The Classic Ketogenic Diet that was developed at Johns Hopkins Hospital is a labor intensive metabolic therapy with rigidly calculated meal plans.

Meals are high in fat, low in carbohydrates and protein to produce a high blood concentration of incompletely burned fat molecules called ketone bodies. Slight fluid restriction increases concentration of the ketone bodies and is useful for optimum effect. The state of ketosis is monitored in the urine while moderate to heavy ketosis is attempted.

The exact mechanism by which the Diet obtains seizure control is unknown. Ketosis, dehydration and acidosis each appear to play a role. The hypothesis, which arrived out of the Epilepsy and Brain Mapping's recent research, suggests that there is an alteration in the (1) acid-base balance; (2) water and electrolyte distribution; (3) lipid concentration (4) brain energy reserve or (5) a central action of ketones on the brain.

It wasn't until 1993, when film producer, Jim Abrahams discovered the Diet for his son, Charlie, that a resurgence began within the medical community.

From Jim and his wife Nancy's experience, they developed the Charlie Foundation to inform people about the Diet.

The Ketogenic Diet has been refined as a rigid metabolic therapy for epilepsy patients.

The usual candidate for the Diet is a patient with medically intractable generalized seizures which are not amenable to medications or surgery.

The results are showing promise in controlling seizures in young children and some adults. Currently, 51% of our Epilepsy and Brain Mapping Program patients are either 90% improved or seizure free.

What is the ketogenic diet?

The ketogenic diet is a stringent, mathematically calculated diet high in fat and low in protein and carbohydrates that, when followed conscientiously, produces a by-product called ketones in patients' blood and urine. High concentrations of ketones in the body control the frequency and severity of seizures, although the biochemical mechanisms for this phenomenon are not yet known.

What is known, however, is that since the diet was first developed and implemented at the prestigious Mayo Clinic and Johns Hopkins University medical schools, many seizure patients have shown marked improvements. Recent clinical studies, including the 1992 Johns Hopkins report published in Epilepsia, attest to the effectiveness of the diet.

Most patients remain on this diet for at least two years, during which time medications may be reduced and even discontinued. Although the diet is high-fat, patients do not gain weight because their caloric intake is restricted to 75 percent of their required daily allowance. The diet is supplemented with vitamins and calcium, so patients do not suffer from any nutritional imbalance.

After two years on the strict regimen, many patients remain seizure-free and no longer require anticonvulsant drugs or the diet. Others demonstrate great gains, but may need to continue their medications and the diet indefinitely.

Egg, Cheese, Onion, Tomato,
Margarine, Vanilla, Sweet10,
Salt & Pepper, Heavy Whipping Cream

Scramble egg and weigh. Add a little of allotted cream, salt and pepper. Pour into heated pan coated with vegetable cooking spray. Spread cheese, onion and tomato on egg. Then flip top over to make omelet and cook a few more minutes until done. Add margarine to cooked omelet. Serve diluted vanilla and Sweet 10 flavored cream as a beverage.

The Ketogenic Diet at the Epilepsy
and Brain Mapping Program

The Epilepsy and Brain Mapping Program has led the way in the treatment of epilepsy. Dedicated to finding the best solutions, neurologist William Sutherling, M.D., medical director has established a comprehensive epilepsy program that allows patients and families as many options as possible, whether they be medical, surgical or dietary.

Pediatric neurologist Tatiana Maleeva, M.D. heads the ketogenic diet team, which also includes Dr. Sutherling, a nurse clinician and Danine Mele-Hayes,R.D. who all received extensive training in the ketogenic diet at Johns Hopkins University's medical school. In fact, all of EBMP's registered dietitians and special epilepsy nurses have undergone training in the diet, so they can provide needed support and instruction to ensure the patient's dietary compliance.

Family preparation begins as soon as patients are considered viable candidates for the diet. The Epilepsy and Brain Mapping Program's team provides families with extensive educational materials and personalized instruction about maximizing dietary compliance in home environments. During inpatient assessment, patients, along with their families, meet daily with the dietitian to obtain a better understanding of dietary requirements. At this time, patients are gradually initiated into the diet, so that by the time they are discharged from the hospital, they are prepared to accept the ketogenic regimen fully.

To help patients and families comply with the ketogenic diet, Epilepsy and Brain Mapping's team offers maximal support and instruction. Questions and concerns can be addressed promptly by phone, fax or Internet. Success in any ketogenic program is in direct proportion to the amount of individualized attention patients and families receive from their health-care team. At EBMP, Drs. Maleeva and Sutherling and their team provide the utmost to optimize success.

Who is eligible for the ketogenic diet?

Epilepsy patients must meet certain criteria:


  • They previously must have tried two anti-convulsant medications.
  • They must undergo an evaluation by their own neurologist and EBMP's ketogenic team to determine their seizure type.
  • They or their families must demonstrate an ability to understand the ketogenic diet and the importance of adhering to its specific requirements.
  • Patients and families must be highly motivated in following the diet.

Dr. Sutherling and his staff have years of experience in tendering outstanding, compassionate care to epilepsy patients and their families. They are known throughout the patient and medical communities for their work with children and their patients.

Stories Of Courage, Inspiration and Success

Seizure And Medication Free At Last
With The Ketogenic Diet

With infectious enthusiasm, young Justin Hein doesn't miss a beat as he jumps off the backyard trampoline, chases the family dog and hugs his nine year old brother, Sam. Like any other boy his age, Justin is free to explore his world with gusto.

That wasn't the case a few years ago when he was suffering from up to as many as five uncontrollable seizures a day. After trying several anti-epileptic medications without success, the Hein's were referred to EBMP to the Ketogenic Diet by their local pediatric neurologist.

After a hospital evaluation it was determined that Justin would be a good candidate for the diet. His family dedicated themselves to the rigors of the Ketogenic Diet regimen for two years.

As a high fat, low carbohydrate and low protein diet, the Ketogenic Diet is a medical therapy which is carefully administered to produce ketones in the body. This in turn helps suppress and/or eliminate seizures for many pediatric patients. Every liquid and food has to be carefully measured.

On a few occasions, Justin experienced seizures as a result of cheating but the family continued their vigilance by locking down their cabinets and hiding all of the trash baskets. As Rose says, "It wasn't an easy time. Everything from TV commercials to social gatherings, revolves around food. But, seeing the fog lift in Justin's eyes, made our commitment to the diet that much stronger."

Today, Justin is completely off of the diet, seizure and medication free. He's able to attend birthday parties and eat whatever he likes.

A Karate Champion's Tale
Of Success And Courage

These days 15 year old Alessandro Azzato has experienced an amazing story of success and courage as a result of the Ketogenic Diet.

With more first place Karate Championship Awards than anyone can count, Alessandro is now enjoying, as he says, "A regular life filled with afterschool activities, video games, homework and Karate."

This wasn't the case four years ago when he remembers the times the hospital was his second home.

Suffering from up to hundreds of seizures a day with no hope of managing them, one of his doctor's finally told his mom, Denise Azzato, "To love him, hug him and hope he makes it to see his 13th birthday."

After trying 10 different anti-epileptic medications without success or hope, Alessandro's family felt even more devastated.

As Denise says, "The hardest part was actually watching him experience language and memory reversals. His days were spent mostly sleeping and barely functioning. These were bleak years for us filled with memories of rushing Alessandro to the hospital emergency room, wondering if he could live through another day of status epilepticus."

"Then, one day, we learned of the Ketogenic Diet program. After placing him on it, we saw him literally wake up, focus and become alert once again. It was truly a miracle for him and our entire family."

With special instructions for his teachers and caregivers, Alessandro has been able to maintain the rigors of the diet at school as well as at home.

Although still on the diet, Alessandro's seizures are well managed allowing him to enjoy many academic and athletic activities that had once eluded him.

To receive more information about our ketogenic diet program, or to refer patients, call (626) 792-7300 or
(800) 621-2102. FAX: (626) 792-7336.
e-mail: [email protected]

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