Weaning off the Ketogenic Diets - how to increase carbs??

ChrisP123

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TL;DR So, has anyone stopped a ketogenic or MAD or LGIT or other diet before? And when and how did they introduce carbs back in??

Hi everyone,

I was on a classical ketogenic diet (went up to a 3:1 ratio, limiting carbohydrates to <10g/day) for the past 4 or so months, but in the last 1-2 months it reduced in efficacy and seizures were getting worse so I thought being on the diet wasn't worth it anymore.

I had read Prof. Kossoff's book The Modified Atkins and Ketogenic Diet - treatments for epilepsy.
The book suggests for a Modified Atkins Diet, you increase the carbs by 5g every 3 days until you reach 85g then you're off the diet and can eat a normal diet.
However, for a classical ketogenic diet (which I was on), it just says reduce the ratio from say 3:1 to 2:1 to 1:1 every 1-2 weeks, then you're off the diet - I'm not sure if that's it or if it's just not clear about increasing carbs and when to start a normal diet!

I'm currently down to a 1:1 ratio and have been for the past 5 days - which have increased the frequency and depth of my (focal) seizures a lot and dropped my urine ketones. But I don't know how to increase the carbs!! If even decreasing the diet ratio from 1.5:1 to 1:1 has made the seizure control this much worse, I don't see how I can just suddenly go from this (which is still less than 10g carbs/day) to eating a normal diet with lots more carbs!
(Also, I was aiming to stay on 1:1 for the full 2 weeks before getting off it to get my brain used to less fat and ketones - but surely this many episodes can't be good for my brain?)

TL;DR So, has anyone stopped a ketogenic or MAD or LGIT or other diet before? And when and how did they introduce carbs back in? Many thanks in advance - really appreciate any advice anyone can give! šŸ˜Š

- Chris šŸ™‚
 

Nakamova

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Hi Chris -- Any chance you could work with a registered dietician or nutritionist to handle the keto-taper? A specialist could help with the type of carbs. (And having neurologist on board wouldn't hurt). I suspect that, as with meds, it's okay to taper at a slower rate than the 5g/every three days (recommended in this study https://www.epilepsybehavior.com/article/S1525-5050(16)00112-8/fulltext for both MAD and classic keto taper), but an experienced professional could provide guidance on what makes sense in your case.
 

ChrisP123

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Hi Chris -- Any chance you could work with a registered dietician or nutritionist to handle the keto-taper? A specialist could help with the type of carbs. (And having neurologist on board wouldn't hurt). I suspect that, as with meds, it's okay to taper at a slower rate than the 5g/every three days (recommended in this study https://www.epilepsybehavior.com/article/S1525-5050(16)00112-8/fulltext for both MAD and classic keto taper), but an experienced professional could provide guidance on what makes sense in your case.
Thanks Nakamova,

I have a specialist neurologist, but he doesn't know much about the diets and the only dieticians who deal with it are paediatric ones as it is very labour intensive, and they won't/can't see adults.
 

Nakamova

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That's frustrating. Are you on any seizure meds? If so, perhaps you could increase the med slowly while tapering down on the diet.
 
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