KD's

So, I started Tuesday and today with  my preceptor that I will spent most of my time with until next Friday. She is mostly a general pediatric dietitian, but we've been spending a lot of time lately with a patient who was admitted to begin a ketogenic diet (KD) regimen.

Super interesting!

Our patient, who is into her teenage years, has been having about 15 seizures a day since she was born. So since medications haven't been all that helpful lately, her family and doctors decided to try out the ketogenic diet. Basically what this diet does, is that the high fat in the diet is the main source of energy, instead of carbohydrate and protein. Because of this, the high fat, or ketones, somehow alter the activity of neurotransmitters. And since this activity is altered, it has been seen in hundreds of studies to decrease the severity and frequency of seizures.

She was started on a 2:1 ketogenic diet. This means that she'll get twice as much fat and she does carbohydrate/protein. In a normal diet, it's the complete opposite. So it's not just that simple. This diet basically gives the patient no room for starch items. This means no bread, pasta, candy, cereals, etc. Plus, this diet has to be controlled so much that the patient (or caregiver) must weigh out their food to the exact gram.

An example of a 2:1 ketogenic diet to get a total of 1600 kcal per day would be:

65 g applesauce, unsweetened
28 g green beans, cooked
32 g chicken breast, no skin, cooked
18 g butter
21 g corn oil


Wait, did everyone catch that? Corn oil and butter. And LOTS of it. That meal alone has approximately 40 g of fat and each meal is about the same. Because it would be nearly impossible to obtain so much fat from solid foods, most of the time additional liquid fats are prescribed. This means that patients generally tend to drink pure heavy whipping cream, olive oil, corn oil, or melted butter in large amounts. And no, it tends not to be very pleasant, I'm sure.

So my role, as an intern, has been to design meals. This means that I have to calculate and decide what items to put on her meal and menus, but exactly how much, in grams. And it's not as easy as just adding more fat as I add more carbohydrate or protein, because I have to stay under a certain amount of calories. And each food has varying amounts of calories/protein/fat/carb so it's not as easy as it sounds.

But amazing exposure. U of M only gets about one ketogenic diet patient a month, and 50% of the time, the patient has been on it for their entire life and has it down and doesn't need much help from an RD. This means that KD's only have to be calculated and manipulated about once every two months. I'm pretty sure I'd never get this kind of exposure at another internship.



174 days...