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The Ketogenic Diet Revisited: Back to the Future

There has been a recent extraordinary resurgence of interest in the ketogenic diet. Some commentaries in the professional and lay literature have been instructive and informative, others have been less so, and some have been frankly contentious. Books, an informative videotape, a made-for-television movie starring Meryl Streep, and many websites are just some of the current venues that are providing information regarding the diet (1). An unfortunate byproduct of this popularization has been a fruitless dialectic: “Does the ketogenic diet deserve a prominent role in the management of children with refractory epilepsy?” The answer to this question has always been yes. In our view, this is a distracting issue and one that should be put aside, because the diet is a time-tested, effective, and safe method for treatment of intractable childhood epilepsy. Only bromides, discovered in 1857, and phenobarbital, discovered in 1910, can match the 76 years of experience with the ketogenic diet. Numerous centers have documented its efficacy, and clinical reports indicate that at least one-third to two-thirds of patients benefit substantially from the diet (2-5). Results of treatment with few antiepileptic drugs (AEDs) can match these statistics. Like AEDs the ketogenic diet has also demonstrated efficacy in experimental models of seizures (6-8). At the Neurological Institute of New York, clinicians have used the conventional long-chain diet as a mainstay for the treatment of drug-resistant childhood epilepsy for >30 years, with good success (9). In the last several years, our dietitians and nutritionists have used a novel and effective approach. The diet is organized into food groups so that substitutions among different foods can be made easily. This makes the diet simpler to use and provides parents with greater flexibility. The broad picture regarding the mechanics and the effectiveness of the ketogenic diet has been clear since 1921. Therefore, we regard