Acute Changes in Liver Function Tests During Initiation of Ketogenic Diet

Area of Science:

• Neurology
• Gastroenterology
• Dietary Therapy

Background:

• The ketogenic diet is a recognized treatment for drug-resistant epilepsy.
• While generally safe, potential side effects include gastrointestinal issues and, rarely, long-term hepatic toxicity.
• Limited evidence exists regarding the ketogenic diet's role in acute liver injury.

Purpose of the Study:

• To investigate the occurrence and patterns of acute liver function test abnormalities during ketogenic diet initiation.
• To assess the impact of ketogenic diet on liver function in patients with medically refractory epilepsy.

Main Methods:

• Retrospective analysis of 25 patients undergoing inpatient ketogenic diet initiation from June 2019 to June 2022.
• Monitoring of liver function tests (LFTs) for hepatocellular and cholestatic patterns.
• Evaluation of interventions such as diet cessation, medication adjustments, or choline supplementation.

Main Results:

• Six out of 25 patients (24%) exhibited acute, asymptomatic LFT changes during diet initiation.
• These changes presented in both hepatocellular and cholestatic patterns.
• Two patients discontinued the diet, while three continued with medication adjustments or choline; all showed short-term LFT normalization. One patient experienced normalization of pre-existing elevated LFTs.

Conclusions:

• Ketogenic diet initiation can lead to acute, asymptomatic liver function test abnormalities, including both hepatocellular and cholestatic patterns.
• These changes can occur independently of concurrent hepatotoxic medications.
• The ketogenic diet can often be continued safely with appropriate management, such as medication modification or choline supplementation.