Thiele: There is less experience using the ketogenic diet with adults. When it was first described in the 1920s, it was described both in children and adults, and it is effective in adults, but it's honestly harder for adults to maintain and tolerate the restrictiveness. Since I've been at the Mass General we have started several adults on it, and it can be extremely effective, but again, the restrictiveness. The diet is kind of like the Atkins diet, so it really has a limit to 10 grams of carbohydrates a day -- which isn't a lot.
That's why there's medications on the classic ketogenic diet now, a modified Atkins diet that's being used at Hopkins, and the modified diet we developed here, called the low glycemic index treatment, and both of those diets are less restrictive, and both of those diets appear to be probably almost as effective as the classic ketogenic diet. So there is increasing interest in using those diets in the adult population because it's thought that adults can tolerate those better because they are so much less restrictive.
Besser: What are some of the downsides of being on this diet?
Thiele: For a kid, a big downside is not being able to eat your own birthday cake, going to other kid's birthdays and not being able to eat the cake or other things the child's having. For the family, a big downside is not being able to go to restaurants. The family can go to a restaurant, but if their child is on the classic ketogenic diet, they have to take that child's meal because on the classic ketogenic diet, the meals are composed by grams of each food substance and the family weighs each component out on a gram scale, and that's not possible to do in a restaurant setting. Another advantage of the modified diets, our low glycemic and the modified Atkins, are, because they are less restrictive, the families can go to restaurants and children can order off menus. Children can eat school lunches that their school provides, just have an understanding that what's on the menu would be compatible with their diet and what would not be. But I think for most kids it's really not being able to eat candy, not being able to eat ice cream, not being able to eat French fries and that's a lot of other things that children enjoy doing.
Besser: Being different from other children.
, Thiele: Being different from other children, and these are children who already feel different from other children because they have epilepsy. And it's a group of kids who are, really to me, superheroes, because they try to be normal kids even though some of them are dealing with 50,100 seizures a day.
Besser: Describe a typical meal for someone on a ketogenic diet.
Thiele: The diet is composed of what is called the ketogenic diet ratio. And that ratio means the grams of fat in a meal to the grams of carbohydrates plus protein.
And many children get started on a 4:1 ratio, meaning they get 4 grams of fat to every gram of carbohydrate plus protein. So a typical meal would be bacon, and often lots of it, with sometimes a small amount of carbohydrate in the form of vegetable or fruit. What many children on the diet, really children on the classic ketogenic diet, don't get, is breads, they don't get grains, they don't get rice because all of those foods are high carbohydrate foods.
Besser: So it really reverses totally the food pyramid for these kids?