“First
Do No Harm,” a film directed by Jim Abrahams, based on real-life
events, relates to the successful treatment of one boy’s severe case of
epilepsy using a ketogenic diet
Children
suffering from epilepsy often remain seizure free after discontinuing a
ketogenic diet, and many eventually are able to resume a normal diet
A
ketogenic diet has also been shown to be effective in the treatment of
ALS, autism, cancer, Parkinson’s disease and Type 2 diabetes, but you
don’t have to be seriously ill to benefit from it
By Dr. Mercola
This year marks the 20th anniversary of "First Do No Harm," a film
directed by American movie director and writer Jim Abrahams. Based on
real-life events, the film relates the successful treatment of one boy's
severe case of epilepsy using a ketogenic diet.
Prior to the fictionalized family's discovery of the diet, their
youngest son, Robbie, was given many pharmaceutical medications, some of
which caused constipation, fevers, rashes and other harmful side
effects, including at least one near-death episode.
Aspects of the storyline mirror Abrahams' own experience with his
infant son Charlie, who makes a brief cameo appearance in the film as
one of Robbie's playmates in the hospital. Charlie was diagnosed with
epilepsy when he was just 11 months old. Similar to the mother in the
movie, played by Meryl Streep, after Abrahams watched his son suffer
through multiple daily seizures, the accompanying accidents and
injuries, and a slew of pharmaceutical drugs, he became aware of the
ketogenic diet through personal research.
As with the boy in the movie, within the first month of implementing
the diet, Charlie became seizure- and drug-free. Charlie continued on
the ketogenic diet for five years, after which he resumed eating regular
food, and has never had another seizure since. "First Do No Harm" will
give you a sense of the intensity and desperation that often accompany
serious illness. You also will get a glimpse of the emotional and
financial burdens placed on families facing a major health crisis.
Moreover, the film shines a bright light on the harm that is
routinely inflicted by doctors and drug companies through what may
appear to be guesswork and trial-and-error procedures related to the
treatment of complex health issues. If you've had doubts that looking
beyond conventional medicine is worth your time, "First Do No Harm" will
remind you again that so-called "alternative approaches," such as the
ketogenic diet, actually underscore the value of plain old common sense
when it comes to optimizing your health.
Why Are Drugs Often the First Choice in Epilepsy Treatment?
As you may know, epilepsy is a neurological disorder marked by
abnormal electrical discharges in the brain that trigger seizures. These
sudden brief episodes can be intense and are generally characterized by
altered or diminished consciousness, convulsions and involuntary
movements. The Epilepsy Foundation suggests epilepsy is the fourth most
common neurological condition, with an estimated 65 million people
worldwide affected by it.1
Some 150,000 Americans are diagnosed with epilepsy annually, with
children and older adults experiencing the highest incidence rates.2
The recurring seizures that accompany epilepsy can have a significant
impact on a person's quality of life, given the heightened risk of
accidents and injuries.
According to the Mayo Clinic,3
pharmaceutical drugs are the first and most commonly used treatment
method for epilepsy. Unfortunately, it takes time and experimentation to
find a suitable drug, and these medications are often accompanied by
unpleasant side effects that can do more harm than good.
Some of the side effects range from the less serious — fatigue,
rashes and weight gain, to the more serious — depression, inflammation
of vital organs, such as your liver, and suicidal behavior. In the
movie, after noticing that one of the other children in her son Robbie's
hospital ward had died, presumably from the treatment administered to
the girl for epilepsy, which included brain surgery, Streep's character
gets angry. Shouting at her son's doctor and two other hospital
employees, she asserts:
"There's something wrong here. There's something really, really,
really wrong! I bring my kid to you people for help, and all you do is
make him sicker. You give him one drug, and then he needs another drug
to cure him of the first one.
And then he needs another drug to take away the side effects of
that one! And another one and another one and another one. I mean, he,
he has had a rash, swollen glands, a fever, constipation, hemorrhoids,
bleeding gums, and he acts like a drunk, a zombie, a psycho. And it's
not because of his sickness. It's because of your cure!"
If drugs are ineffective, as they were for Robbie, other potential interventions for epilepsy sufferers include:4
Surgery: If your seizures originate in a small,
well-defined area of your brain that does not interfere with vital
functions such as hearing, motor function or speech, it may be possible
to surgically remove the area suspected to be the source of your
seizures
Vagus nerve stimulation: An implanted pulse
generator similar to a pacemaker stimulates your vagus nerve,
stabilizing abnormal electrical activity in your brain; such treatment
has been shown to reduce seizures by 20 to 40 percent
Ketogenic diet: A diet high in healthy fats and low
in carbohydrates that, for epileptics, is strictly monitored and
medically supervised, the diet works for some, but not all epileptics
When Conventional Treatments Fail, Hopeful Alternatives Often Surface
Just as Streep was making plans to remove Robbie from the hospital
where he had been treated unsuccessfully with toxic, life-altering drugs
for months, Robbie's doctor was making plans to recommend brain
surgery.
In desperation, Streep had been scouring medical journals and other
publications for weeks when she stumbled across a book by Samuel
Livingston, published in 1972, titled "Comprehensive Management of
Epilepsy in Infancy, Childhood and Adolescence." When attempting to
inform Robbie's doctor of her findings, Streep states:
"I've been doing some reading, and I've come across a treatment
for epilepsy called the ketogenic diet. It's by a doctor from Johns
Hopkins. And the diet, as best as I understand it makes the body go into
a fasting state, and something about that fasting state stops the
seizures."
In response, the doctor, who clearly is not a fan of a dietary intervention, sarcastically retorts:
"'The Comprehensive Management of Epilepsy in Infancy, Childhood
and Adolescence' by Samuel Livingston. The bible on pediatric epilepsy.
Every neurologist in the country owns a copy. With the exception of the
material on the ketogenic diet, it's an invaluable piece of medical
literature. The diet is not an approved treatment, but there have been a
lot of studies.
Those studies are anecdotal, and not the kind of studies we base
sound medical judgment on — not double-blind studies. The ketogenic diet
is highly suspect. You have to starve the child to begin with, and what
you feed him consists mainly of fat, which is not only unpalatable, but
nutritionally inadequate and extremely difficult to maintain. I've seen
it tried a few times, and my experience is that it simply doesn't
work."
Streep is undaunted by the doctor's sarcastic response and becomes
even more determined to travel to Johns Hopkins to have her son
evaluated as a candidate for the treatment using the ketogenic diet.
Within a matter of days, Robbie begins the diet and is weaned off his
medications.
In short order, his seizures are diminished and then totally gone.
His parents are amazed at his recovery. Streep discovers that the
dietician helping Robbie with his new manner of eating had been
administering the ketogenic diet at Johns Hopkins for more than 40
years. In response, Streep's husband in the film, played by Fred Ward,
says:
"I mean, how many children have been given drugs and operated on,
and not one of them was told of this diet? Something doesn't make
sense. I mean, if all the doctors we've talked to know about this …
ketogenic diet, even if they don't like it for some reason, don't they
have to tell us about it? Can they really censor information like this?
How can there be joint decision making if they don't give us
information and tell us the options? Didn't you say Doc Peterson, talked
with his neurologist friends about Robbie — and not one of them
mentioned the diet? … Just drugs and surgery. If [the diet] stands any
chance of working, let alone a 1 in 3 chance of stopping his seizures
altogether, why would they rob us of that hope?"
The Ketogenic Diet and Intermittent Fasting: A Powerful Combination
A ketogenic diet calls for minimizing carbohydrates and replacing
them with healthy fats and adequate amounts of high-quality protein. I
recommend a cyclical or targeted ketogenic diet for everyone, where you
increase carbs and protein once you are able to burn fat for fuel on the
two to three days a week you are strength training.
I believe this is healthy for most individuals, whether they have a
chronic health problem or not. I say that because the ketogenic diet
will help you optimize your health by converting from burning
carbohydrates for energy to burning fat as your primary source of fuel.
You can learn more about this approach to improving mitochondrial
function in my latest book, "Fat for Fuel."
One of the most common side effects of being a sugar-burner is that
you end up with insulin and leptin resistance, which it at the root of
most chronic disease. Keep in mind that adopting the ketogenic diet
along with intermittent fasting
may further boost your results. Intermittent fasting is one of the most
effective strategies I know of to shift your body from burning sugar to
burning fat as your primary fuel.
While there are many different strategies, my favorite (and the one I
personally used to become fat adapted) is to simply restrict your daily
eating to within a six- to eight-hour window, which means you're
fasting for about 16 to18 hours each day. I have now increased that time
to 20 to 21 hours per day of fasting.
This kind of intermittent fasting can also be a useful modality to
help you make a more gradual transition to a ketogenic diet, as it helps
break your body's addiction to glucose. In fact, eliminating sugar
cravings is one of the most welcomed side effects of intermittent
fasting. If you are overweight and have a serious disease, then I
believe water fasting for a week or more is likely a better option.
Getting the Word Out About the Ketogenic Diet for Children With Epilepsy
After discovering the ketogenic diet and seeing how it transformed
his son's life, Abrahams and his wife launched The Charlie Foundation to
Help Cure Pediatric Epilepsy in 1994. After the organization expanded
its mission and sought to apply the diet to conditions such as ALS,
autism, cancer, Parkinson's and Type 2 diabetes, it was renamed The Charlie Foundation for Ketogenic Therapies.5 About his experience with helping his son, Abrahams said:6
"After monotherapy, and then endless drug cocktails failed, I
started doing my own research and stumbled across the ketogenic diet — a
nearly extinct, high-fat diet for kids with intractable epilepsy that
was known to help control and often even stop seizures. With the advent
of new drugs, the diet — once a first line of therapy — had fallen into
disuse. However, we were able to find a dietitian who was familiar with
it and who was willing to start Charlie on it right away.
His seizures went away in two days. He stopped taking drugs
within a month, and his development returned. It was a miracle. After
five years on the diet, he began to eat regular foods again and the
seizures have never come back …
I asked Charlie's doctor why we had to learn about the diet on
our own — why none of his other doctors had ever told us about it. He
believed the diet would never become accepted as a conventional
treatment because of the way our medical establishment shares
information.
[After Charlie was healed], my life took on new purpose. The
ketogenic diet had to be made an option — an early option. Because
doctors weren't informing families about this treatment option, were
misinforming them or were administering the diet improperly, this
information needed to go directly to the families."
Since its inception, the Foundation has confirmed the:7
Value of the ketogenic diet thousands of times anecdotally, as well as by a randomized controlled study,8 for the successful treatment of epilepsy
Improvement of uncontrolled seizures in children and adults, with
many becoming drug- and seizure-free and able to return to a normal diet
Development of less restrictive versions of the ketogenic diet for use by a larger segment of the global epilepsy population
Presence of more than 200 hospitals worldwide with ketogenic diet
programs, which includes a requirement for all advanced-level epilepsy
treatment centers in the U.S. to provide ketogenic diet therapy
Creation of new applications of the ketogenic diet for ALS, autism, cancer, Parkinson's disease and Type 2 diabetes
Ketogenic Diet Also Effective for Adult Epileptics
While the ketogenic diet has a successful track record in treating
epileptic children, adult studies have been somewhat scarce. A 2014 body
of research published in Neurology9,10 analyzed two types of diets used to treat adult sufferers of epilepsy:
Ketogenic diet, consisting of a 3-to-1-to-1 or 4-to-1-to-1
fat-to-carbohydrate-to-protein ratio, with 87 to 90 percent of calories
from fat
Modified Atkins diet, comprising a 1-to-1-to-1
fat-to-carbohydrate-to-protein ratio, with approximately 50 percent of
calories from fat
In all, the results were very similar between the two diets:
Thirty-two percent of those on a ketogenic diet and 29 percent of those
on a modified Atkins diet reduced their seizures by about half. A small
subset of patients — 9 percent of those following a ketogenic diet, and 5
percent of those using a modified Atkins diet — reduced the frequency
of their seizures by more than 90 percent.
While the beneficial effects were persistent as long as participants
remained on the diet, the rates of acceptance and continuance of the
diets were found to be low. More than half of all patients following a
ketogenic diet discontinued it before the end of the study period, as
did 42 percent of those on a modified Atkins diet. For those who stayed
the course, however, the results were typically rapid and quite
beneficial.
While it has been shown that children sometimes remain seizure-free
after discontinuing a ketogenic diet, adult epileptics very likely must
maintain the diet indefinitely, or suffer a relapse. Dr. Pavel Klein,
neurologist and director of the Mid-Atlantic Epilepsy and Sleep Center
in Bethesda, Maryland, a co-author of the research, stated:
"Unfortunately, long-term use of these diets is low because they
are so limited and complicated. Most people eventually stop the diet
because of the culinary and social restrictions. However, these studies
show the diets are moderately to very effective as another option for
people with epilepsy."
How to Get Started With the Ketogenic Diet
As you will see below, the ketogenic diet recommended for epileptics
is close to what could be considered an ideal way of eating for most
people. In fact, I believe a cyclical ketogenic diet can be very
beneficial for the vast majority of people, either alone or in
combination with intermittent fasting.
The primary difference between someone struggling with a chronic
disease such as epilepsy or cancer and people who have not yet been
diagnosed with a chronic disease comes down to how strictly you must
follow it and how long you have to maintain this type of regimen.
As a general rule, if you are insulin resistant, I recommend
intermittent fasting along with a ketogenic-type diet for as long as it
takes to resolve your insulin resistance. At that point, you can
increase your number of meals. Regardless of whether you're
intermittently fasting or not, I believe the following food guidelines
will be beneficial for you — especially if you're trying to shed
unwanted weight. Start by:
Avoiding processed foods, refined sugar and processed fructose in excess of 15 grams per day and grains
Eating whole foods, ideally organic and minimizing or ideally eliminating all processed foods
Replacing grain carbohydrates with large amounts of organic
vegetables, higher amounts of healthy fats and low-to-moderate amounts
of high-quality protein; more information about protein follows below
Consuming about 50 to 85 percent of your total diet in high-quality,
healthy fats — saturated and monounsaturated fats from animal and
tropical oil sources — including the following:
Animal-based omega-3 fat such as krill oil, and small fatty fish like anchovies and sardines
It's important to note that most Americans eat far more protein than
needed for optimal health. On average, your body requires about one-half
gram of protein per pound of lean body mass, which translates to about
40 to 70 grams of protein a day for most people. If you aggressively
exercise, are a competitive athlete or are pregnant, you may need up to
25 percent more protein than average.
The rationale behind limiting your protein is significant. When you
consume excessive protein, it activates your mTOR (mammalian target of
rapamycin) pathway, which can help you gain large muscle, but may also
increase your risk of cancer. There is also research suggesting the mTOR gene is a significant regulator of the aging process.11 Suppressing this gene appears to be linked to longer life.
To determine whether you're getting too much protein, first calculate
your lean body mass by subtracting your body fat percentage from 100.
For example, if you have 20 percent body fat, you have 80 percent lean
body mass. Then write down everything you're eating for a few days, and
calculate the amount of daily protein from all sources. You could simply
Google each food to find out how much protein it contains. An easy tip
to remember is that a 3 to 4 ounce serving of protein is about the size
of a standard deck of playing cards.
Two Additional Considerations for Epilepsy
While it does not necessarily work for everyone, I wholeheartedly
endorse cyclical or targeted ketosis as a first line of treatment for
epilepsy and most all other chronic diseases. It is particularly
beneficial if you are seeking a drug-free alternative, or have found
drugs to be more detrimental than helpful, to managing your seizures.
That said, two other considerations I want to mention that may help you
manage your seizures are:
• Cannabis oil:
Children with epilepsy can often find rapid relief using cannabis oil,
although results vary, and not every child will respond well
immediately. Dr. Margaret Gedde, owner and founder of Gedde Whole
Health, located in Colorado, a provider of medical marijuana physician
services, suggests about 25 percent of child epileptics experience a
significant reduction in seizures within days or weeks when using
cannabis oil. • Vitamin D:
Because having frequent seizures may interfere with your ability to get
outdoors and get sun exposure, epileptics may be deficient in vitamin
D. Some antiepileptic drugs can interfere with its metabolism, also
leading to deficiency.
Because epilepsy is a disorder of the central nervous system,
particularly your brain, and vitamin D is a neuroregulatory steroidal
hormone that influences nearly 3,000 different genes in your body, your
vitamin D levels can positively influence your condition. For starters,
vitamin D can enhance the amount of important chemicals in your brain
needed to protect your brain cells.
Changing Your Diet Now May Enable You to Avoid Drugs and Surgery Later
In a climactic scene in "First Do No Harm," when Robbie was being
released from his local hospital so his mom could take him to Johns
Hopkins to investigate the ketogenic diet, a family friend, who was also
a licensed physician, told Robbie's doctor:
"When you and I became doctors, we swore an oath that said,
'First do no harm.' Now, if these folks want to try to control their
son's seizures by changing what he eats — instead of drugs and surgery —
well, I think they deserve that chance."
I couldn't agree more with this man's assessment — we all are worthy
of high-quality, individualized medical treatment. No matter the medical
advice or diagnosis you have received, I believe you can improve your
health today simply by changing how and what you eat.
By making a commitment to a cyclical or targeted ketogenic diet with
intermittent fasting now, you may be able to avoid drugs and surgery
later. The ketogenic diet has been shown to improve the quality of life
for epileptics, and I believe it can improve your quality of life, too!
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