Posts

By Celez Suratos, MS, RD, ACCN15 Blogger

An individual only needs two things to easily access a myriad of information: a device that has the ability to connect to the internet, and an internet connection. Such information may be as simple as finding nearby show times for a movie, or something more complex, such as trying to self-diagnosis when exhibiting symptoms of a particular disease. This concept is the same when it comes to how the general public may be finding nutrition information. Along with the ease of access of internet searches however, is a high potential of inaccurate or incomplete nutrition information that’s widely distributed.

This can be further exhibited when it comes to myths surrounding carbohydrate (CHO) intake in people with diabetes mellitus (DM). DM is a complex disease in and of itself.Add the ever-evolving nutrition recommendations, such as the diabetic exchange list, glycemic index, and CHO counting into the mix, and one may be more sympathetic as to why a patient may struggle with compliance and management of his or her diabetes.

Alison Evert, MS, RD, CDE from the University of Washington Medical Center approached some of the frequent concerns that arise from patients and healthcare providers when it comes to DM and CHO intake at the 2015 Advances and Controversies in Clinical Nutrition conference. From the presentation and based on a 2005 Dietary Reference Intake report, individuals need to consume at least approximately 139 gram (g) of CHO per day (this does not include creating glucose through pathophysiological processes, such as gluconeogenesis) in order to meet minimum obligatory glucose needs. Ms. Evert reports recent data of median intake of CHO as 220-330 g/day by men and 180-230 g/day by women. Moreover, data from a 2014 National Health and Nutrition Examination Survey (NHANES) reports that adults (20 years and older) without diabetes consume 48 to 50 percent of their daily calories from CHOs. This information tells consumers that intake of CHOs is a necessity, whether or not he or she has DM. It also communicates to nutrition educators that there may not be an ideal percentage of calories that should be consumed from a single macronutrient.

This begs the question, is current and best practice to make percentage recommendations of macronutrient intake based off of total calories, or is this an archaic and irrelevant practice? During her session, Ms. Evert reflected on her time as a dietetic intern in which she made specific calculations on g of CHO a diabetic should consume per day, and passed on a meal plan to patients based on this information. Imagine trying to explain a generic serving recommendation, such as “eat 13 to 17 servings of CHO per day” to an ill and perhaps non-compliant, underserved, or even under-educated patient.

The take-away message Ms. Evert’s presentation is that patients with DM need individualized nutrition recommendations/meals plans, particularly as there are major differences in type 1 versus type 2 DM, the spectrum of type 2 DM progression among patients, and medications that affect glycemic control. Her suggestion – make it a point to discuss what our food sources of CHO are and focus on lifestyle behavior change.

By: Ann L.

Over 300,000 American children under the age of 14 are living with epilepsy.  Some children can have hundreds of seizures per day, which can severely limit their ability to participate in social activities.  Seizure control is important for helping kids achieve otherwise normal lives.

In the 1920s, it was noted that children who fasted for up to three weeks were seemingly cured of their epilepsy.  Dr. Wilder at the Mayo Clinic was the first to describe a diet designed to mimic this starvation state that was high in fat and low in carbohydrates.  However, due to the development of anticonvulsants in the 1930s, the diet fell out of favor and was deemed unnecessary.  Since the mid-1990s, there has been renewed public and scientific interest in the ketogenic diet to treat epilepsy that is not responsive to drugs.

What is the ketogenic diet?  

The classic ketogenic diet provides 90% of calories from fat, a minimum of 1 g/kg protein, and minimal carbohydrates.  The ratio of fats to protein and carbohydrates is 4:1.  Heavy cream, butter, and oil are some of the foods that can become staples of children on a ketogenic diet.  The diet does require vitamin and mineral supplementation.

When should a ketogenic diet be used?

According to a 2008 consensus report from an international expert panel, the ketogenic diet “should be offered to a child after two anticonvulsants are used unsuccessfully” (1).  The diet must be started under close medical supervision in consultation with a physician and a dietician.

Is it an effective treatment?

In 2008, the first randomized controlled trial of the ketogenic diet demonstrated that 38% of children on the ketogenic diet had a >50% reduction in seizures compared with only 6% in the control group (2).  Observational studies have also reported similar rates of seizure control achieved by use of the ketogenic diet.  For children who achieve seizure freedom, 80% will remain seizure free after discontinuation of the diet.

Are there any long-term health consequences?

While the duration of time spent on the ketogenic diet varies widely between individuals, most children stay on the diet between 1-2 years.  Some of the major concerns with the ketogenic diet include impaired growth, kidney stones, and dyslipidemia.  Patients must follow up regularly with their physicians to monitor growth and blood chemistries.

Further Reading:
1.  Freeman JM, Kossoff EH.  Ketosis and the ketogenic diet, 2010: advances in treating epilepsy and other disorders.  Adv Pediatr. 2010;57(1):315-29.
2.  Neal EG et al.  The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial.  Lancet Neurol. 2008 Jun;7(6):500-6. Epub 2008 May 2.
3.  The Charlie Foundation.  http://www.charliefoundation.org/