The acid alkaline balance
While the ketogenic diet is usually implemented with foods that are acid forming, there is no basis for thinking that acid forming foods contribute to the success of the diet. I have been able to devise an alkaline based diet for Roberta and I believe this modification may well be relevant for others.
I know that acidosis has always been my daughter's nemesis. And I know, too, that the acidosis of the ketogenic diet is described in the literature as disappearing after a few days (ie, acidosis is not what makes the ketogenic diet work), so I make a point of balancing her keto-meals as best I can. I think body sense tells us that we want to have more alkaline than acid in our meals.
If a child stops eating, it is a clear sign that there is metabolic overload. To us, that means too much acid - a build-up of organic acids. Please note that the acidity I'm discussing is not a ‘medical’ condition (ie, it is not picked up by any medical tests) and it is not extreme enough to be called "acidosis". But Roberta’s neurologist has seen with his own eyes that, when she is on an unmodified ketogenic diet, she does not have the complete seizure control that she has on an alkaline version of the diet. When she's not eating and you give her water with a little orange juice, that is restful to her overwrought metabolism and it is also alkaline (although orange juice is acidic, it metabolises to alkaline ash - as do all fruits except cranberries and plums (prunes).
As usual, my daughter was telling me what she needed. Just as she had always wanted fat, once on the diet she wanted coffee with every meal. Caffeine is not recommended for seizure patients, so I kept saying no even to decaf until I learned that coffee (presumably decaf also) burns in the body to an alkaline ash. I think we all tend to balance our meals in this way. For example, if you were having bacon and eggs for breakfast, wouldn't you find orange juice and coffee to be complementary? If you know that bacon and eggs are acid forming and orange juice and coffee are alkaline forming, you start to get a sense of this macrobiotic concept.
Correcting acidosis will not take anyone out of ketosis. If you read the Freeman/Kelly book carefully, it specifically states that acidosis is not the magic bullet, since the body corrects acidosis in short order. Roberta was released from the hospital with a prescription for polycitra, a formulation to alkalinise the body. I'm afraid to give it to her because it has orange colouring in it; but I continue to work diligently on alkalinising her meals - egg whites instead of whole eggs, almonds, low carbohydrate veggies with every meal etc.
A critical degree of acidosis - the state of too much acid in the blood (acidemia) or urine (acidurea) - chews up body tissue. Perhaps this is why depakote and the diet have a dangerous potential in combination - if it's true that depakote can induce acidosis, (which is what I've been thinking), then the diet and depakote constitute a double whammy. We know depakote can cause a reading on the ketostix. We know from the PDR that depakote can cause hyperammonemia (too much alkaline, ie, the opposite state). I know acid and ammonia are a dangerous mixture.
GLA is an omega-6 essential fatty acid that has an important role in prostaglandin regulation. Omega-6s have to be in balance with omega-3s (eg fish oils and flaxseed oil). If you're supplementing with essential fatty acid's, you might want to try experimenting with both - always using conservative amounts. Remember, also, that they are acids. My own experience is to beware of too many acid elements in a diet that is already skewed in that direction. Acidosis seems to be the trigger of my daughter's seizures. In her case, high ketone readings correlate with acidosis. So, for us, dark readings have to be avoided like the plague.
Can there be production of too many ketones? Does it make sense to talk about being "overly ketotic"? Individuals on the ketogenic diet are supposed to be ketotic not acidotic.
continue to Practical
aspects of Roberta's diet
return to Roberta's diet
(update 1.3: 18 July 2002)
(issue : 26 March 1998)