Ketogenic Diets in Children:  A Brief Overview

Ketogenic Diets in Children:  A Brief Overview

The Ketogenic Diet (KD) has been used for over a century in children, mostly for the treatment of seizures that are difficult to control.1 The diet itself is a very high fat, low carbohydrate nutrition plan with protein intake that can vary based on the child’s age and needs.  For instance, an infant on the diet is usually given more protein because of the need to support growth and development. Because the diet is very low-carb, the body has to use other fuel sources to get energy and this source is a group of molecules called ketone bodies.  

In children with hard-to-treat seizures, this diet has shown a good amount of success. Two-thirds of children on KD’s will have a noticeable drop in their seizure frequency with a third having a more than 50% reduction. One in ten children can see their seizures decrease by more than 90%.2 The degree of success depends heavily on the underlying condition being addressed as some diseases and syndromes respond more favorably than others.  The exact reason for this response is unclear, but several possibilities exist. Nerve cells in the brain are particularly good at using ketone bodies for fuel so there may be a direct effect on nerve cell metabolism when the energy source switches over. Also, KD’s are thought to have significant anti-inflammatory effects, and this alone may reduce the irritability of the nerves in the body and prevents them from getting to the point where they are over-excited.1 A less excitable nervous system is thought to be less likely to go into seizures. Some of the conditions where KD’s are more helpful in children are infantile spasms, FIRES syndrome, glucose transporter protein-1 (GLUT-1) deficiency, pyruvate dehydrogenase deficiency, tuberous sclerosis, Angelman syndrome, and some mitochondrial diseases.3  

Keto diet for obesity

KD’s are used in adults to treat obesity and reduce its complications like type 2 diabetes and cardiovascular disease. While there is ongoing research in this area for pediatric age ranges, the increasing rate of obesity in children and teens has called into question the need for other therapies besides the old standby of reducing calorie intake and increasing exercise.4 Especially for children whose weight is already out of control, starting an exercise regimen can be difficult prior to significant weight loss.  In these cases, a KD regimen may help them get to a weight where an exercise regimen is easier to start and maintain. 

Another area where KD’s can help in obesity is through their anti-inflammatory actions.  Being overweight is known to cause inflammatory chemicals to be released in the body, especially in the gut, and the ketone bodies used for fuel during a KD have anti-inflammatory and antioxidant properties. Additionally, the hormones that reduce appetite are increased by a KD while those that stimulate hunger are decreased.4 All of these factors can assist the pediatric patient in achieving faster weight loss than with other diet plans that only focus on calorie reduction rather than also modifying the content of those calories.

Other potential benefits of keto diet

Another area of increasing interest in KD’s is their ability to reduce the severity of other inflammatory diseases such as asthma. KD’s alter the bacteria normally found in the intestines (called the flora) and this seems to reduce flora that produces pro-inflammatory chemicals that make asthma worse.  Ketone bodies themselves also seem to reduce irritation and inflammation in the airway.5 While again, this use of these diets for asthma in children is still being studied, there have been reports of KD plans improving asthma in adults and even some research suggesting that modified KD’s during pregnancy and breastfeeding can reduce the development of asthma in children as they get older.5 

The importance of regular monitoring and medical supervision

It is important to emphasize that starting a KD is not to be taken lightly, especially in children.  A KD is not right for everyone, regardless of age.  Some medical conditions can’t be on a KD at all. Children with poor liver, kidney or pancreas function; those with ketolysis defects, prolonged QT syndrome or other heart problems; and children having glycogen storage and fatty acid oxidation defects can’t be on a KD.  Children who are already having problems with growth and development may not be good candidates for KD plans.3  Pregnant women and breastfeeding mothers should understand that it is possible that there could be negative effects on the growth and development of the baby if the diet is not constructed and followed properly.4  For infants and young children, starting a KD may need to be done in a hospital under close monitoring by a medical and dietary team.1   Abdominal pain, vomiting and constipation can occur and are often reasons for stopping the diet and blood tests are needed from time to time to keep an eye on body chemistry and metabolism, especially in children.3  The bottom line is that if you’ve done your research and think a KD may be right for you or your child, discuss it with a knowledgeable medical provider so the right plan can be selected and monitored.  

A ketogenic diet has long been known to have anti-inflammatory and hunger-reducing effects. The ability of these diets to control seizures in some children has been known for generations, but exciting new areas of research indicate that they can be helpful in controlling other inflammatory problems in the body and even be of help in tackling childhood obesity and possibly asthma as well.  Because children are growing and developing rapidly, it is especially important that the use of a ketogenic diet in kids and teens be monitored by a doctor. The same is true for pregnant and breastfeeding women. However, as medical science learns more about the effects of ketone bodies on the gut flora, nerves, and other body functions, these diets are an increasingly exciting area of interest for promoting health and wellness in all ages. 

  1. Bough, K. J., and Rho, J. M. (2007). Anticonvulsant mechanisms of the ketogenic diet. Epilepsia 48,      43–58. doi: 10.1111/j.1528-1167.2007. 00915.x
  2. The Royal Children’s Hospital Melbourne.  (n.d).  Ketogenic Diet
  3. Kossoff, EH, et al. (2018). Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 3(2):175-192.
  4. Calcaterra, V., et. al. (2021). Metabolic Derangement in Pediatric Patient with Obesity:  The Role of Ketogenic Diet as a Therapeutic Tool.  Nutrients. 13(8):2805.
  5. Alsharairi, N.A.  (2020). The Role of Short-Chain Fatty Acids in the Interplay between a Very Low-Calorie Ketogenic Diet and the Infant Gut Microbiota and Its Therapeutic Implications for Reducing Asthma. nt J of Mol SciI. 2(24): 9580.

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