Questions and answers

(J. Klepper, Aschaffenburg; updated 01.2007)

Which drugs are allowed on a ketogenic diet?

Every drug needs to be carefully checked for carbohydrates. In particular, most drugs in liquid form for children contain sugar! If in doubt, contact your physician.

Most anticonvulsants can be maintained when introducing the ketogenic diet. If seizure control improves on the diet, a trial to carfully discontinue the medication may be warranted.

Does the diet interfere with vaccinations?

No. Children on the ketogenic diet should receive the standard vaccinations as recommended.

How can I control the ketosis effectively?

When the metabolic state is unclear, when loss of ketosis is suspected because of a dietary mistake or an unexpected seizure, glucose and the ketone body 3-hydroxybutyrate can be determined in blood with a simple bedside device similar to diabetic blood glucose monitoring. Once the ketotic state is stable, dip stick analysis in urine are usually sufficient to monitor ketosis.

Will my child gain weight with all this fat in the diet?

No. The diet is strictly calcuated to supply an age-appropriate amount of calories.This is part of the responsibilities of the dietician during follow-up. Sometimes even a caloric restriction might be helpful to achieve better ketosis.

How can I ensure the diet works in kindergarden and school?

Inform caretakers and teachers about the special diet of your child. They can help to avoid dietary breakthroughs by uncontrolled food intake. Ask your dietitian for meals that can be easly prepared in advance and transported in snack-boxes. Use a cooler and find out if a microwave is available for your child.

Is travel unlimited when on a ketogenic diet?

Basically yes. It is always helpful to check in advance if basic facilities to prepare ketogenic meals are available in motels or lodges. Caution is necessary when travelling in foreign countries with limited food availability or poor medical support – in case of a hospital admission due to diarrhea or other illnesses it might not be possible to maintain the ketogenic diet. If you plan such journeys, try to obtain a travel insurance that will bring you and your child back to your home country in case of serious illness.

What shall I do when my child suffers an unexpected seizure?

Unexpected seizures are often the result of a sudden loss of ketosis due to dietary mistakes. Find out if your child had a sweetie or crisps from other children or your next door neighbour. Did you change ingredients of the diet? Check ketosis and contact your physician for further advice. Often the diet can simply be continued and ketosis will return.

Are there long-term side effects to be expected on a ketogenic diet?

The diet has been used for decades. As far as we know ketosis does not affect growth, liver or kidney function. Elevated blood lipids are a concern as they potentially increase the risk of arteriosclerosis. However, no long-term studies are available to answer this question.

Which fatty acids should be preferred in a ketogenic diet?

Similar to general recommendations vegetable fats should be preferred over animal fats as they contain higher amounts of essential and polyunsaturated fatty acids.

Can babies on the ketogenic diet be breastfed?

Breast milk contains relatively high amounts of fat, but is not ketogenic. Infants starting a ketogenic diet need to be weaned and will be fed with carbohydrate-free infant formula, fat emulsions and adequate supplements.