Sometimes a 90% Fat Diet Is Good For You

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This weekend, the New York Times Magazine has an article written by Fred Vogelstein, a contributing editor to Wired and father to a young boy with epilepsy. Sam’s condition is severe: at one point, the boy was having up to 130 seizures a day and was not responsive to medication. To treat him, the family has put Sam on a special diet: a typical breakfast consists of eggs mixed with heavy cream and served with bacon; lunch is full-fat yogurt mixed with coconut oil; dinner: hot dogs, cheese, nuts, more bacon. (More on The ‘Other’ Salt: 5 Foods Rich in Potassium)

If it sounds like a fringe treatment, guess again. The ketogenic diet is prescribed at more than 100 hospitals in the U.S., Canada and elsewhere for patients with epilepsy, Vogelstein reports, including Massachusetts General Hospital for Children, where Sam’s doctor heads up the pediatric epilepsy program.

The diet, which contains nearly 90% fat, is designed to trick the body into starvation mode, forcing it to burn fat for energy instead of carbohydrates — the body barely gets any carbohydrate to burn. For reasons that are still unclear, Vogelstein writes, ketosis has an antiepileptic effect, working to control seizures when drugs fail. (More on Who’s Stressed in America? The Answer May Surprise You)

The regimen is mainstream, but because it seems just plain wrong given the overall declining state of U.S. children’s diets, Vogel says people tend to see his child’s treatment as some kooky, alternative-fringe therapy. He explains:

The idea of food as medicine has been a controversial topic in this country in recent years. For decades the fight that the late Robert Atkins and his low-carb acolytes had with mainstream medicine has been as vitriolic as a religious war. There are food cures for everything from cancer and heart disease to cataracts. Doctors talk about diet as a part of basic good health all the time. But talk to them about a diet instead of drugs to stop an infection or treat a tumor and most would be visibly alarmed, and in many cases, they would have good reason to be. A decade ago most doctors held the same contempt for keto. An Atkins-like diet that worked as well — and often better — than antiepileptic drugs? Common sense suggests that’s crazy.

But when it comes to keto’s impact on pediatric seizures, there is wide acceptance. There are about two dozen backward-looking analyses of patient data suggesting keto works, and, more significant, two randomized, controlled studies published in 2008. One of the trials, by researchers at University College London, found that 38 percent of patients on the diet had their seizure frequency reduced more than 50 percent and that 7 percent had their seizure frequency reduced more than 90 percent.

The diet comes with inherent hardships. Risks include kidney stones and constipation. If Sam didn’t also take a daily multivitamin and a calcium-magnesium supplement to make up for lost nutrients, Vogelstein writes, his growth would be stunted and his teeth and hair would fall out. Above all, it’s hard to be a kid who can’t have birthday cake, cookies or ice cream — on Halloween, Sam has to trade his candy in for a present. Minor slips are unacceptable; this is an exact science of grams, ratios and dire consequences: after eating half a piece of his friend’s toast, Sam went into uncontrolled seizures for a week. (More on Do Overweight People Smell Food Better?)

The diet isn’t supposed to last forever, though. Vogelstein reports that most children who respond to it stay on it for two years. And research suggests that there are few long-term health effects of the diet after you stop it. For more on the effects of keto, as it’s known, read the full Times Magazine article. It’s a fascinating reminder that drugs are not the only medicine and certainly not the only strategy for improving health. Often, the right solutions can be counterintuitive and difficult.

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