How Do You Implement the Diet?

Abstract

AbstractHow the ketogenic diet (KD) is implemented varies between centers. Some randomized published data now exist, to support implementation practices, differences are center specific and preference based. In an attempt to unify practices, a consensus statement was written in 2008 and was updated in 2018. The KD can be safely used in patients of all ages, can be modified for specific dietary needs, and can be administered as food, formula, or intravenous alimentation. Effectiveness, compliance, and minimization of side effects are achieved using a team-based, family-centered support structure. The KD is commonly initiated in an inpatient setting with a gradual increase in the fat content. A few centers still initiate the KD with a brief fast. Outpatient initiation with slower advancement to a full diet can be challenging but can be safely executed. Time to determine response and duration of treatment vary. Side effects are now better understood and best managed proactively by monitoring, but they cannot always be prevented and must be weighed against the benefits of continuing the therapy.