Ketogenic diet (KD),  a proven treatment for epilepsy, is of interest in mitochondrial and peroxisomal (cellular energy) research. Fat provides up to 90% of calories in KD, yet there is no scientific consensus as to how fatty acids (the constituents of fat) might be exploited to improve efficacy. The composition of fatty acids in cow’s milk closely resembles that of human milk, which meets the exceptional energy demands of infant brain. Fatty acids from the non-dairy portion of ASEK diet (notably arachidonic acid), combined with dairy fatty acids, approximate the fatty acid composition of human milk. Eighteen years learning to manage my daughter Roberta’s KD treatment for epilepsy and autism, have taught me that fatty acid composition is key to her success. 

Roberta’s ASEK menus are free of additives, gluten, starches, casein, and milk sugars. Proportions of potassium to sodium chloride, magnesium to calcium, oxidants to anti-oxidants, are the ratios inherent in the nutrient-dense organic foods she consumes daily: 2 eggs, 3 oz. meat, 3 oz. fish; 3 oz. ghee (clarified butter), 5 oz. 40% dairy cream and crème fraiche, 6 cups varied low carbohydrate green vegetables (3 cups raw, 3 cups cooked = 9 servings by Mayo Clinic definition); 1 lemon or lime (juice and pulp); 6 almonds, 6 walnut pieces; 6 teaspoons “gomasio” seasoning (sesame seeds, sea weed and sea salt), divided among 3 evenly spaced meals approximately equal in calories.

Ketone bodies are produced not only from fat but also amino acids (the building blocks of protein), some of which are ketogenic (generating ketone bodies, as well as alpha-keto acids that fuel the liver), others glucogenic (generating glucose). For the same caloric intake, increasing protein and lowering fat decreases the classic 4:1 and 3:1 KD ratios of fat to combined protein and carbohydrate. Lowering fat reduces ketone body production and its associated burden of acidosis.  There is metabolic inefficiency in the production of high levels of ketone bodies that “burn up” the Krebs energy cycle without replenishing it. Moreover, the greater the levels of ketone bodies in blood and urine, the greater is the risk of adverse effects.

Connections between nerve cells depend on the structural integrity of phospholipid (fat) membranes which require specific fatty acids. ASEK diet’s fatty acid and nutritional composition, promotion of euketonemia: neither too many ketone bodies (hyperketonemia) nor too few (hypoketonemia), and acid-base homeostasis, constitute a unique bioenergetic therapy. Setting aside how KD might come to be applied in the treatment of major diseases, at stake world-wide is the well-being of an estimated one billion sufferers from neurological disorders alone.

Roberta’s ASEK diet supports homeostasis by uninterrupted maintenance of low/normal glucose levels: 80mg/dL (4.4 mM/L) – 100mg/dL (5.6 mM/L); euketonemia defined as urinary acetoacetate levels fluctuating between trace and moderate, and moderate beta-hydroxybuterate blood level ~16.9mg/dL (~1.6 mM/L); and prevention of acid-base imbalance induced by the obligatory potassium loss that accompanies the excretion of ketones. Despite a neuronal migration disorder (SBH), mild lissencephaly, and Lennox Gastaut Syndrome, Roberta celebrated her 45th birthday seizure-controlled for 10 years, healthy, happy, and steadily overcoming developmental delays. The homeostasis achieved by her dietary, medical, and lifestyle protocols precludes break-through seizure activity.

The ASEK website is lovingly dedicated to my keto-teacher Millicent Teague Kelly who is enjoying retirement after nearly five decades of medical dietary practice. Milly hand-calculated for her patients ketogenic menus based on a preponderant and fixed amount of dairy fat.

Isabel Walcutt (isabel.walcutt@gmail.com)