Thiele: That's true. By the time a lot families learn about the diet or come to talk to us about the diet, their children have been on numerous medications, the children are continuing to have seizures, they're having side effects from the medication and many people view this diet as their last chance at controlling their child's seizures. Now with increasing awareness of the diet and the fact that more and more people are learning about it and hearing about it, many people come to consider the diet earlier in the treatment of their epilepsy, oftentimes after only one or two medications instead of after eight to 10 medications.
Besser: How effective is this treatment?
Thiele: It's very effective. And this has been looked at. The ketogenic diet has been used for more than 80 years, and every time anyone has looked at the efficacy of the diet in study form, about a third of children who go on the diet become seizure-free, about a third of children have a great than 50 percent reduction in seizures. and for the other third, the diet doesn't work and that's often because the children have trouble tolerating the restrictions.
Besser: When you think about seizures and the complexity of seizures, and then you think about treating this with diet, you have to wonder how does this work?
Thiele: How the diet works is a very big question, because when children are on this diet, they're restricted from having birthday cake, from having French fries, from having potato chips, from having Halloween candy. So you're taking a child who's already living with epilepsy, and you're further restricting their world. So it would be much easier if we could figure out how this diet works and put it in a pill form so people could take it that way. Because it's so extremely effective, and it continues to be more effective than any medicine we have, there's an increasing amount of interest in the basic science community about what the mechanism of the diet is. It would help us understand epilepsy. And the diet is also expanding in other areas, especially neurologic disease, and there's increasing interest of using a similar diet in cancer. So obviously, understanding the mechanisms of the diet would help further help its utility in these other areas.
Besser: What kinds of things are being looked at for treatment with a ketogenic diet?
Thiele: Right now there's some preliminary evidence in Parkinson's disease and Alzheimer's disease that a diet similar to the ketogenic diet may be very effective. And there's actually a critical trial, ongoing, in ALS, or Lou Gehrig's, disease of using a similar diet and there's a lot of evidence, mainly animal model evidence, that similar diets may be very effective in helping to treat cancer.
Besser: Treating cancer?
Thiele: Treating cancer. There's evidence in prostate cancer and there's a lot of evidence in some brain cancers, like neuroblastoma. And I think that's because cancer cells are rapidly dividing so they have a very high metabolic rate and they use a lot of energy.
And so the ketogenic diet basically shuts down the cell's energy production and makes the cells rely more heavily on fat metabolism, and cancer cells, I think, are not thought to do that as effectively.
. Besser: Is this diet used to treat adults with seizures as well?