounts of food need to be worked out for each patient by the dietitian. Each portion of food must be carefully prepared using a gram scale, which will need to be purchased to weigh items exactly. Even a tiny mistake in weighing or measuring food can break the diet effect and lead to a seizure.

Sample Discharge Instructions

  1. Continue your current seizure medications.
  2. Take the following supplements:
    • Theragran - M (multivitamin) once a day
    • Caltrate 600 mg, one pill three times a day
    • Colace 100 mg, twice a day
    • Neutraphos packet three times a day
    • Selenium (two forms are available)
    • Selenium 200 mcg + vitamin C or Selenium Plus 200 mcg
  3. Measure your urine ketones daily or as recommended by your physician. If it is not purple, skip the next one to two meals and re-check keto-stix. If still not purple, contact your physician.
  4. Get the first set of blood tests in two weeks (from your discharge date).
  5. Get the next blood tests every month for the first three months on the diet. Afterwards, blood tests should be performed once every three months.
  6. You need a follow-up electrocardiogram (EKG) six months after beginning the diet, then every six to 12 months.
  7. You need a bone density test after being on the diet for one year, then again after two years on the diet.
  8. Track your seizures on a calendar and bring it with you to your follow-up visits.

Medical Follow-up

You will need to be seen approximately two weeks after starting the diet, and then you will be seen every six to eight weeks as deemed necessary by your physician. You will have screening laboratory studies done as an outpatient before your two-week visit. Visits will be monthly for three months, and then they will be completed every three months.

Additionally, EKG studies will be done periodically during your follow-up, and a DEXA scan is typically performed once you have been on the diet for three months. If you remain on a diet for longer than one year, the DEXA scan will be repeated.