Ketogenic Diet for Epilepsy

The ketogenic diet is a high-fat, low-carbohydrate diet used to treat epilepsy. It is commonly recommended for children with refractory (treatment-resistant) epilepsy. Adults with epilepsy also benefit from the keto diet and similar plans.

Study results vary, but many have shown that a ketogenic diet can reduce the frequency of seizures in people with epilepsy by 50% or more. Some people have even reported no seizures after starting and staying on the diet.

This article discusses the ketogenic diet for epilepsy. It explains how the keto diet works to control epileptic seizures. It also offers ways to modify the traditional ketogenic diet while still being effective.

What Is a Ketogenic Diet?

Keto diets work to control seizures by inducing a state of ketosis. This switches the body's metabolism from burning glucose for energy to using ketone bodies. It is thought these two fuel sources act differently on parts of the brain that trigger seizures.

Under normal circumstances, carbohydrates in food are converted into glucose, which fuels the brain and other parts of the body. If you don't consume enough carbohydrates, the body will convert fat into ketone bodies, which replace glucose as the brain's fuel source.

As ketone bodies increase in the bloodstream, a body is said to go into a state of ketosis. Ketosis appears to decrease the frequency of seizures in many—but not all—people with epilepsy.

Principles of a Keto Diet for Epilepsy

To induce ketosis, you'll need to reduce your carb intake and increase your fat intake. To maintain normal body function and growth, an adequate intake of dietary protein is needed.

The diet is ideally overseen and directed by a neurologist (who specializes in disorders of the brain and nervous system) or a registered dietitian specializing in the ketogenic diet.

For people with refractory epilepsy, children especially, the diet may start in the hospital with a fasting period of 18 to 24 hours. (This is not necessary but may help induce ketosis quicker).

The diet is then started by slowly increasing calories and the ratio of fat to carbohydrates and protein. By the end of day three, the person should be consuming the number of calories they normally consume per day.

Because the keto diet does not provide all of the vitamins and minerals needed for a balanced diet, vitamin and mineral supplements are typically prescribed, most especially calcium, vitamin D, B vitamins, and selenium.

What Does a Keto Diet for Epilepsy Look Like?

A classic keto diet consists of 2 to 4 grams of fat for every 1 gram of protein and carbohydrate. That represents anywhere from 75% to 90% of calories from fat.

The main fat sources for the ketogenic diet are butter, heavy whipping cream, mayonnaise, and polyunsaturated or monounsaturated oils (like canola or olive oils). Coconut oil or special medium-chain triglycerides (MCT) oil may also be used.

Building a keto diet plan almost invariably requires the input of a qualified healthcare provider who can guide you through the types and proportions of foods you need to meet the strict dietary goals.

Here is an example of a daily ketogenic menu for epilepsy:

Cheating Is Not Advised

Unlike weight-loss diets, the occasional cheat day is not recommended when following a keto diet for epilepsy.

In order to get the seizure-prevention benefits of a keto diet, it is important to maintain a state of ketosis. This means consistently keeping your daily carbohydrate intake low. Eating too many carbs in one day can knock you out of ketosis.

Possible Side Effects

It is not uncommon to feel fatigued and weak after starting a ketogenic diet, but these tend to subside as your body adapts to the diet.

In children, the keto diet can impact a child's growth and development. It is often used for a year or two and then gradually transitioned to a balanced diet if epilepsy is well managed.

At the same time, the long-term use of a ketogenic diet in children and adults can lead to potentially severe complications like:

• Chronic constipation
• Slowed growth
• High cholesterol
• Kidney stones
• Increased risk of bone fractures
  

Effectiveness

Studies generally show that about a third of children with epilepsy who follow the ketogenic diet will have at least a 90% reduction in seizures, while another third will experience a reduction of between 50% and 90%.

Some children with epilepsy are able to become completely seizure-free on a ketogenic diet. What's more, research shows these benefits can persist even after discontinuing the diet. This suggests the keto diet may have neuroprotective effects.

Similar findings have been seen in older children and adults. One 2014 study published in the journal Seizure reported that 45% of adolescents and adults with epilepsy saw a reduction of seizure frequency of 50% or greater.

A 2017 study in Seizure suggests that a keto diet may help pregnant people control seizures and use lower doses of epilepsy drugs during pregnancy. However, the safety of this approach has not been established.

Alternatives to the Keto Diet

Many adults with epilepsy find it difficult to adhere to a keto diet. The modified Atkins diet is a popular and easier-to-follow alternative to a traditional keto diet. The diet is far less restrictive as calories, fluids, and protein are not measured.

The diet begins with 10 grams of carbohydrates per day for the first month, which is slowly increased to 15 or 20 grams per day.

Research shows the modified Atkins diet is almost as effective as the traditional keto diet in children over the age of 2. Children under the age of 2 have better results on a strict keto diet, a 2015 study in the journal Epilepsia found.

For adults and older children, though, the modified Atkins diet is far more tolerable than the keto diet.

Helping Kids Cope With a Keto Diet

With a school-aged child, keeping them on the diet during the school day is difficult but essential. Thinking and planning ahead can help you be successful. You may want to try some of the following strategies:

• Talk to your child: Make sure your child understands the diet and why sticking to it is essential. Let them know they shouldn't trade food with other kids. As hard as it is, they also shouldn't eat food from vending machines or treats handed out in class.
• Talk to the school: The teacher, guidance counselor, nurse, and administration all need to be aware of your child's special dietary needs (as well as other health-related matters). You'll want to have regular conversations with them, and you may want to have a 504 plan or individualized education plan (IEP) in place as well.
• Become a planner: Gather several recipes for appropriate meals that can make convenient, easy-to-pack lunches. If possible, you may want to provide appropriate treats for your child for holiday parties and other special events that you may know about ahead of time. The Charlie Foundation and Clara's Menu are good resources for child-friendly keto recipes.
• Educate family members: It's important that family members and regular caregivers know how to prepare a meal for a child with epilepsy.
• Establish routines: The timing of meals and snacks needs to be consistent in order for your child's glucose levels to remain as stable as possible. You may need to work with your child's teachers on this.
• Involve a friend: Having a friend at school who understands the importance of your child's diet may help them feel less awkward about being "different" and give them someone to lean on for support when needed. Make sure your child is OK with this and give them input on which friend to choose.
• Find a support group: Epilepsy support groups, in-person or online, can share advice on how to accustom your child to the diet.

You'll also want to make parents of your child's friends aware of the special diet and that what some people may consider "a little harmless cheating" may not be harmless at all. It's a good idea to provide food for your child to take to parties and playdates.

Summary

The ketogenic diet is an effective treatment for people with epilepsy. The high-fat, low-carbohydrate diet has been shown to reduce the frequency of seizures in children and adults.

The diet switches the body's fuel from glucose to ketones. It puts the body into a state of ketosis, which appears to have seizure-preventive effects. These benefits sometimes last even after the diet has been stopped.

The classic ketogenic diet for epilepsy consists of 2 to 4 grams of fat for every 1 gram of protein and carbohydrate. It can be difficult to adhere to a strict keto diet, and many people are able to achieve similar benefits with a modified Atkins diet.

It is important to work with your doctor and a nutritionist to ensure you are following the diet correctly. To avoid nutritional deficiencies, children and some adults on a ketogenic diet may need vitamin supplements.

Epilepsy Doctor Discussion Guide

Get our printable guide for your next healthcare provider's appointment to help you ask the right questions.

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