A dietary supplement that mimics the effects of the high-fat, low-carbohydrate ketogenic diet is well-tolerated and appears to reduce seizures in children and adults with treatment-resistant epilepsy, early research suggests. However, at least one expert has concerns.
In an open-label feasibility study, researchers assessed a liquid supplement known as K.Vita (Vitaflo International Ltd), which contains both decanoic acid and octanoic acid.
Although the study was small, the findings are promising, co-investigator Matthew Walker, MD, PhD, University College London (UCL) Institute of Neurology, Department of Clinical and Experimental Epilepsy, United Kingdom, told Medscape Medical News.
"The dietary supplement was reasonably well-tolerated and while we weren't specifically looking for efficacy here, we did see some patients had quite dramatic results in terms of reduced seizures," Walker said.
Unlike the ketogenic diet, this dietary supplement is "very easy" to follow, involves only minor dietary modifications, and doesn't require the intervention of a dietitian, he added.
The findings were published online July 23 in Brain Communications.
In the ketogenic diet, the body uses body fat as its primary fuel source. The switch from carbohydrates to fat for body fuel results in build-up ketones.
Previous research shows the ketogenic diet is effective in reducing seizures in some patients with epilepsy. However, many patients find it difficult to tolerate, especially for extended periods. Walker also noted that ketones may have other long-term side effects, including osteoporosis.
He added that his team was keen to learn what elements of the ketogenic diet affect seizures.
"Interestingly, we found that one of the fats used in the ketogenic diet, decanoic acid, has quite marked anti-seizure effects," Walker said.
Previous research has shown that decanoic acid, a medium chain triglyceride (MCT)-derived fatty acid, can cross the blood–brain barrier and decrease excitatory neurotransmission and network excitability in vitro.
Walker noted that ketones are necessary in order to reduce seizures.
"Rather than have a very high-fat, low-carbohydrate diet that causes ketones, we thought 'why don't we use a diet in which we just use mainly this fat, this decanoic acid, and avoid ketosis'," he said.
The researchers then went to work developing the K.Vita dietary supplement, which mainly contains decanoic acid but also another fat, octanoic acid.
The feasibility study included 61 patients (59% female) who began taking the supplement. Of these, 35 were children (aged 3 to 18 years) and 26 were adults. The children had Dravet syndrome or another genetically driven form of epilepsy, while most of the adults had a focal epilepsy.
All participants had failed multiple antiseizure medications — a median of three for children and 10 for adults who completed the trial. Of the 61 original participants, 20 (19 children and 1 adult) had tried the ketogenic diet but had stopped it for various reasons, including noncompliance and lack of efficacy.
The liquid supplement was introduced gradually. The amount administered was based on weight in the children and was a standard amount in adults, with the target being 240 mL.
Participants consumed the supplement in equal servings taken at regular intervals as part of a meal or snack. They could take it alone or mix it with yogurt or another food.
Patients with feeding tubes took the supplement immediately before or after or mixed into an enteral feed, with a water flush afterwards.
Researchers provided patients and caregivers with guidance on excluding highly refined sugary foods and beverages. Starchy foods such as bread, pasta, rice, and potatoes were not restricted.
The study consisted of three visits: baseline, 5 weeks, and 12 weeks, in addition to regular phone and email contact. Participants were also asked to keep a seizure diary.
Highly Acceptable to Patients
Overall, the study withdrawal rate was 33%. After a protocol change involving a slower introduction of the supplement, there were fewer withdrawals, Walker reported.
He noted that the proportion of participants who completed the study (41 of 61) is "much better than with most studies of adults following the ketogenic diet."
The most frequently reported gastrointestinal symptoms with the supplement were bloating and constipation, but these were predominantly mild and tended to decrease over time. This, said Walker, contrasts to the ketogenic diet where side effects tend to persist.
There was no significant change in body weight or body mass index. "We did not see weight gain as a problem at all," Walker said.
Of 15 caregivers and 19 adults who returned an acceptability questionnaire, 84% agreed or strongly agreed the supplement had a good flavor (strawberry); 88% liked the appearance and color; 77% liked the texture and consistency; and 88% agreed or strongly agreed it was easy to take.
About one third of adults and two thirds of caregivers said they believed the supplement reduced seizures.
50% Seizure Reduction
Only three children and one adult became ketotic. This is typically classified as a beta-hydroxybutyrate (BHB) greater than 1 mmol/L (10.4 mg/dL).
The BHB levels detected were markedly lower than those observed in individuals following a ketogenic diet, the investigators note.
Nineteen of the 41 participants completed the diaries. There were also data from physician recordings, so researchers were able to retrieve seizure frequencies for 32 of the 41 (78%).
Of these 32 patients, 14 (44%) had a 50% or greater reduction in seizures. Overall, children and adults "responded similarly," Walker said.
He acknowledged the study numbers are small and emphasized that larger studies are needed to determine efficacy. He also hopes for a future randomized controlled trial comparing K.Vita with another supplement that contains different types of fats.
Interestingly, the product has already "passed" the regulatory approval process in the United Kingdom, so it can be labeled as a medicinal food and should be available for use at the beginning of 2022, Walker said.
Asked to comment on the findings for Medscape Medical News, Daniel Goldenholz, MD, PhD, instructor in the Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, said the supplement may be helpful, but he has concerns about the study.
Many patients with epilepsy are "desperate" for therapies that will help treat their seizures, said Goldenholz, who was not involved with the research.
"If there's a dietary therapy that has the potential for being helpful, I'm loving that. I need that. My patients are begging for something that works," he said. It is "really exciting" that researchers are working on that goal, Goldenholz added.
However, he noted that it is too soon to start talking to patients about this new product. He also pointed out that a significant fraction of the study participants dropped out, many because they couldn't tolerate the supplement. In addition, others didn't produce a seizure diary.
Goldenholz and his colleagues have published several studies showing that patients with no intervention at all can sometimes show a reduction in seizures compared with their baseline results.
"We found sizable 50% reductions attributable entirely to the natural fluctuations in seizure rates, rather than any therapy at all, he said.
Goldenholz added that he hopes to see future studies on this topic, and on similar therapies "with sufficient data and more reliable metrics for efficacy."
The study was funded by Vitaflo International Ltd. Walker reports having received grants from Vitaflo International Ltd and personal fees from UCB Pharma, Eisai, and Sage. In addition, along with colleagues, he has a patent (Nutritional product) pending.
Brain Commun. Published online July 23, 2021. Abstract
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Cite this: Can a Supplement That Mimics the Keto Diet Reduce Seizures? - Medscape - Jul 26, 2021.