A diet high in fat and low in carbohydrates (sugars) that causes the body to break down fat into molecules called ketones. Ketones circulate in the blood and become the main source of energy for many cells in the body. A ketogenic diet is used to treat some types of epilepsy and is being studied in the treatment of some types of cancer.

Carbohydrate is one of three macronutrients in food that provide calories, or “energy,” for the body. Each gram of carbohydrate provides 4 calories.

What It Is

Carbohydrate is found primarily in plant foods; the exception is dairy products, which contain milk sugar (lactose). There are several types of carbohydrate:

• Sugars are the smallest type of carbohydrate and include single sugars and those with two sugar molecules joined together.
• Sugar alcohols are carbohydrates that chemically have characteristics of both sugars and alcohols.
• Starches are made up of many of glucose molecules linked together into long chains.
• Dietary fiber is made up of many sugar molecules linked together. But unlike starches, fiber is bound together in such a way that it cannot be readily digested. There are two types of dietary fiber: soluble and insoluble.

Where It Is Found

• Sugars are found naturally in foods such as dairy products, fruits, and vegetables. Sugars are also added to foods and beverages for taste, texture and preservation, and are often found in foods such as grain-based and dairy desserts, sugar-sweetened beverages, and sweets.
• Sugar alcohols are found naturally in small amounts in a variety of fruits and vegetables. Sugar alcohols are also commercially produced from sugars and starch and added as reduced-calorie sweeteners to foods, such as chewing gum, frostings, grain-based and dairy desserts, and sweets.
• Starches are found naturally in beans and peas (such as garbanzo beans, kidney beans, lentils, and split peas), grains (such as barley, brown rice, corn, oats, and wheat), and vegetables (such as carrots and potatoes). Starches can also be added to foods during processing or preparation to thicken or stabilize them.
• Dietary fiber is found in beans and peas, fruits, nuts and seeds, vegetables, and whole grain foods (such as brown rice and whole grain breads, cereals, pasta).

What It Does

• Sugars and starches are the body’s main sources of calories. Your body breaks down these carbohydrates into glucose. Glucose in the blood (often referred to as “blood sugar”) is the primary energy source for the body. Sugars are also used to sweeten, preserve, and improve the functional attributes of food.
• Sugar alcohols provide a sweet taste with fewer calories per gram than table sugar (sucrose), and are commonly used in place of sugar in food. Sugar alcohols also have other functions in food, including producing a “cooling” sensation in the mouth, adding bulk and texture to food, and helping to retain moisture and prevent browning.
• Dietary fiber promotes intestinal regularity and helps prevents constipation. Fiber also makes you feel full, slows digestion and the rate at which carbohydrates and other nutrients are absorbed into the bloodstream, and can interfere with the absorption of dietary fat and cholesterol.

Health Facts

• Most Americans exceed the recommended limits for added sugars and do not get the recommended amounts of dietary fiber in the diet.
• Diets lower in added sugars and higher in dietary fiber and nutrient-dense* foods and beverages can reduce the risk of cardiovascular disease.
• The Dietary Guidelines for Americans recommends consuming less than 10% of calories per day from added sugars and at least half of total grains as whole grains, and limiting the intake of refined grains and products made with refined grains.

*Nutrient-Dense: Defined Nutrient-dense foods and beverages contain vitamins, minerals, dietary fiber, and other beneficial substances that may have positive health effects. They are also naturally lean or low in saturated fat and have little or no added saturated fat, sugars, refined starches, and sodium. Examples of nutrient dense foods are: beans and peas, eggs, fat-free (skim) and low-fat (1%) dairy products, fruits, lean meats and poultry, seafood, unsalted nuts and seeds, vegetables, and whole grains.

Action Steps For Monitoring Total Carbohydrate in Your Diet

Use the Nutrition Facts Label as your tool for monitoring consumption of total carbohydrate. The Nutrition Facts Label on food and beverage packages shows the amount in grams (g) of total carbohydrate and the Percent Daily Value (%DV) of total carbohydrate in one serving of the food.

The Nutrition Facts Label also lists the types of carbohydrate that make up the total carbohydrate in a product. This includes the amount in grams (g) per serving of dietary fiber and sugars and the %DV of dietary fiber. Food manufacturers may also voluntarily list the amount in grams (g) per serving of soluble and/or insoluble fiber, sugar alcohols, and “other carbohydrate.” “Other carbohydrate” generally reflects the amount of starch in a product and is defined as the difference between total carbohydrate and the sum of dietary fiber, sugars, and sugar alcohols.

The Daily Value for total carbohydrate is 300 g per day. This is based on a 2,000 calorie diet — your Daily Value may be higher or lower depending on your calorie needs.

• When comparing foods, look at the %DV of total carbohydrate. The goal is to get 100% of the Daily Value for total carbohydrate on most days. And remember:
  • 5% DV or less of total carbohydrate per serving is low
  • 20% DV or more of total carbohydrate per serving is high
• Focus on eating nutrient-dense foods that contain dietary fiber combined with other beneficial nutrients and naturally occurring sugars.
• Switch from refined to whole grain versions of commonly consumed foods (such as breads, cereals, pasta, and rice), and try to make them at least half of your daily grain choices. Try options that don’t include added saturated fats, sugars, or sodium, such as bread instead of croissants, English muffins instead of biscuits, and plain popcorn instead of buttered.
• Choose fruit (fresh, frozen, dried, or canned in 100% natural juice) as snacks, salads, or desserts.
• Keep raw, cut-up vegetables handy for quick snacks – choose colorful dark green, orange, and red vegetables, such as broccoli florets, carrots, and red peppers.

You’ve probably heard of glycemic index and glycemic load. Some studies suggest that sticking to foods with a low glycemic index may help prevent diabetes, cardiovascular disease and cancer. Some claim it helps with weight loss. The truth is, we don’t know all the answers yet. Here’s what you need to know.

The glycemic index and load concern carbohydrates, or carbs—one of the main types of nutrients in our diets. Carbs with a simple chemical structure are called sugars. Sugars are found naturally in foods like fruits, vegetables and milk products. They’re also added to many foods and drinks. Complex carbs, like starches and fiber, are found in whole-grain breads and cereals, starchy vegetables and legumes.

Your digestive system changes the carbs you eat into glucose, a type of sugar that your body uses for energy. Simple carbs are more quickly digested and absorbed than complex ones, so simple carbs can raise your blood glucose levels faster and higher.

People with diabetes need to manage their blood glucose levels. High blood glucose can damage tissues and organs. In time, it can lead to heart disease, blindness, kidney failure and other problems. If you have diabetes, controlling your blood glucose will prevent or delay these health complications. So it’s important to understand how foods and drinks affect your blood sugar.

“The evidence seems to support the concept that the more complex carbohydrates will lead to better blood sugar control than the more simple sugars,” says Dr. Myrlene Staten, an NIH diabetes expert.

Researchers developed the glycemic index to measure the quality of carbs in foods. It shows how the carbs in different foods raise blood sugar. White rice, for example, has a higher glycemic index than brown rice, which has more complex carbs.

But it’s not just the types of carbs that matter. The more carbs you eat, the more your blood sugar rises. “The glycemic index really doesn’t take into consideration how much you eat,” explains Dr. Somdat Mahabir, who studies cancer risk at NIH.

That’s why researchers came up with the concept of glycemic load. It captures both the types of carbs in a food and the amount of carbs in a serving. Essentially, it shows how a portion of food affects your blood sugar. Many things affect the glycemic load, including food processing, how ripe a fruit is, how a food is prepared and how long it’s been stored.

Studies of people who use these concepts to guide their diets have found mixed results. “There’s evidence to show that glycemic index and glycemic load are not associated with body weight,” says Dr. Catherine Loria, an NIH expert on nutrition and heart health. “There’s really not enough evidence to show if glycemic index is related to heart disease.” A possible link to cancer is also being explored.

Glycemic index and glycemic load aren’t things you’ll see on a label, so they’re not easy to use. But labels do show helpful information: calories, total carbohydrates, sugars and fiber.

“It makes sense for everybody, not only diabetics, to eat the more complex carbohydrates because they will be more gradually absorbed, and blood sugar highs and lows will be smaller,” Staten says. Whole foods with complex carbs will give you more minerals and vitamins, too, and are usually good sources of fiber.

Choose More Complex Carbs

• Choose cereals high in fiber (5 or more grams per serving).
• Switch to whole grains. Look for whole-grain bread, whole-wheat pasta, brown or wild rice, barley, quinoa and bulgur.
• Eat more fresh fruits and vegetables and drink less juice.
• Don’t forget legumes. Try different kinds of beans and lentils.
• Snack on fruit and small portions of nuts and seeds. Limit candy and other junk food.

A high-fat, very low carbohydrate ketogenic diet is an age-old treatment for medication resistant epilepsies and there has been a renewed interest in recent years in how it works. The diet effectively reduces seizures for some people, especially children with certain forms of epilepsy. Studies have shown that more than 50 percent of people who try the ketogenic diet have a greater than 50 percent improvement in seizure control and 10 percent experience seizure freedom. However, for some people, the regimen is difficult to maintain.

Researchers are trying to learn exactly how the ketogenic diet prevents seizures. They hope to find ways to mimic its seizure-blocking effects without the dietary restrictions. Studies have advanced the understanding of the connection between energy metabolism and neuronal excitability, and in the process and may contribute to a better understanding of how the ketogenic diet promotes seizure control.

In addition, researchers are looking at modified versions of and alternatives to the ketogenic diet. For example, studies show promising results for a modified Atkins diet and for a low-glycemicindex diet, both of which are less restrictive and easier to follow than the ketogenic diet. However, well-controlled randomized controlled trials have yet to assess the approaches, and many questions remain about the optimal circumstances of their use.

Researchers are trying to learn exactly how the ketogenic diet prevents seizures. They hope to find ways to mimic its seizure-blocking effects without the dietary restrictions. Studies have advanced the understanding of the connection between energy metabolism and neuronal excitability.

Treating infantile spasms

Getting the seizures to stop and the EEG to improve is the goal of treatment (hypsarrhythmia should stop). 

The first-line of treatment uses hormones (like adrenocorticotrophic hormone [ACTH] or prednisolone) or the anti-seizure drug vigabatrin. These treatments are very effective, but they have serious side effects. Parents and caregivers should discuss these treatments with a pediatric neurologist (a doctor who specializes in children's nervous system).  

In some children, brain lesions cause the spasms. IS may decrease if these lesions are removed by surgery. 

When standard treatments do not improve IS, doctors may suggest other options like the ketogenic diet and anti-seizure drugs. 

It is very important for treatment to start as soon as possible. If spams (and hypsarrhythmia) continue, they can have negative effects on the development of a child's brain.

No cause can be found in 30 to 35 percent of individuals and Lennox-Gastaut syndrome can be very difficult to treat. A combination of seizure medications and other treatments may be used to improve seizure control and other associated conditions.

The medication valproate is generally considered a first-line therapy for various seizure types. Other anticonvulsant medications may include clobazam, felbamate, lamotrigine, rufinamide, topiramate, and cannabidiol. The U.S. Food and Drug Administration (FDA) approved cannabidiol (Epidolex, derived from marijuana) for the treatment of seizures associated with Lennox-Gastaut syndrome in individuals ages 2 and older. The drug contains only small amount of the psychoactive element in marijuana and does not induce euphoria associated with the drug.

Other treatment options include:

• Dietary therapy with the ketogenic diet
• Vagus nerve stimulation
• Epilepsy surgery (typically a corpus callostomy, which involves severing the band of nerve fibers that connect the two halves of the brain to prevent seizures from spreading)

Medication may be combined with the other treatments to optimize seizure control. Children who improve initially may later show tolerance to a drug or have uncontrollable seizures.

The prognosis for individuals with Lennox-Gastaut syndrome varies. There is no cure for the disorder. Complete recovery, including freedom from seizures, is very rare.

Most cases of Dravet syndrome are caused by mutation in the SCN1A gene, which is required for the proper function of brain cells. Dravet syndrome is a lifelong condition.

Seizures in Dravet syndrome are difficult to control but can be reduced by anticonvulsant drugs. Some anticonvulsant medications (such as oxcarbazepine, carbamazepine, phenytoin, and lamotrigine) should not be used on a daily basis as they may make seizures worse. A ketogenic diet, high in fats and low in carbohydrates, also may be helpful.

The U.S. Food and Drug Administration (FDA) approved the drugs fenfluramine and cannabidiol to treat seizures with Dravet syndrome in people ages 2 and older.