Dietary therapies

Question 1

How does MCT diet differ from Ketogenic diet? (4)

Answer 1

• Uses MCT oil as a source of medium-chain fatty acids
• More easily absorbed than Long-chain fatty acid (KDT)
• More easily delivered to liver than LCFA
• Thus allows greater consumption of protein and carbohydrates

Question 2

Calories obtained from Fat in:
- Keto Diet
- MCT Diet
- MAD
- LGIT Diet

Answer 2

• Keto diet: 90%
• MCT diet: 60-70%
• MAD: 60-65% (30% protein)
• LGIT diet 60% (20-30% protein)

Question 3

Downside of MCT diet

Answer 3

more GI side effects from MCT oil (i.e. diarrhea, vomiting, abdominal pain)

Question 4

Contraindications for Dietary therapy

Answer 4

• Disorders of fatty acid metabolism

Question 5

Conditions in which KDT Is Treatment Of Choice

Answer 5

• Glucose transporter deficiency (glucose can’t be transported across BBB)
• Pyruvate dehydrogenaze deficiency (pyruvate cannot be metabolized into acetyl-CoA)

Question 6

Duration of dietary therapy
- Time to give therapy to see results
- consider discontinuation after___.

Answer 6

• “give it a chance” time: 3 months
• consider discontinuation after 2 years

Question 7

Short-Term complications of Ketogenic diet (4)

Answer 7

Short term
- vomiting
- dehydration
- hypoglycemia
- acidosis

Question 8

Recommend surveillance testing for KDT
- how often?
- blood (12)
- Urine (3)

Answer 8

Every 3 months:
Labs
- Fasting lipids
- BMP
- HFP
- Calcium
- magnesium
- phosphorous
- CBC
- Free and total Carnitine
- Zinc
- Selenium
- Vitamin D
-Beta hydroxy butyrate
Urine
- Urinalysis
- Urine calcium
- Creatinine

Question 9

Add-on testing for longer term Dietary therapies (i.e. > 2 years) or high risk patients

Answer 9

Consider DEXA scan