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The ketogenic diet to prevent secondary brain injury in traumatic brain injury patients: an intervention design study.

We aim to investigate if the ketogenic diet can be given to adults soon after having a serious head injury.
The ketogenic diet is a special diet that is high in fat and low in carbohydrate (sugars). It is used in children with severe epilepsy to control seizures. We are interested because the ketogenic diet may reduce brain damage after a serious head injury.

Damage to the brain following an accident has two forms. Primary injury happens at the moment of impact and cannot be altered. Secondary injury happens in the minutes, hours and days after the event. It can be affected by medical treatment. Less secondary injury means patients are more likely to survive, and to survive with less disability.
One cause of secondary injury is a reduced blood supply to injured parts of the brain. This means oxygen and sugars needed for normal nerve function are in short supply. The nerves are damaged or die. This results in brain swelling and inflammation. Blood supply falls further.

Breaking this vicious circle will prevent secondary damage to the brain.

Ketones are part of normal healthy metabolism. The ketogenic diet causes the body to make more ketones. These provide extra fuel for the brain to keep nerves alive. Ketones also limit damage in nerves already affected by low fuel levels. Finally ketones may work even when the brain is swollen and inflamed.

Before doing a study to find out if the ketogenic diet helps in head injury we need to know two things:

  1. The brain normally depends on sugar to keep running. We need to know if the low levels of sugars in the ketogenic diet are safe after brain injury.
  2. The brain needs ketones as quickly as possible to keep nerves alive. We need to know how quickly the ketogenic diet produces extra ketones in the body.

We want to answer both questions in an initial study. We will then know if the ketogenic diet is suitable for adults soon after a serious head injury. We can then do a bigger study to see if this means patients survive with less disability on a ketogenic diet.

Dr Kate Crewdson

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