This news item was created by students Justin Kenagy, Jamie Harris, Sara Peterson, Matt Rengel, and Jade Curry as part of their Chemistry 212 Collaborative Group Activities in WS00 under the guidance of Prof. Rainer Glaser.

Glaser's "Chemistry is in the News"
To Accompany Wade Organic Chemistry 4/e.
Chapter 18. Aldehydes and Ketones.


For each of the following questions, please refer to the following article:

KETOGENIC DIET HELPS EPILEPTIC CHILDREN WHO FAIL DRUGS
By Andrew Bowser (Medical Tribune, March 1, 1999)


Editorial Comments

Greater than 2.5 million people in the US suffer from epilepsy, a neurological condition that produces disturbances in the brain's electrical impulses, causing patients with epilepsy to have frequent seizures. There is no known cause for about 70 percent of the cases of epilepsy, so treatment is difficult.

In his article, "Ketogenic Diet Helps Children Who Fail Drugs", Andrew Bowser claims that a ketogenic diet helps to reduce the amount of seizures for children. Evidence of short-term reduction of 50-90% of seizures was seen by about 4/5 of the children tested in the first year. The ketogenic diet is mentioned and supported in the article to help epileptic children who fail common drugs for their seizures.

The American Brain Tumor Association defines seizures as "an attack caused by the abnormal electrical activity in the brain". Often, the patient will encounter a loss of consciousness, and/or some sensory dysfunctions. Seizures last only for a brief period of time, but may vary by type seizure. Some of these types are generalized seizures, where all of the brain is affected, or partial seizures, when some or part of the brain is affected, which may spread. Some of the known causes for seizures are drug withdrawal, brain tumors, oxygen deficiency, poisons, and head injuries.

The first path to treat children with epilepsy is anticonvulsive medications. There are several medications used to treat epilepsy in children, and certain types of medications control specific types of seizures. The most common types of medications are carbamazepine, and divalpoex. More recent drugs include diastat, tiagabine, and fosphenytoin. The mechanism of action of anticonvulsive drugs is not fully known, but one theory is that these drugs block the flow of abnormally fast nerve impulses in the brain. Other types of anticonvulsive drugs are thought to increase the flow of chloride ions, and thereby stabilize the nerve cell. These drugs are usually effective, although side effects such as drowsiness, weight gain, dizziness, blurred vision, low blood pressure and vitamin deficiencies pose a threat. Children on these drugs must take regular blood tests to ensure that the drugs are not damaging their liver, kidneys, or blood cells. For children who do not respond positively to anticonvulsive medications, or children who are unable to take the medication because of negative side effects, the ketogenic diet is the next step used to control seizures. If anticonvulsive methods fail, doctors implement the ketogenic diet. This diet has appeared in medical literature for well over seventy years. It was replaced when modern anti-convulsants became available, even though it had a very good success rate. The diet may be safer for some children because it has fewer side effects than anticonvulsive drugs. The ketogenic diet works by mimicking the effects of starvation. Normally, food is converted into glucose by the body. If there is insufficient food, a body will burn glucose stored as glycogen. Once the glycogen is used up, the body burns stored fat. The body starts to burn ketones manufactured by the body fat as well as glucose. This process is called ketosis. The production and usage of ketone bodies appears central to the success of the diet. It is not understood why ketone bodies help to control seizures.

In the ketogenic diet, ketone bodies are products in reactions of fatty acids in the liver. Ketone bodies, most commonly acetoacetate and acetone, are made by the condensation of two acetyl-CoA molecules during the metabolism of fat. These ketone bodies can be harmful to an individual, poisoning or killing body cells if these products are not removed from the blood. Ketone bodies are usually broken down by insulin, but in children with diabetes, there is not sufficient insulin in the blood to degrade these ketone bodies. The ketone bodies can build up in the blood leading to serious illness or coma. Insulin factors should be taken into consideration before prescribing a ketogenic diet to any child. A dietary concern of the ketogenic diet is the low daily carbohydrate intake of the child. The primary carbohydrate that needs to be regulated is glucose (structure). The body uses glucose along with other carbohydrates as a major source of energy. As a result of the ketogenic diet, glucose levels are extremely low causing the body to burn fat, leading to the production of ketone bodies, a process known as ketosis. The ketogenic diet is difficult to maintain because a single sweet or an extra snack could throw the whole diet off balance. A typical meal might include fish and green vegetables with a white sauce followed by fresh fruit in cream, along with many variations. As stated above, the fuel preference for the body is carbohydrates, and then fat. The ketogenic diet tries to manipulate the fuel intake so that body fat is used to produce ketone bodies. The actual mechanism for the ketogenic dietŐs ability to restrict seizures in epileptic children is not known, however, the diet is of great value to children who do not respond to medication.



Pertinent Text References
Chapter 18. Aldehydes and Ketones


Questions

Question 1: How are ketone bodies produced in the body?

Question 2: What happens to the glucose levels in the body while on a ketogenic diet and what are the side-effects of this?

Question 3: Are ketogenic diets a better alternative to anticonvulsant medication? Why or why not?

Question 4: Ketogenic diets are starting to be used by healthy individuals for weight loss. What are the consequences of this diet, and why is it useful for weight loss? Why do athletes follow the opposite of a ketogenic diet?

Question 5: Should HMO's pay for patients to consult with a ketogenic diet specialist, even if the patient responds to anticonvulsive medications?



Answers

Question 1: Ketone bodies are produced by the reactions of fatty acids in the liver. Two acetyl CoA molecules are (most commonly) turned into either acetoacetate and acetone during the metabolism of fat.

Question 2: Glucose levels are extremely low during the course of the ketogenic diet. This causes ketone bodies to be produced, a process called ketosis, which is the key to the ketogenic diet.

Question 3: Yes and no. The ketogenic diet has fewer and less damaging side effects than anti-convulsive drugs and is a more natural approach to controlling seizures, but it is a strenuous diet, especially for the children it is used to treat, and can easily be thrown off course. Also, the fact that the real reason for its success is not known concerns many neurologists. It is best used on children who do not respond well to medication.

Question 4: In most diets, your body burns up the carbs you get in your daily diet, and only after they are gone does the body begin to consume the fat that plagues the dieters. The ketogenic diet does not need to bother with the carbs and lets the body go straightinto burning other fuels. This can be dangerous because if the person on the diet is not being carefully monitored by doctors, like an epileptic child is, ketone bodies can build up. If they are not broken down quickly enough by insulin, ketong build-up can lead to serious illnesses or comas when they poison and kill body cells.

Athletes prefer high carb diets because carbohydrates are easiest to burn for quick bursts of energy.

Question 5: Yes, the ketogenic diet could be a better alternative for them. And no, it's a waste of money. This is really a case-by-case ethical discussion question with no real answer.