Ketogenic diet in a clinical practice

Namen diplomskega dela je bil narediti pregled uporabe ketogene diete, kot primarne ali podporne terapije za osebe z epilepsijo, s poudarkom na terapiji za dojenčke in otroke. Cilj prehranske terapije s ketogeno dieto je prenehanje oziroma zmanjšanje pogostosti in jakosti epileptičnih napadov. Lahko se uporablja kot samostojna terapija oziroma v kombinaciji s protiepileptičnimi zdravili. Uspešnost diete temelji na številnih, med seboj povezanih mehanizmih, ki spremenijo presnovo posameznika. Možganom namesto glukoze zagotovijo nadomesten vir energije v obliki ketonskih telesc (acetona, acetoacetata in beta-hidroksibutirata), ti pa omogočajo počasnejše sproščanje energije in s tem preprečijo prevzdraženost sinaps ter posledično epileptične napade. Ketogena dieta je v osnovi zelo restriktivna dieta, omejuje vnos ogljikovih hidratov in beljakovin, kar lahko privede do pomanjkanja določenih hranil, zato je nujno uvajanje prehranske terapije pod nadzorom kliničnega dietetika in nevrologa. Potreben je pregled pred uvajanjem in nato redni pregledi med izvajanjem diete, kjer se redno spremljajo primernost vnosa hranil, vrednosti ketonov v urinu in krvi ter nekaterih drugih biokemičnih parametrov v krvi. Glede na izvide se sama dieta po potrebi prilagaja, da se zagotovi čim večja uspešnost. Prehranska terapija pri vseh bolnikih nima enakega učinka, zato je nujen individualen pristop. V diplomskem delu so predstavljene različne vrste ketogene diete, možni stranski učinki ter celoten potek prehranske terapije, od uvajanja do prekinitve ketogene diete.The purpose of this thesis was to overview the use of a ketognic diet as a primary or supporting therapy for patients which struggle with epilepsy, with an emphasis on therapy for infants and children. Main goal of a therapy with the ketogenic diet is to eliminate or at least minimize occurrence and intensity of epileptic seizures. It can be used as an independent therapy or in a combination with antiseizure drugs. The efficacy of this diet is based upon numerous interlinked mechanisms which alter the body\u27s metabolism. Instead of glucose it provides brain with an alternate source of energy in a form of ketone bodies (acetone, acetoacetate, and beta hydroxtbutyrate), which allows more gradual release of energy and subsequently prevention of overstimulation of synapses as well as epileptic seizures. Ketogenic diet is fundamentally a very restrictive diet since it limits the amount of allowed carbohydrates and protein, which could lead to malnutrition. Because of that initiation of the diet should always be under supervision from a clinical dietitian and a neurologist. Before the diet initiation every patient must be thoroughly examined. During the check-ups nutrient levels, other biochemical values, as well as urine and blood ketone levels are assessed so the diet can be efficiently regulated to ensure optimal results. This nutrition therapy has a different effect on patients therefore an individual approach is required. This thesis presents different types of ketogenic diets, possible adverse effects, and a proposal of nutrition management for the patients, from the initiation to discontinuation of the nutrition therapy