1900 calorie diet calculator
These studies generally examined a cohort of patients recently treated by the physician (what is known as a retrospective study ) and selected patients who had successfully maintained the dietary restrictions. However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. Russel Wilder, at the Mayo Clinic, built on this research and coined the term ketogenic diet to describe a diet that produced a high level of ketone bodies in the blood ( ketonemia ) through an excess of fat and lack of carbohydrate. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. During this period the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. Early studies reported high success rates: in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. He tested it on twelve children and adolescents with intractable seizures. He achieved similar results despite only having studied the patients for a short time. Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. By 1930, the diet had also been studied in 100 teenagers and adults. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. These occur when cortical neurons fire excessively, hypersynchronously, or both, leading to temporary disruption of normal brain function. Clifford Barborka, also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Variations on the Johns Hopkins protocol are common. Excess calcium in the urine ( hypercalciuria ) occurs due to increased bone demineralisation with acidosis. About 60% of patients will achieve control of their epilepsy with the first drug they use, whereas about 30% do not achieve control with drugs. Further studies in the 1920s indicated that seizures generally returned after the fast. Around this time, Bernarr Macfadden, an American exponent of physical culture, popularised the use of fasting to restore health. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. The ketogenic diet is a high- fat, adequate- protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. A seizure can be focal (confined to one part of the brain) or generalised (spread widely throughout the brain and leading to a loss of consciousness). Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction and 13% were seizure-free, though these figures include many who were no longer on the diet. This article is about a dietary therapy for epilepsy. However, these studies are difficult to compare to modern trials.
There followed an explosion of scientific interest in the diet. Peterman documented positive effects (improved alertness, behaviour and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant drugs. At the initial consultation, patients are screened for conditions that may contraindicate the diet. Houston Merritt and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. The percentage of those still on the diet at two, three and four years was 39%, 20% and 12% respectively. Rawle Geyelin reported his experiences to the American Medical Association convention. Epilepsy is considered refractory (not yielding to treatment) when two or three anticonvulsant drugs have failed to control it. Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to John Freeman at Johns Hopkins Hospital, which had continued to offer the therapy. The ketone bodies pass into the brain and replace glucose as an energy source. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. For information on ketogenic diets as a lifestyle choice or for weight loss, see Low-carbohydrate diet and No-carbohydrate diet. His disciple, the osteopathic physician Hugh Conklin, of Battle Creek, Michigan, began to treat his epilepsy patients by recommending fasting. For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. The diet forces the body to burn fats rather than carbohydrates. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive or due to illness, and most of those who remained were benefiting from it. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. After a ketogenic breakfast on the fourth day, the patient is discharged. In 1921, Rollin Woodyatt reviewed the research on diet and diabetes. This might affect, for example, the muscles, the senses, consciousness, or a combination. When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). By 2007, the ketogenic diet was available from around 75 centres in 45 countries, and less restrictive variants, such as the modified Atkins diet, were in use, particularly among older children and adults. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Early and modern studies also differ because the treatment protocol has changed. Often there is no initial fast (fasting increases the risk of acidosis and hypoglycaemia and weight loss). In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet.
