I asked Dr. Eva Catenaccio of the Johns Hopkins University School of Medicine to summarize her recent article published in Pediatric Neurology. Dr. Catenaccio is currently completing her training as a pediatric neurologist at Johns Hopkins University. He will begin the epilepsy fellowship at Philadelphia Children’s Hospital in July. – Eric Kossoff
The ketogenic diet enjoys a period of immense popularity, both in the medical community and in the general public. Its benefits have been proven in epilepsy and are being explored in diabetes, cancer and Alzheimer’s disease. It has received celebrity support and there has been an explosion of “keto” products on the market. But this isn’t the first time the ketogenic diet is #trending. As we approach his 100th birthday, many of us in the field have stepped back in time to look at his incredible story … and found some surprises.
How was the ketogenic diet discovered?
In the early 1900s, some doctors used fasting to control seizures. But fasting only worked to reduce seizures while an individual could go without food. Then, a pioneering endocrinologist at the Mayo Clinic in Rochester, Minnesota, wondered if the same benefits could be obtained by using a high-fat diet that would cause ketosis in the same way as fasting. Ketosis occurs when the body does not have readily available sugar (glucose) and instead metabolizes fats into ketone bodies for energy.
And it turned out that the ketogenic diet worked! Pediatricians at Harvard University’s Mayo Clinic and Johns Hopkins Hospital began using the ketogenic diet to treat children and adults with epilepsy with promising results.
Hospitals that played a role in the history of the ketogenic diet (all images are in the public domain):
The Johns Hopkins Hospital (1900)
The Mayo Clinic (St. Mary’s Hospital) (1910)
Massachusetts General Hospital (1941)
So why did the ketogenic diet fall into disfavor?
The usual story is that doctors lost interest in the ketogenic diet due to the discovery of drugs to prevent seizures, starting with phenytoin in 1938 and valproic acid in 1967. Why would anyone want to follow a strict diet when only could i take a pill? ? But when my co-authors, Dr. Pinto and Bergin (Harvard), Dr. Kossoff (Hopkins) and Dr. Nickels (Mayo Clinic) and I began to redirect the scientific literature, we realized that there could be another more complicated explanation …
It turns out that many of the early ketogenic diet researchers of the 1920s did not collaborate and did not mentor younger colleagues in the use of the diet. They tended to publish articles as sole authors and did not refer to the work of other institutions. One doctor published more than ten articles on the ketogenic diet, but did not publish any with a co-author. When doctors who discovered the ketogenic diet retired, died, or began researching other topics (including one that studied urinary tract infections!), There were no other doctors trained to administer the diet that could be done. charge. In addition to the rise in seizure medications, the lack of collaboration and mentoring we believe probably contributed to the loss of interest in the ketogenic diet worldwide by neurologists and hospitals. It all happened in the early 1940s, before many of the new unsportsmanlike drugs became available.
How did the ketogenic diet return?
Even during the “dark ages” of the ketogenic diet, doctors at Johns Hopkins Hospital still used it to treat a small number of patients each year. But it took the effort of a highly motivated family to re-emphasize the ketogenic diet. Jim Abrahams, a prominent film producer, had a son, Charlie, who suffered from severe epilepsy. While researching treatments, he came across a book written by Hopkins ’team, which inspired him to seek out the ketogenic diet as a treatment for Charlie. After starting the ketogenic diet, Charlie never had another seizure and was finally able to stop all the seizure medications. The Abrahams family later founded the Charlie Foundation in 1994 to spread awareness about the ketogenic diet as a treatment for epilepsy. The Charlie Foundation and other parent charities such as Matthew’s Friends have helped fund collaborative research, group training, multicenter studies, and international meetings.
What can we learn from the rise, fall and rebirth of the ketogenic diet?
Since the 1990s, the use of the ketogenic diet has expanded dramatically. But this time doctors, researchers and patients and families are working together. Researchers are coordinating studies at different hospitals and universities. Young doctors, like me, are being trained on how and why to administer the ketogenic diet. Patients and families share knowledge and experience through online groups and foundations. Collaboration and mentoring are key to ensuring that the ketogenic diet does not disappear again. These efforts also lead to discovering how the ketogenic diet can help individuals with several different neurological conditions.
As we approach the centenary of the creation of the ketogenic diet this year, I hope the ketogenic diet community continues to work together to raise awareness, fund research, and bring together the best minds to fight for the health of children with epilepsy.