Abstracts

Rationale: The Indian version of the classical ketogenic diet was introduced in 1996. Initially, the Johns Hopkins Hospital protocol was used. However, some problems arose, including the high keto ratios (ratio of fats to protein + carbohydrate) used and the high lipid levels often encountered (1). Methods: Total of 141 patients with uncontrolled epilepsy and with age ranging from 5 months to 57 years were put on the Indianized version of ketogenic diet. 57 patients were put on 3:1 to 4:1 ratios and 84 patients were on lower ratios. The higher ratio patients were divided into two groups as follows 3.1-3.5:1 and >3.5:1. Those on lower ratios were divided into 4 groups, 1-1.5:1, 1.6-2:1, 2.1-2.5:1, and 2.6-3:1.The lipid levels namely cholesterol, LDL, and triglycerides were found to be high in those who were using saturated fats, solely or mainly. We then changed them to a mixture of fats, namely, SFA: MUFA: PUFA in a ratio of 1:2:1. Results: The high keto ratios usually used (3:1 to 4:1) were found to be unnecessary in all. Many patients maintained a stable urine ketosis of 4+ on lower ratios (1.5:1 to 3:1). So, lower ratios of 2:1 or 2.5:1 were initiated and then adjusted to maintain stable 4 + urine ketosis. Patients achieved good seizure control with varying ratios. The differences between the seizure frequencies of patients in each ratio group were found not to be significant. Seizure control of patients was also independent of age at which the diet began, the extent to which their calorie intake varied from the recommended 75% of RDA and the variation of their initial weight from their Ideal Body Weight (IBW). The lipid levels remained within the normal ranges on a mixed fat KD. Conclusions: Lower keto ratios are as effective as higher ratios as long as urine ketone levels of 4+ are maintained. Lower ratio diets are more palatable (2). Lipid levels can be maintained in the normal range by a simple method of giving mixed fats.