The ketogenic diet has been used since the 1920's as an alternative therapy to antiepileptic drugs (AED) in children with intractable seizures. The diet is high in fat (up to 90% of calories) and low in carbohydrate and protein. To date, there have been no studies evaluating growth and laboratory parameters in children on the diet. In this retrospective study, biochemical and growth data were collected from 12 children (age: 4.0 ± 3.6 yrs) pre- and 6 months on the ketogenic diet. The diet contained 90% of calories from fat (P/S ratio 4.4), 10% of calories from protein/carbohydrate supplemented with additional vitamins and minerals. Biochemical data included hemoglobin (Hb), hematocrit (Hct), white blood cell count (WBC), red blood cell count (RBC), platlets, total cholesterol (TC), total protein (TP), albumin (Alb), serum glutamic oxaloacetic transaminase (AST), serum glutamic pyruvic transaminase(ALT), calcium, phosphorus, blood urea nitrogen (BUN) and creatinine. All children demonstrated decreased seizure number. There was no significant change in Hb, Hct, WBC, RBC, platlets, TC, TP, Alb, calcium, phosphorus, or creatinine 6 months after starting the diet; all parameters remained within the normal range. There were significant decreases in AST (pre- vs. 6 months; 49.2 ± 28.7 units/L vs. 32.5 ± 19.3 units/L, P ≤ 0.05), and BUN (11.2 ± 5.8 mg/dl vs. 7.5 ± 2.4 mg/dl, P ≤ 0.01). ALT levels normalized (34.0 ± 29.0 units/L vs. 17.2 ± 8.9 units/L) although the decrease was not statistically significant (P = 0.06). There was a significant increase in height (93.0 ± 20.7cm vs. 99.7 ± 20.5 cm, P ≤ 0.001) and weight (16.9 ± 9.5 kg vs. 18.2 ± 8.8 kg, P≤ 0.05). Weight for height was similar pre-diet and at 6 months (106± 15% vs. 104 ± 18%). These findings suggest that liver function, as assessed by AST and ALT, was improved following 6 months on the ketogenic diet. This change may have resulted from the discontinuation of AED's once the diet was initiated. The decrease in BUN may be a consequence of the low protein content of the ketogenic diet. Still, normal growth was sustained in these children over a 6 month period. Thus, the ketogenic diet appears safe both in terms of growth and laboratory parameters.
