Appropriate Uses, Adverse Effects and Safety

Since the 1920s, the keto diet has been used to treat children and adolescents with refractory epilepsy – a seizure disorder.

Epilepsy is defined as refractory when treatment with at least two traditional antiepileptic drugs has failed.

In several studies conducted in children with this disease, following a keto diet had decreased the frequency of epileptic seizures by up to 50% (1).

The anti-epileptic effects of the keto diet are thought to be the result of several factors (1, 2, 3):

• reduced cerebral excitability
• improved energy metabolism
• antioxidant effects of the brain

This mode of consumption has also been used in combination with traditional chemotherapy to treat certain types of brain cancer in adults and in children (4, 5, 6, 7).

Almost all tumors depend on carbohydrates (glucose) for their energy. It has been said that the keto diet deprives tumor cells of the glucose they need, thus helping to reduce the size of the tumor when it is associated with other forms of treatment (8).

Although several animal studies have been conducted and human studies are ongoing, additional data is needed to establish the long-term efficacy of the keto diet for the treatment of brain cancer in children .

Over the last 20 years, new versions of the keto diet have emerged, some of which are less restrictive and provide many of the same benefits. This includes the modified Atkins diet (2).

While the keto therapeutic diet limits calories, carbohydrates and protein, the modified Atkins diet is more liberal with respect to calories, liquids and proteins. This allows more flexibility while offering similar benefits (9, ten).

Keto Diet for the management of epilepsy

When implementing the keto diet to help manage epilepsy in children, a specific diet is followed to ensure consistent results. The diet is usually administered under the supervision of a doctor, a registered nurse and a dietitian.

Before starting the diet, a registered dietician is consulted to determine the nutritional needs of the child and establish a meal plan. Traditionally, the diet includes 90% fat, 6 to 8% protein and 2 to 4% carbohydrates (11).

The program often starts in a hospital or intensive outpatient clinic for the first 1-2 weeks. On the first day, one-third of the total calorie goal is achieved, followed by two-thirds on the second day and 100% on the third day (11).

In a clinical setting, all-in-one formulas containing the necessary nutrients can be used to initiate the keto diet for the first week, after which whole foods are gradually reintroduced (11).

The child and parents are well informed about the diet and the necessary resources are provided before they return home.

The diet is usually followed for about two years. It is then interrupted or replaced by a modified Atkins diet to allow more flexibility (1).

Studies have also shown that the keto diet can be safe and effective for infants and young children with refractory epilepsy (12, 13, 14).

Nevertheless, as these populations are extremely vulnerable, the decision to use this diet must be made individually by a physician.

summary The keto diet is used in children and adolescents under close medical supervision, mainly to help treat refractory epilepsy and brain cancer.

Like any diet that limits one or more food groups, the keto diet can have some detrimental effects.

The risk of side effects increases in children and adolescents because their growing body is more likely.

The main adverse effects associated with the keto diet in children are (15, 16):

In a therapeutic setting, appropriate measures are taken to minimize adverse effects.

Medical advice is mandatory when the keto diet is used to treat epilepsy or cancer in children and adolescents. Without this, the risk of serious side effects increases, outweighing the potential benefits.

summary Given the restrictive nature of the keto diet, the potential for adverse effects is high in children and adolescents. Dehydration, hypoglycemia and stunting are some of the major side effects.

Children are in a phase of their lives in which they grow faster and develop their food preferences.

During this crucial period, adequate nutrition is important. Excessive restriction of food intake for certain food groups or micronutrients, as in the case of the keto diet, can have an impact on growth and overall health.

Keto dieting would also affect your child's cultural experience when eating with peers and family.

Given the high rates of obesity in children, many children could benefit from a reduced carbohydrate intake. However, the keto diet is too restrictive for the healthy and growing child (17).

summary Given the restrictive nature of the keto diet and its potential effects on growth and food culture, it is not recommended for healthy children.

Teens are at a time in their lives where the body image can become more and more important to them.

Adhering to too restrictive diets can lead to unhealthy behaviors and significantly affect their relationship with food.

These unhealthy behaviors may result in eating disorders, common in adolescents (18, 19).

One study suggests that the keto diet may be effective for weight loss in teens, but many other dietary patterns are less restrictive and easier to follow in the long term, such as whole-food diets (20, 21, 22).

The same idea applies to children. Although the keto diet may promote weight loss, other dietary habits require less restriction and do not carry the risks associated with the keto diet (20).

Unless a keto diet is recommended and guided by a doctor for medical purposes, it is inappropriate for most children and adolescents.

summary Following a restrictive diet like keto can lead to unhealthy eating behaviors and affect the growth of children and adolescents. Therefore, the keto diet is not recommended for weight loss in this population.

The keto diet is used alongside traditional therapies to treat children and adolescents with epilepsy and brain cancer.

Medical advice is mandatory and can help minimize side effects such as dehydration and digestive problems.

Due to its restrictive nature, the diet is neither appropriate nor safe for most children and adolescents in good health.