Preventing Side Effects and Diet Discontinuation

Abstract

Abstract In general, the ketogenic diet is well tolerated. Common side effects include constipation, vomiting, acidosis, and vitamin/mineral deficiencies. More significant side effects are rare, but include pancreatitis, hepatitis, kidney stones, and cardiomyopathy. During initiation, transient side effects can include dehydration, hypoglycemia, acidosis, vomiting, and refusal to eat. There are many reasons for ketogenic diet discontinuation, the most common being lack of efficacy after 3 to 6 months, or if seizures worsen. After 2 years of a patient’s effective use of the KD, most neurologists would consider discontinuation. The typical approach is a gradually lowering of the ratio of fat to protein and carbohydrate, then relaxing the weighing of ingredients, and finally adding new carbohydrate foods while keeping calories constant. This is followed by relaxation of calorie restriction and then gradual introduction of carbohydrate-containing foods. Approximately 80% of children will remain seizure-free when tapered off the KD if they have completely responded to diet therapy and are medication-free.