Team effort, dedication and patient belief co-operation will lead to successful set up of ketogenic diet clinic in any part of world.
For KD center, we need multi-disciplinary team which is as follows:-
But do they all need to learn ketogenic diet in detail- the answer is NO’.
Then who needs the extensive training of KD – Yes you are right!!- The Physician and Dietician.
Basically, Ketogenic diet is a therapeutic diet, so the experts of respective fields are required to come together and work as team.
As you all know ketogenic diet is a restrictive diet and it is mainly given in medical conditions where medicine has its role to play. Ethically only physician can prescribe medication not the dietician. Any kind of serious medical illnesses or nutritional deficiencies are only treated by a Physician. Similarly, KD has a lot with the food products and their nutritional components which only a Dietician is well versed with it. So it is really important that Physician and Dietician works together.
Consequences of only dietician trained in ketogenic diet practicing with an untrained Physician:-
Untrained Physician will not know the following things:-
- When and on whom to start KD
- Information of sugar free medicines
- How to taper medicines while on KD.
- How to taper KD
- Side effects of KD
Consequences of trained Physician in ketogenic diet practicing with untrained Dietician:-
This will lead to a serious problem as books and colleges do not teach Ketogenic diet in a systematic way so this combination of trained Physician with untrained dietician is a big ‘NO’ situation as half knowledge is more dangerous than no knowledge.
As dietician is an important part of Ketogenic diet- counseling, calculation and fine tuning needs to be perfectly done.
The calculation aspect is very crucial in learning about ketogenic diet. Many dieticians are clueless to deal with the calculation of recipes in Ketogenic diet which is the base of KD.
Dieticians need to be taught about fine-tuning ketogenic diet. KD is fine-tuned on the basis of ketones, seizures, height, weight etc
Dietician should be expert in giving variety of recipes to the patients. They give only 2-3 recipes which can lead to monotony and lack of compliance from patients.
They should know the correct way to check for urinary ketones using the urine dipstick.
Counselling of Ketogenic diet should be done at ease with patient, making them understand KD in layman language is a challenge.
If there is no team approach what can go ‘WRONG’ ?
Ketogenic diet introduced in 1921.Everything can go wrong. KD therapy needs a team approach. Most doctors feel that once they have referred the person to a dietician their part is over. Dieticians read a few articles and books and start the KD.
WHAT CAN GO WRONG – EVERYTHING – Practical example:-
Child on KD since four months no seizure reduction. Parents about to give up the KD Came to us as last resort. We investigate WHY? Urine ketone (UK) chart not maintained, UK checked occasionally. UK done by us on day of arrival – Trace. Child on KD since three months. Now refuses to eat-WHY? Dietician has given 3 recipes to be used daily. Child rebels after few weeks, throws tantrums. Grabs food from other children in school. OK after we speak to child and fashion recipes as per child’s likes and dislikes with around 30-40 choices .Child of six months on KD since six months .Now refuses to eat-WHY? Dietician has instructed parents to make one recipe a day and partition it into six meals and feed the child. After dietetic counselling for parents the child accepts feeds.
“Team work: Simply stated, it is less me and more we”. So this is why team approach is so important for Ketogenic diet.
We would like to sum up with beautiful quote – “Coming together is beginning. Keeping together is progress and working together is success”- by Henry Ford.