The ketogenic diet (KD) is a specialized high-fat, low-carbohydrate diet primarily used to manage epilepsy, particularly in children. It was initially developed in 1923 by Dr. Russell Wilder at the Mayo Clinic. The diet aims to shift the body's metabolism from primarily using glucose for energy to using ketones, which are produced from fat breakdown. This metabolic shift can reduce the frequency of seizures in some individuals with epilepsy.
Types of Ketogenic Diets for Epilepsy
Several variations of the ketogenic diet are used to treat epilepsy, each with different macronutrient ratios and restrictions:
Classic Ketogenic Diet (KD): This is the most restrictive version, traditionally initiated with a 24-hour fast and a short inpatient hospital stay for monitoring. Food and drink are precisely weighed and measured. The classic KD involves 70 to 90 percent of a child’s calories being provided by fat, compared to the 25 to 40 percent that is usually recommended for children. The amount of fat is determined by the ketogenic ratio, which is the ratio of grams of fat to grams of carbohydrate plus protein. A dietitian calculates the patient’s meal ratio and educates the patient or caregivers on maintaining the diet.
Medium-Chain Triglyceride (MCT) Diet: This diet uses a ketogenic ratio of 1.9:1 (1.9 grams of fat for every gram of protein and carbohydrate). It relies on medium-chain triglycerides (MCTs), which are fats derived from coconut and palm oils. MCTs are more efficiently digested and produce more ketones than long-chain triglycerides (LCTs). About 60% of calories come from MCT oil or supplements, alongside traditional fats, protein, and carbohydrates. The MCT diet is typically started in a hospital under medical supervision. Due to potential stomach issues, the dietician may recommend starting with a lower MCT percentage (40-50%) before adjusting up or down.
Modified Atkins Diet (MAD): A less restrictive approach, the MAD is a blend of the classic KD and the Atkins Diet. It typically follows a 1:1 ratio (one gram of fat for every gram of protein and carbohydrate). Caloric intake is composed of approximately 65% fat, 25% protein, and 10% carbohydrates. Unlike the classic KD, there are no restrictions on liquids, calories, or protein, but carbohydrate intake is limited. The modified Atkins diet is more flexible than the classic ketogenic diet and may be easier to incorporate into normal life.
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Low Glycemic Index Treatment (LGIT): This diet emphasizes complex carbohydrates with a low glycemic index (GI). The glycemic index measures how much a food raises blood sugar levels. LGIT involves consuming foods with a GI less than 50, such as unprocessed whole grains, meats, dairy, some fruits, and vegetables. A typical LGIT macronutrient breakdown is 60% fat, 20-30% protein, and 10% carbohydrate. There are no restrictions on fat and protein intake, and LGIT allows for a larger carbohydrate intake; however, these carbohydrates must have a GI of less than 50.
Recipes for the Ketogenic Diet
Note: The following recipes are designed for patients under the care of medical professionals familiar with ketogenic diet protocols. Always consult with your medical team before making dietary changes.
Recipes Designed for Classic Ketogenic Diet
- Apple Cobbler
- Avocado Brownies
- Birthday Cupcake
- Blueberry Yogurt Bunnies
- Caramel Pecan Tarts
- Carrot Cake Cookies
- Cheesecake
- Chocolate Brownie
- Chocolate Chip Cookies
- Chocolate Chunk Cookies
- Chocolate Nut Fudge
- Chocolate Peanut Butter Cups
- Chocolate Pudding
- Churros
- Cinnamon Graham KetoBar
- Cinnamon Pecan Cookies
- Cinnamon Rolls
- Coconut and Peanut Butter Candies
- Creamy Jell-O®
- Creme Brulee
- Cupcakes with Chocolate Buttercream Frosting
- Festive Jell-O Cup
- Frozen Fruity Cream Cheese Treats
- Fudge Brownie
- Gummy Bears
- Iced Pumpkin Cake
- Ice Cream Cone
- Jell-O Parfait®
- Key Lime Pie
- Lemon Almond Cake
- Marshmallows
- Marshmallow Cereal Treat
- Nut Bars
- Orange Creamsicle Ice Cream
- Peanut Butter Cookies
- Pumpkin Fudge Pops
- Pumpkin Pecan Cheesecake
- Raspberry Meringue
- Snickerdoodle Cookie
- Strawberry Chocolate Ice Cream
- Strawberry Coconut Ice Cream
- Strawberry Shortcake
- Strawberry Sunflower Bar
- Strawberry Valentines
- Sugar Cookies
- Vanilla Cream Cakes
- Vanilla Ice Cream
- Watermelon Sorbet
- Whoopie Pie
Recipes Designed for Modified Ketogenic Diet (MKD)
Note: These recipes should only be followed if specifically prescribed by your medical team.
- Birthday Cupcake
- Broccoli Cheddar Discs
- Cauliflower Parmesan Sticks
- Cheese Pizza
- Chicken Bites
- Chocolate Glazed Donuts
- Oatmeal & Raspberries
- Waffles
Helpful Tips and Tricks for Ketogenic Cooking
- Fat Hiding Tricks:
- Combine weighed heavy cream and mayonnaise with weighed raw eggs, cook the mixture in a pan to form fluffy scrambled eggs.
- Add weighed canola oil to weighed yogurt; the oil will completely absorb and blend into the yogurt.
- Mix weighed room temperature butter into weighed creamy peanut butter. This not only helps hide fat, but also increases the volume of the spread.
- Add weighed canola oil into weighed liquid heavy cream. Use a milk frother (used to make cappuccinos) to emulsify the two together perfectly. Can be served as a drink!
- Cooking Tips:
- When weighing your ketogenic ingredients in one bowl, always start with the dry ingredients. Try to form small mounds of the dry ingredients while weighing to allow for easy removal if the weight goes over.
- The liquid ingredients (heavy cream, oil, etc.) should be weighed in a separate bowl individually. The reason for this is because if you weigh two liquids together and go over on the weight, you will not be able to safely remove the one liquid due to them mixing together.
- Always be sure to use nonstick cooking spray (any brand). Ketogenic foods tend to stick more than regular foods due to their high fat content. It’s important that no food residue is left behind on any cookware to avoid losing nutritional value.
- Dry seasonings can be used on the ketogenic diet as a “free” ingredient (single dry seasonings only, not pre-packaged mixes). In large quantities, fat tends to mask the natural flavors of foods that we know and love, therefore we encourage you to season the foods with dry seasonings to make them tasty and enjoyable. Especially salt!
- Ketogenic foods generally freeze very well, however the reheating process can be tricky. When reheating foods, the fats always tend to melt first, which is the main component for ketogenic foods. The best way to reheat keto foods is in the oven or on the stove top.
- When baking ketogenic foods, never fill molds all the way to the top (¾ full is ideal). During the baking process, the heat may make the fat separate from the recipe, creating a pool of fat on the top. If the recipe is filled all the way to the top, the melted fat will go over the edge and result in loss of nutritional value.
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