PDF herunterladen
Aktuelle Ernährungsmedizin 2016; 41(06): 458-476
DOI: 10.1055/s-0042-119172
Fort- und Weiterbildung
© Georg Thieme Verlag KG Stuttgart · New York

Ketogene Diäten

Ketogenic Diets
N. Erickson
Zentrum für Prävention, Ernährungs- und Sportmedizin, Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München
,
A. Boscheri
Zentrum für Prävention, Ernährungs- und Sportmedizin, Präventive und Rehabilitative Sportmedizin, Klinikum rechts der Isar, Technische Universität München
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
16. Dezember 2016 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Zusammenfassung

In den letzten Jahrzehnten haben ketogene Diäten in der Behandlung von pharmakoresistenter Epilepsie und als mögliche Anwendung für weitere Indikationen weltweit wieder an Popularität gewonnen. Heutzutage bestehen 4 Hauptvarianten: die klassische ketogene Diät (KD), die Mittelkettige-Triglyzeride-Diät (MCT-Diät), die modifizierte Atkins-Diät (MAD) und die Niedrig-glykämische-Index-Therapie (LGIT). Die KD ist in der Durchführung besonders aufwendig, weshalb die Adhärenz oft ein Problem ist und die verschiedenen Varianten entwickelt wurden. Trotz zunehmend intensiver Forschung sind die Wirkungsmechanismen noch nicht komplett aufgeklärt. Die Empfehlung für eine ketogene Diät gilt nach wie vor für ausgewählte Indikationen, die Erweiterung auf nicht etablierte Indikationen wie z. B. Krebserkrankungen ist derzeit, außer für Forschungszwecke, wissenschaftlich nicht ausreichend belegt.

Dieser Artikel gibt einen Überblick über die verschiedenen Hauptvarianten der ketogenen Diät, erklärt die etablierten Standards für deren Anwendungen in der Klinik, listet die Indikationen sowie Kontraindikationen auf und beschreibt die Nebenwirkungen, die bei der Durchführung einer solchen Ernährungsform auftreten können.

Abstract

Ketogenic diets have recently been regaining worldwide popularity in the treatment of refractory epilepsy and as possible treatment option for further indications. Nowadays four main forms exist: The Classic Ketogenic Diat (KD) the Middle-Chain-Triglyceride Diet, (MCT-Diet), the modified Atkins-Diet (MAD) and the Low-Glycemic-Index-Therapy (LGIT). Despite the rapidly growing body of research, the mechanisms of action remain unclear and may be indication dependent. Due to the complex nature of the diets, especially the KD, compliance and long-term adherence can be low. Ketogenic diets are a valid therapy option for selected indications. Due to very limited scientific data supporting the application of the diet for non-established indications such as cancer, its use in the clinic should be limited only to well-controlled clinical trials.

This article gives an overview of the different main versions of the ketogenic diet, explains the established standards for it use in clinical settings, lists the indications and contraindications, and describes possible side effects

Schlüsselwörter

ketogene Diät - Epilepsie - Krebs - Mittelkettige-Triglyzeride-Diät - modifizierte Atkins-Diät - Niedrig-glykämische-Index-Therapie

Keywords

ketogenic diet - epilepsy - cancer - low glycemic index treatment - modified Atkins diet - medium-chain triglyceride ketogenic diet
 

  • Literatur

  • 1 Wheless JW. History and Origin of the Ketogenic Diet. In: Stafstrom CE, Rho JM, eds. Epilepsy and the Ketogenic Diet. Totowa, NJ, USA: Humana Press Inc; 2004. Chapter 2: 31-50
    CrossrefGoogle Scholar
  • 2 Hartman AL, Vining EP. Clinical aspects of the ketogenic diet. Epilepsia 2007; 48: 31-42
    PubMedGoogle Scholar
  • 3 Wilder RM. The effect on ketonemia on the course of epilepsy. Mayo Clin Bull 1921; 2: 307
    PubMedGoogle Scholar
  • 4 Peterman MG. The ketogenic diet in epilepsy. JAMA 1925; 84: 1979-1983
    CrossrefPubMedGoogle Scholar
  • 5 Henderson CB, Filloux FM, Alder SC et al. Efficacy of the ketogenic diet as a treatment option for epilepsy: meta-analysis. J Child Neurol 2006; 21: 193-198
    CrossrefPubMedGoogle Scholar
  • 6 Kossoff EH, Wang HS. Dietary therapies for epilepsy. Biomed J 2013; 36: 2-8
    CrossrefPubMedGoogle Scholar
  • 7 Kossoff EH, Cervenka MC, Henry BJ et al. A decade of the modified Atkins diet (2003 – 2013): Results, insights, and future directions. Epilepsy Behav 2013; 29: 437-442
    CrossrefPubMedGoogle Scholar
  • 8 Liu YM, Wang HS. Medium-chain triglyceride ketogenic diet, an effective treatment for drug-resistant epilepsy and a comparison with other ketogenic diets. Biomed J 2013; 36: 9-15
    CrossrefPubMedGoogle Scholar
  • 9 Lee PR, Kossoff EH. Dietary treatments for epilepsy: management guidelines for the general practitioner. Epilepsy Behav 2011; 21: 115-121
    CrossrefPubMedGoogle Scholar
  • 10 Ye F, Li XJ, Jiang WL et al. Efficacy of and patient compliance with a ketogenic diet in adults with intractable epilepsy: a meta-analysis. J Clin Neurol 2015; 11: 26-31
    CrossrefPubMedGoogle Scholar
  • 11 Paoli A, Bianco A, Damiani E et al. Ketogenic diet in neuromuscular and neurodegenerative diseases. Biomed Res Int 2014; 2014: 474296
    PubMedGoogle Scholar
  • 12 Klepper J, Leiendecker B. Ketogene Diät bei refraktärer Epilepsie im Kindesalter. Monatsschrift Kinderheilkunde 2011; 159: 739-744
    CrossrefPubMedGoogle Scholar
  • 13 Klepper J, Della Marina A, Elpers C et al. S1-Leitlinie 022/021. Leitlinien der Gesellschaft für Neuropädiatrie. Ketogene Diäten. Stand 04/2014. Gesellschaft für Neuropädiatrie (GNP), Arbeitsgemeinschaft für Pädiatrische Diätetik (APV), VDD, Society for the Study of Inborn Errors of Metabolism – Dietitians Group (SSIEM-DG). AWMF S1-Leitlinie 022/021. Aschaffenburg; Erlangen: 2014. Im Internet: http://www.awmf.org/uploads/tx_szleitlinien/022-021l_S1_Ketogene_Di%C3%A4ten_2014-04.pdf (Stand: 07.09.2016)
    Google Scholar
  • 14 Bueno NB, de Melo IS, de Oliveira SL et al. Very-low-carbohydrate ketogenic diet v. low-fat diet for long-term weight loss: a meta-analysis of randomised controlled trials. Br J Nutr 2013; 110: 1178-1187
    CrossrefPubMedGoogle Scholar
  • 15 Payne NE, Cross JH, Sander JW et al. The ketogenic and related diets in adolescents and adults – a review. Epilepsia 2011; 52: 1941-1948
    CrossrefPubMedGoogle Scholar
  • 16 van der Louw EJTM, van den Hurk ThAM, Catsman-Berrevoets CE, Lambrechts DJAE, Visser G, de Ruijter M, Rietveld JE. Epilepsie Vereiniging Nederland, Volwassen, Kinderen en Stofwisselingsziekten, Samenwerkingsverband Ketogeen Dieet Nederland.. Zorgpad Ketogeen dieet behandeling bij refractaire epilepsie & metabole ziekten bij kinderen. Behandelarenversie. Rotterdam: 2014: 1-56
    Google Scholar
  • 17 Kossoff EH, Zupec-Kania BA, Amark PE et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia 2009; 50: 304-317
    CrossrefPubMedGoogle Scholar
  • 18 Pfeifer HH, Lyczkowski DA, Thiele EA. Low glycemic index treatment: implementation and new insights into efficacy. Epilepsia 2008; 49 (Suppl. 08) 42-45
    PubMedGoogle Scholar
  • 19 Deutsche Gesellschaft für Ernährung, Österreichische Gesellschaft für Ernährung, Schweizerische Gesellschaft für Ernährungsforschung, Schweizerische Vereinigung für Ernährung Hrsg. Referenzwerte für die Nährstoffzufuhr. 2. Aufl., 1. Ausgabe 2015. [cited 2015 10/11/2015]. Im Internet: https://www.dge.de/wissenschaft/referenzwerte/ (Stand: 07.09.2016)
    Google Scholar
  • 20 Kossoff EH, Dorward JL. The modified Atkins diet. Epilepsia 2008; 49 (Suppl. 08) 37-41
    CrossrefPubMedGoogle Scholar
  • 21 Müller MJ. Studentsʼs Corner: Ketogene Diäten. Aktuel Ernahrungsmed 2013; 38: 429-430
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 22 Seo JH, Lee YM, Lee JS et al. Efficacy and tolerability of the ketogenic diet according to lipid:nonlipid ratios – comparison of 3:1 with 4:1 diet. Epilepsia 2007; 48: 801-805
    CrossrefPubMedGoogle Scholar
  • 23 Bergqvist AG, Schall JI, Gallagher PR et al. Fasting versus gradual initiation of the ketogenic diet: a prospective, randomized clinical trial of efficacy. Epilepsia 2005; 46: 1810-1819
    CrossrefPubMedGoogle Scholar
  • 24 National Clinical Guideline Centre (NCGC), Commissioned by the National Institute for Health and Clinical Excellence (NICE). The Epilepsies: The diagnosis and management of the epilepsies in adults and children in primary and secondary care. Pharmacological Update of Clinical Guideline 20. Final. Methods, evidence and recommendations, January 2012. NICE CG 137 Full. London: National Clinical Guideline Centre (NCGC); 2012: 1-636
    Google Scholar
  • 25 Neal EG, Chaffe H, Schwartz RH et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol 2008; 7: 500-506
    CrossrefPubMedGoogle Scholar
  • 26 Neal EG, Chaffe H, Schwartz RH et al. A randomized trial of classical and medium-chain triglyceride ketogenic diets in the treatment of childhood epilepsy. Epilepsia 2009; 50: 1109-1117
    CrossrefPubMedGoogle Scholar
  • 27 Muzykewicz DA, Lyczkowski DA, Memon N et al. Efficacy, safety, and tolerability of the low glycemic index treatment in pediatric epilepsy. Epilepsia 2009; 50: 1118-1126
    CrossrefPubMedGoogle Scholar
  • 28 Coppola G, D'Aniello A, Messana T et al. Low glycemic index diet in children and young adults with refractory epilepsy: first Italian experience. Seizure 2011; 20: 526-528
    CrossrefPubMedGoogle Scholar
  • 29 Hong AM, Turner Z, Hamdy RF et al. Infantile spasms treated with the ketogenic diet: prospective single-center experience in 104 consecutive infants. Epilepsia 2010; 51: 1403-1407
    CrossrefPubMedGoogle Scholar
  • 30 Kang HC, Lee YJ, Lee JS et al. Comparison of short- versus long-term ketogenic diet for intractable infantile spasms. Epilepsia 2011; 52: 781-787
    CrossrefPubMedGoogle Scholar
  • 31 Kossoff EH, Hedderick EF, Turner Z et al. A case-control evaluation of the ketogenic diet versus ACTH for new-onset infantile spasms. Epilepsia 2008; 49: 1504-1509
    CrossrefPubMedGoogle Scholar
  • 32 Kossoff EH, Hartman AL. Ketogenic diets: new advances for metabolism-based therapies. Curr Opin Neurol 2012; 25: 173-178
    CrossrefPubMedGoogle Scholar
  • 33 Kossoff EH, Nabbout R. Use of dietary therapy for status epilepticus. J Child Neurol 2013; 28: 1049-1051
    CrossrefPubMedGoogle Scholar
  • 34 Thakur KT, Probasco JC, Hocker SE et al. Ketogenic diet for adults in super-refractory status epilepticus. Neurology 2014; 82: 665-670
    CrossrefPubMedGoogle Scholar
  • 35 Allen BG, Bhatia SK, Anderson CM et al. Ketogenic diets as an adjuvant cancer therapy: History and potential mechanism. Redox Biol 2014; 2C: 963-970
    PubMedGoogle Scholar
  • 36 Roubergue A, Philibert B, Gautier A et al. Excellent response to a ketogenic diet in a patient with alternating hemiplegia of childhood. JIMD Rep 2015; 15: 7-12
    PubMedGoogle Scholar
  • 37 Mastriani KS, Williams VC, Hulsey TC et al. Evidence-based versus reported epilepsy management practices. J Child Neurol 2008; 23: 507-514
    CrossrefPubMedGoogle Scholar
  • 38 Klein P, Tyrlikova I, Mathews GC. Dietary treatment in adults with refractory epilepsy: a review. Neurology 2014; 83: 1978-1985
    CrossrefPubMedGoogle Scholar
  • 39 Felton EA, Cervenka MC. Dietary therapy is the best option for refractory nonsurgical epilepsy. Epilepsia 2015; 56: 1325-1329
    CrossrefPubMedGoogle Scholar
  • 40 Bergqvist AG, Schall JI, Stallings VA et al. Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet. Am J Clin Nutr 2008; 88: 1678-1684
    CrossrefPubMedGoogle Scholar
  • 41 DocCheckFlexikon. Lennox-Gastaut-Syndrom. Im Internet: http://flexikon.doccheck.com/de/Lennox-Gastaut-Syndrom (Stand: 07.09.2016)
    Google Scholar
  • 42 Freeman JM, Vining EP, Kossoff EH et al. A blinded, crossover study of the efficacy of the ketogenic diet. Epilepsia 2009; 50: 322-325
    CrossrefPubMedGoogle Scholar
  • 43 Levy RG, Cooper PN, Giri P. Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev 2012 3. CD001903
    PubMedGoogle Scholar
  • 44 Sharma S, Sankhyan N, Gulati S et al. Use of the modified Atkins diet for treatment of refractory childhood epilepsy: a randomized controlled trial. Epilepsia 2013; 54: 481-486
    CrossrefPubMedGoogle Scholar
  • 45 Nei M, Ngo L, Sirven JI et al. Ketogenic diet in adolescents and adults with epilepsy. Seizure 2014; 23: 439-442
    CrossrefPubMedGoogle Scholar
  • 46 Vining EP, Pyzik P, McGrogan J et al. Growth of children on the ketogenic diet. Dev Med Child Neurol 2002; 44: 796-802
    PubMedGoogle Scholar
  • 47 Patel A, Pyzik PL, Turner Z et al. Long-term outcomes of children treated with the ketogenic diet in the past. Epilepsia 2010; 51: 1277-1282
    CrossrefPubMedGoogle Scholar
  • 48 Chen W, Kossoff EH. Long-term follow-up of children treated with the modified Atkins diet. J Child Neurol 2012; 27: 754-758
    CrossrefPubMedGoogle Scholar
  • 49 Lambrechts DA, de Kinderen RJ, Vles HS et al. The MCT-ketogenic diet as a treatment option in refractory childhood epilepsy: A prospective study with 2-year follow-up. Epilepsy Behav 2015; 51: 261-266
    CrossrefPubMedGoogle Scholar
  • 50 Cervenka MC, Patton K, Eloyan A et al. The impact of the modified Atkins diet on lipid profiles in adults with epilepsy. Nutr Neurosci 2016; 19: 131-137
    CrossrefPubMedGoogle Scholar
  • 51 Bertoli S, Trentani C, Ferraris C et al. Long-term effects of a ketogenic diet on body composition and bone mineralization in GLUT-1 deficiency syndrome: a case series. Nutrition 2014; 30: 726-728
    CrossrefPubMedGoogle Scholar
  • 52 IJff DM, Kinderen RJ, Vader CI et al. Subjectively Perceived Side-Effects of Anti-Epileptic Drugs in Chronic Refractory Epilepsy. Adv Pharmacoepidemiol Drug Saf 2015; 4: 186
    PubMedGoogle Scholar
  • 53 Bergqvist AG, Chee CM, Lutchka L et al. Selenium deficiency associated with cardiomyopathy: a complication of the ketogenic diet. Epilepsia 2003; 44: 618-620
    CrossrefPubMedGoogle Scholar
  • 54 Nebeling LC, Lerner E. Implementing a ketogenic diet based on medium-chain triglyceride oil in pediatric patients with cancer. J Am Diet Assoc 1995; 95: 693-697
    CrossrefPubMedGoogle Scholar
  • 55 Nebeling LC, Miraldi F, Shurin SB et al. Effects of a ketogenic diet on tumor metabolism and nutritional status in pediatric oncology patients: two case reports. J Am Coll Nutr 1995; 14: 202-208
    CrossrefPubMedGoogle Scholar
  • 56 Bozzetti F, Cozzaglio L, Gavazzi C et al. Total nutritional manipulation in humans: report of a cancer patient. Clin Nutr 1996; 15: 207-209
    CrossrefPubMedGoogle Scholar
  • 57 Zuccoli G, Marcello N, Pisanello A et al. Metabolic management of glioblastoma multiforme using standard therapy together with a restricted ketogenic diet: Case Report. Nutr Metab (Lond) 2010; 7: 33
    CrossrefPubMedGoogle Scholar
  • 58 Raffaghello L, Safdie F, Bianchi G et al. Fasting and differential chemotherapy protection in patients. Cell Cycle 2010; 9: 4474-4476
    CrossrefPubMedGoogle Scholar
  • 59 Branca JJ, Pacini S, Ruggiero M. Effects of Pre-surgical Vitamin D Supplementation and Ketogenic Diet in a Patient with Recurrent Breast Cancer. Anticancer Res 2015; 35: 5525-5532
    PubMedGoogle Scholar
  • 60 Klement RJ, Sweeney RA. Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes 2016; 9: 143
    CrossrefPubMedGoogle Scholar
  • 61 Rossi-Fanelli F, Franchi F, Mulieri M et al. Effect of energy substrate manipulation on tumour cell proliferation in parenterally fed cancer patients. Clin Nutr 1991; 10: 228-232
    CrossrefPubMedGoogle Scholar
  • 62 Chu-Shore CJ, Thiele EA. Tumor growth in patients with tuberous sclerosis complex on the ketogenic diet. Brain Dev 2010; 32: 318-322
    CrossrefPubMedGoogle Scholar
  • 63 Schmidt M, Pfetzer N, Schwab M et al. Effects of a ketogenic diet on the quality of life in 16 patients with advanced cancer: A pilot trial. Nutr Metab (Lond) 2011; 8: 54
    CrossrefPubMedGoogle Scholar
  • 64 Fine EJ, Segal-Isaacson CJ, Feinman RD et al. Targeting insulin inhibition as a metabolic therapy in advanced cancer: a pilot safety and feasibility dietary trial in 10 patients. Nutrition 2012; 28: 1028-1035
    CrossrefPubMedGoogle Scholar
  • 65 Schroeder U, Himpe B, Pries R et al. Decline of lactate in tumor tissue after ketogenic diet: in vivo microdialysis study in patients with head and neck cancer. Nutr Cancer 2013; 65: 843-849
    CrossrefPubMedGoogle Scholar
  • 66 Rieger J, Bahr O, Maurer GD et al. ERGO: a pilot study of ketogenic diet in recurrent glioblastoma. Int J Oncol 2014; 44: 1843-1852
    CrossrefPubMedGoogle Scholar
  • 67 Champ CE, Palmer JD, Volek JS et al. Targeting metabolism with a ketogenic diet during the treatment of glioblastoma multiforme. J Neurooncol 2014; 117: 125-131
    CrossrefPubMedGoogle Scholar
  • 68 Jansen N, Walach H. The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: A case series in general practice. Oncol Lett 2016; 11: 584-589
    PubMedGoogle Scholar