The unpalatability of the foods in the ketogenic diet is often cited as a reason for the small number of children treated with the diet. Researchers from the Kennedy Krieger Institute in Baltimore, USA, carried out a study looking at the food preferences of children with epilepsy, which was published in the journal Epilepsy & Behavior in August.

Some children do extremely well on the diet, but many drop out. It is so intense it counts as a medical treatment, and has to be prescribed, like tablets. It has to be tailored to a specific child's needs, which needs accurate calorie and fluid calculation (so it's a lot of work for parents). It contains highly fatty foods, such as butter, cream, mayonnaise, peanut butter, and oils, in quantities most people find unappealing. Special oils to boost fat intake are also available.

Dr Adrianna Amari and her colleagues tested the food preferences of 29 children with seizures and compared them to those of 30 children with no history of seizures. The children were aged between 2 and 17 years. They also tested whether the children's parents were good at predicting what sort of foods the child preferred.

The children in the study were given a series of choices to make between small tastes of two foods, one high in fat (for example, a spoonful of mayonnaise or cream cheese) and one high in carbohydrate (for example, a sweet or crisps). They had to say which one they preferred. The researchers found that the children with seizures showed a significantly higher preference for fatty foods over carbohydrate-high foods, compared to the children with no history of seizures. They also found that parents didn't accurately predict which foods their child preferred.

This interesting finding opens up a number of possibilities. It may be possible, for example, to predict a child's response to the ketogenic diet by how great their preference for fatty foods is in a test like this. The underlying reasons for these preferences also need investigation: is there an underlying metabolic trigger here?

More about the diet
The ketogenic diet is an effective treatment for some childhood epilepsies. The diet contains a very high proportion of fat and low quantities of carbohydrate. Under these conditions, the body has to burn fats for energy rather than burning carbohydrates. Among the by-products of this process are chemicals called ketones. High levels of these in the body reduce seizures, though exactly how this works is not yet understood. More information about the diet can be
found here

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