The ketogenic diet is a therapeutic diet that is often used in the management of certain health conditions, such as drug-resistant epilepsy. There are several different variants of the diet that can be applied in different circumstances.
In addition to the different diets outlines below, the ketogenic diet can be administered via a gastrostomy tube. There are also many other variants of ketogenic diets that are practiced in different regions of the world.
The 5 Types of Keto
The classic ketogenic diet requires the involvement of a dietitian, who will make dietary recommendations based on individual characteristics such as age, weight, physical activity culture, and food preferences.
The energy requirements for a child following the ketogenic diet is typically 10-20% less than recommended daily amounts, due to the high-density energy in the fats that make up the majority of the diet. The ratio of fat to carbohydrates and protein combined is approximately 4:1 but may be lower for young or obese children.
A typical meal on the classic ketogenic diet consists of heavy whipping cream, protein-rich food such as meat, low-carbohydrate vegetable, and fats such as butter or vegetable oil. Fruit and vegetables that are high in carbohydrates, such as bananas, potatoes, peas, and corn, are not included in the diet.
It is worth noting that the classic ketogenic diet is not balanced as it includes very few portions of fruits, vegetables, cereals, and sources of calcium. As a result, supplementation is required to compensate for this, which usually includes multivitamin, calcium, and vitamin D supplements.
Medium-chain triglyceride (MCT) variant
MCTs generate more ketones per unit of energy than the long-chain triglycerides that are present in normal dietary fat. Therefore, a diet rich in MCTs can have a lower proportion of fat and more protein and carbohydrates while still producing the same effect. This is preferable, as individuals can have greater variety in their diet while also slightly increasing their portion sizes.
Caution in using high quantities of MCT oil must be practiced, as adverse effects such as abdominal cramping, diarrhea, and vomiting have been reported in high doses. Approximately 45% of MCT oil is considered to be a good balance in the response and risk of side effects.
Modified Atkins diet (MAD)
This variant is based on the Atkins diet and stems from the discovery that the induction phase of the Atkins diet was reported to help in the control of epileptic seizures in 2003. The diet was then modified with the aim to extend the induction phase, which involved higher fat intake than a normal, balanced diet.
This differs from the classic diet, in that the fat to protein and carbohydrate ratio is approximately 1:1. Children following this diet therefore generally require less support from a dietician. Dietary supplements are still required, however, to ensure children receive essential vitamins and minerals.
Low glycemic index treatment (LGIT)
The LGIT variant is a less limiting regimen that is based on the stabilization of blood glucose levels. The concept that carbohydrate restriction and increased fat consumption in the diet is thought to be involved in the mechanism of action of the ketogenic diet is extrapolated to reduce seizure by controlling blood glucose levels.
Intake of fat remains high, with about 60% of calorie intake coming from fats, but more carbohydrates are allowed to be consumed than in other variants, such as the classic or Atkins diet. The restriction is based on the type of carbohydrates, which should have a glycemic index lower than 50.