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 endocrine and metabolic factors requires that a continuous ingestion of a diet high in lipid calories is necessary to achieve such a state and yet maintain body weight. The resulting condition provides for much of the cerebral energy requirements in the form of ketone bodies. We review energy metabolism with special emphasis on fatty acid oxidation to provide the readers with a foundation that facilitates identification of patients who will especially benefit from this diet, as well as to assist clinicians in screening candidates who may experience a catastrophic outcome if fasted and placed on this diet. The review includes a discussion of the role of carnitine in mitochondrial fatty acid metabolism, and the criteria for carnitine supplementation. Only limited information is available regarding the interaction of the diet with the commonly used antiepileptic drugs.