PREFACE
The ketogenic diet has figuratively and literally entered adulthood.
From its earliest beginnings in the 1920s, the infancy of the ketogenic diet was full of the turmoil of youth. Widespread use, even popularity, was the hallmark of the classic ketogenic diet in the 1920s and 1930s. Article after article came out of the Mayo Clinic and other hospitals, each one adding more patients and demonstrating efficacy for epilepsy. The unbridled enthusiasm of youth, however, often meets reality in adolescence. As the diet became a “teenager” in the 1950s through 1980s, it was more of a radical, unproven idea struggling to find acceptance in a big world of pharmaceuticals. Adults (and adult neurologists) ignored it, leaving it to its own devices in several select centers.
Young adulthood has been kind to the ketogenic diet, and just as college life for a teenager raises awareness of new ideas, unique possibilities, and brand-new directions, the ketogenic diet had a rebirth in 1994 with The Charlie Foundation’s founding and the first edition of this book. Over the past 5 editions and 22 years, the ketogenic diet has finally gone from “voodoo” alternative medicine to respected, “nonpharmacologic” treatment for epilepsy. New ideas over the past two decades have included not just one but four dietary treatments, consideration for new-onset treatment instead of a last resort, and myriad different ways to start the diet. The emergence of powdered, premade ketogenic diet formulas have both revolutionized the use of this treatment for infants and those with feeding tubes, but using these powders as a baking mix have allowed for ketogenic foods to be created that are nearly indistinguishable from their carb-containing namesakes. As many neurologists familiar with the past 22 years of changes in the diet have said, “it’s not your parent’s ketogenic diet.”
We believe the use of dietary therapy has truly entered adulthood today. This 6th edition reflects where the field is going, and it’s an exciting future. For one, as evident in the title, the modified Atkins diet (often referred to as “MAD”) is now 13 years old and this “alternative” diet has found its niche for teens, adults, and some other interesting uses when an outpatient, less restrictive dietary option is needed. An entire section of this book is now devoted to the MAD. Drs. Elizabeth Neal and Heidi Pfeifer have additionally revised their excellent chapters from the 5th edition on the MCT diet and low glycemic index treatments, respectively.
Perhaps most notably, this edition has increased its focus on the use of dietary therapy for adults. A mainstream concept in the 1930s, only to lapse into obscurity for seven decades, the use of the MAD has led to a rebirth in using diets for patients over age 18 years. Reflecting this change, two of our new coauthors, Dr. Cervenka and Ms. Henry, coordinate the Johns Hopkins Adult Epilepsy Diet Center and have written the sections on diets and adults that comprise a large portion of this book.
In 2011, the 5th edition had a single, very brief, chapter on the concept of using diets for conditions other than epilepsy. Now the research and clinical use has caught up to the interest from many patients. At the 4th International Ketogenic Diet Symposium held in 2014 in Liverpool, a large number of lectures were focused on this topic. Now an entire section of this book is devoted to discussions of using various forms of the ketogenic diet for cancer, autism, migraines, and dementia, with excellent guest authors providing their expertise. One can only predict the 7th and 8th editions of this book will see this section expand greatly.
Lastly, as evident by all the countries represented at the Liverpool meeting (and languages spoken in hallways and poster sessions!), the diet has truly gone global. The International League Against Epilepsy has taken notice of the use of dietary therapy and commissioned a Task Force to help bring it to developing countries. Chapters of this book are devoted to the international use of the diet and this edition is the first to be translated officially into another language (Spanish). Just as students graduating college often travel abroad to expand their horizons, the ketogenic diet has increased its scope internationally and is better off for it.
Despite all of the new ideas and uses that have been achieved in the ketogenic diet’s adulthood, it is always wise to keep linked to its youth. This 6th edition is packed with chapters on epilepsy, tricks and tips to make the diet a success, and how to keep motivated when times get rough. One of the best ways to be successful is to have a great ketogenic diet team, and one of our star team members is our nurse practitioner Sarah Doerrer: she is also now a new coauthor. Never forget, however, that all dietary therapies must be done under the supervision of a neurologist and dietitian familiar with it. Just like any medical therapy, there are real risks involved.
We all hope you enjoy this book and it helps you appreciate just how far the diet has come in the past 100 years from infancy to middle age. It’s been an amazing “maturity” and the diet is only getting more popular, increasingly researched, and easier for patients to do. Best of luck to you, your child, or your loved one as you embark on your ketogenic diet journey!
(“Selfie” photo taken on the first day we started working on this edition!)
Zahava Turner, RD, CSP, LDN, Bobbie Henry, RD, LDN, Mackenzie Cervenka, MD, Sarah Doerrer, CPNP, Eric Kossoff, MD
(from left to right)