Re: Emma and Barbara - paper including ree dx etc - found it finally....

[Guest guest]

,

Thanks for this paper. Where does it come from?

Indirect calorimetry will help with an estimate of calories. i.e. It

measures basic metabolism. You still have to add on activity level. It

doesn't get rid of fine-tuning which can be so important for good or

great control.

Bill

& Hill wrote:

> Here it is, I have put asterixes on the relevant part about the diff

> between cal need assessments after giving the ree dx (termed

> calorimetry here - same thing) as opposed to using tables to

> calculate cal needs instead.

[Guest guest]

At first I thought they must be lying. Then I saw that it was from

Florida, so it is probably just a result of hanging chads. 8-)

Otherwise, we should all go there and do the diet. Isn't Snively that

nasty character from the cartoons?

Bill

& Hill wrote:

> Efficacy Studies Two groups reported on efficacy of the diet. Snively

> and colleagues[1] from the University of Florida, Gainesville,

> provided additional retrospective evidence of the efficacy of the

> diet in 17 children under 2 years of age. Two patients quickly

> withdrew; of the 15 who remained on the diet, 40% became almost

> seizure-free and 53% experienced more than a 50% reduction in seizure

> frequency. The durability of this outcome is not clear, but these

> investigators continue to demonstrate the lack of difficulty in using

> the diet in very young children.

[Guest guest]

Either they need a better questionaire or you had better avoid some of

these keto centres.

Bill

> Side Effects and Complications Several presentations described

> monitoring, side effects, and potential complications of the diet. In

> a very interesting attempt to document how various centers monitor

> and implement the diet, Frantz and colleagues[6] from The Children's

> Hospital of Philadelphia, Pennsylvania, reported questionnaire

> responses from 14 centers. Almost half did not restrict protein on

> the diet, 20% did not restrict calories, almost a third did not

> provide education classes, and almost half the centers did not

> evaluate lipid or prealbumin levels before initiating the diet. This

> study highlights how variable the approach to the diet can be and the

> need for better standards of care if we hope to use this therapy

> optimally.

[Guest guest]

There is no question that vitamin and mineral supplements are critical

for patients who are on the diet. My experience is that most dieticians

are lacking in this aspect of the diet. Hopefully we can educate them.

Children who are also on AED's with the diet probably are most at risk.

I don't know whether this was considered in the studies.

Bill

> Bergqvist and the group from The Children's Hospital of Philadelphia

> have also begun to examine bone density in children on the ketogenic

> diet.[7] Using a cross-sectional (rather than longitudinal) design

> they showed that males on the ketogenic diet for 12-24 months

> experienced a significantly worse osteopenia than females. This is

> part of an ongoing prospective study that may clarify observations

> made in 1979, when Hahn and colleagues[8] reported that children on

> the diet had a significant reduction in serum 25OHD as well as loss

> of bone mass, which can be partially reversed by vitamin D treatment.

> This work will be important to providing optimal care for children

> who are on the diet for an extended period of time.

[Guest guest]

I vote for calorie restriction. For us, raising or lowering ketones

didn't make much difference. However, does that explain how the diet

ceases working during illnesses? It probably means that both effects are

important.

I thought that one centre was already using blood glucose levels to fine

tune the diet.

It is reassuring to see that that is still interest in researching the diet.

Bill

> Ketogenic Diet Special Interest Group During the evening meeting of

> the Ketogenic Diet Special Interest Group, a lively discussion

> revolved around whether caloric restriction or ketosis is at the

> heart of the efficacy of the diet. We know that caloric restriction

> reduces synaptic excitability, increases fast inhibition in the

> dentate gyrus, and raises the electroconvulsive threshold. However,

> ketosis may be more important in maximal dentate afterdischarge.

> Participants queried whether we could possibly use blood glucose

> levels as a surrogate for BHB, and specifically whether lower blood

> glucose levels may be directly related to seizure control. One of the

> suggestions that also evolved from this discussion was whether a

> protocol should be devised that would look at calorie restriction vs

> nonrestriction in an otherwise classical ketogenic diet. Certainly in

> diabetic patients who are both ketotic and hyperglycemic, there is no

> protection against seizures. It might also be possible to

> retrospectively look at glucose levels in children who have been on

> the diet and establish whether there is a relationship to seizure

> control.