Metabolic and endocrine aspects of the ketogenic diet

The ketogenic diet (KD) is designed to simulate the biochemical effects of fasting by maintaining a state of ketosis. The complex interplay of endocri ne and metabolic factors requires that a continuous ingestion of a diet hig h in lipid calories is necessary to achieve such a state and yet maintain b ody weight. The resulting condition provides for much of the cerebral energ y requirements in the form of ketone bodies. We review energy metabolism wi th special emphasis on fatty acid oxidation to provide the readers with a f oundation that facilitates identification of patients who will especially b enefit from this diet, as well as to assist clinicians in screening candida tes who may experience a catastrophic outcome if fasted and placed on this diet. The review includes a discussion of the role of carnitine in mitochon drial fatty acid metabolism, and the criteria for carnitine supplementation . Only limited information is available regarding the interaction of the di et with the commonly used antiepileptic drugs. (C) 1999 Elsevier Science B. V. All rights reserved.