Dissertation September 24 2024 New PhD – candidate Ellen Molteberg
Ellen Molteberg defended her thesis “Endocrine effects of modified Atkins diet in adult patients with drug resistant epilepsy” for the degree of PhD at the University of Oslo. This was a joint project between ERGO – the epilepsy research group in department of neurology, The National Centre for Epilepsy, and the Hormonal laboratory, Oslo university hospital. Ellen Molteberg is now working as senior consultant and Head of adult epileptology at the National Centre for Epilepsy in Sandvika which is part of Oslo university hospital. The committee consisted of adjunct professor Pavel Klein, George Washington University, and director, Mid-Atlantic Epilepsy and Sleep Center, Washington DC, USA as first opponent, senior consultant Marianne Grytaas, Department of Endocrinology, Haukeland university hospital as second opponent, and professor Ole Morten Rønning, Department of Neurology, Akershus university hospital and University of Oslo as third opponent and head of committee. Main supervisor was professor Erik Taubøll, ERGO, Department of Neurology, and co-supervisor senior consultant Per Medbøe Thorsby, Hormonal laboratory, Oslo university hospital.
Summary of the thesis:
Endocrine effects of modified Atkins diet in adult patients with drug-resistant epilepsy
Patients with drug-resistant epilepsy may have good effect of ketogenic diet, like the modified Atkins diet (MAD). The diet is very high in fat and very low in carbohydrates. The adverse effects seem to be mild and/or transient. However, little is known about the long-term effects of MAD.
The aim of the thesis, was to explore the long-term effects of MAD on endocrine functions, including thyroid function, calcium- and bone metabolism, and stress parameters from the adrenal glands. The study showed that using the MAD for 12 weeks resulted in significant endocrine changes.
The ketogenic diet resulted in a decrease in thyroid hormones that may be important for patients with low levels of thyroid hormones before start of the diet, ande patients that use anti-seizure medication with hypothyroidism as a known adverse effect.
Bone metabolism was reduced which may result in a reduction in bone density. The alterations were most pronounced in young patients. As bone mass peaks at the age of 20-30 years of age, a reduced bone mass early in life may result in an increased risk of fractures later. This is especially important for patients with epilepsy, as they are known to have an increased risk of fractures. Consequently, a ketogenic diet may increase the risk of bone fractures.
Stress is a well-known seizure-precipitating factor in patients with epilepsy. The study showed no increase in the “fight or flight”- hormones from the adrenal glands (metanephrines), but a slight reduction in cortisol.
The study provides new insights about the effects of MAD on endocrine functions in adult patients with drug-resistant epilepsy. The findings should be taken into account when treating patients with a ketogenic diet like MAD.
