1. Pre-Initiation Caregiver Training
Pediatric Neurology: Paul R. Carney, MD
Zhao Liu, MD, PhD
Edgard Andrade, MD
Pediatric Gastroenterology (GI):
Joel Andres, MD
Christopher Jolley, MD
Research Coordinators: Peggy R. Borum, PhD
Lauren L. Jones, PhD

2. Overview of KT Fasting was recognized as a way to control seizures.
Seizures would return once a normal diet was resumed.
In 1921 KT was born.
Although the therapy helps many children, we do not know how it works.

3. Ketogenic Therapy (KT)
High fat, low carbohydrate, adequate protein diet
Ketogenic Ratio = Fat : protein + carbohydrate
Forces the body to utilize fat (in the form of ketones) rather than carbohydrates as the main source of energy
Ketones are a byproduct of fatty acid metabolism
For every 4 grams of fat you have 1 gram of pro +

4. Ketogenic Therapy (KT)
Neurological treatment
not a diet for weight control
Similar to your other therapies for seizures
such as antiepileptic drugs (AEDs)
All changes that are made must be cleared by the research team and your clinical providers
For these reasons, we do not call it the Ketogenic Diet

5. Ketogenic Therapy (KT)
KetoBuddy
Support network
Improve your child’s care
Research the mechanism of KT
Weekly contact
Data collection
Create and make meals
Resource to assist you with all your child’s needs
We DO NOT change medications or provide any medical advice.
As your child’s KetoBuddy we are here to provide a support network for your family, gather information about your child, attend clinic visits, and notify the clinic staff of any non-urgent issues to be addressed
If you have a medical emergency, contact your clinical providers.
Research the mechanism of the diet to improve therapy

6. UF Ketogenic Therapy Research Program
KetoBuddy support system
More frequent monitoring of your child’s overall health
More labs
More measurements
Metabolic cart
Daily records
Monitor the progress and personalize your child’s therapy
Patient visits are at Shands in the GCRC
All research procedures are done free of charge
Inpatient visits at the GCRC are free of charge
Research procedures include blood draws, metabolic cart. The EEG is a standard of care so your insurance will be billed for that. The stay at the GCRC is covered if you have to stay over night.

7. Qualifications for Ketogenic Therapy
Typically (but not exclusively) used for children
If AEDs or other therapies are ineffective or produce undesirable side effects
If a surgical procedure is not an option
Intended for patients without fatty acid oxidation disorders
we screen for fatty acid oxidation disorder prior to your child’s initiation onto KT.

8. Before Initiation Food Preferences Questionnaire
In order to help your child adjust into a state of ketosis easier, the weekend before:
Limit simple sugars and starches
Drink sugar-free or unsweetened liquids
Night before Initiation:
Overnight fast for at least 8 hours
Allowed to have water and medications

9. Initiation
Day 1-2
Start on a 1.5:1 ratio of fat : protein + carbohydrate
Ratio increases by 0.5 every 1-2 meals
Day 3
Usually discharge between a 3:1 to 4:1 ratio
Procedure is subject to change depending on how your child tolerates the ratio
Meal schedule is also dependent on what your child usually eats

10. What to Bring to Initiation
Caregivers Guide
Foods/drink for Initiation that you and your KetoBuddy discussed
Daily home records of seizures
Multistix 10 SG
Food Scale
All medications and supplements in their original bottles
Videos, DVD player and DVDs, favorite toys, coloring books…something to keep your child occupied and feel more at home

11. What will be provided at Initiation
A mini fridge, microwave, and kitchen supplies
One caregiver will be provided with meals during their GCRC stay
Wireless internet access is available if you wish to bring your laptop

12. What to expect the first few weeks after Initiation
Adjustment period may include
Lethargy
Nausea/Vomiting
Hunger
Record keeping