Dante Carrillo
The ketogenic diet is a high-fat, low-carbohydrate meal plan that has been used to treat epilepsy since the 1920s. It is typically considered after other treatments, such as medication or surgery, have failed to control seizures. The diet can be adapted to suit different cultures and individual needs, and it has been shown to be effective in reducing seizures in children and adults. However, it can be challenging to adhere to due to its restrictiveness, and there are potential side effects, including constipation, hunger, and lack of energy. While the exact mechanism of how the keto diet affects epilepsy is still being researched, it is believed to be related to changes in metabolism and the availability of energy for neurons to activate seizures.
| Characteristics | Values |
|---|---|
| What is it? | A high-fat, low-carb meal plan that resets how your body uses food. |
| Who is it for? | Children or adults with epilepsy whose seizures are not controlled with anti-seizure medications (ASMs). |
| How does it work? | Carbohydrates from foods like sugars and starches usually provide most of your energy. The keto diet lowers the amount of carbs you eat and teaches your body to burn fat for energy instead. Burning fat leads to the formation of excess ketones in your body, known as ketosis. |
| What foods are included? | Butter, heavy whipping cream, mayonnaise, and oils (e.g., canola or olive). |
| What foods are excluded? | All sources of carbohydrates. |
| How long should it be followed? | The ketogenic diet is usually monitored by a healthcare provider, who may stop it after a few years if it helps manage epilepsy well. |
| What are the side effects? | Constipation, hunger, vomiting, and lack of energy are common at the start of treatment. The diet may also cause sluggishness, and it does not provide all the vitamins and minerals found in a balanced diet, so supplements may be required. |
| What are the benefits? | The diet can be adapted to different cultures and individual dietary needs and preferences. It has been shown to reduce seizures in some people and may lead to increased alertness, awareness, and responsiveness. |
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What You'll Learn
Ketogenic diet as a treatment for epilepsy
The ketogenic diet is a treatment option for children or adults with epilepsy whose seizures are not controlled with anti-seizure medications (ASMs). It is a high-fat, low-carbohydrate meal plan that can be adapted to diets from different cultures and for people with allergies or those on modified texture diets. The diet teaches the body to burn fat for energy instead of carbohydrates, resulting in a metabolic state known as ketosis. The classic ketogenic diet (CKD) provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein, with approximately 90% of calories derived from fat.
The ketogenic diet has been used as a treatment for epilepsy since the 1920s and has been shown to be effective in infants, children, and adults with epilepsy. It is often considered when other treatment options, such as medication and surgery, have failed to control seizures. The diet can be started on an outpatient basis without the need for fasting, and the types of foods eaten and how the diet is calculated can vary. However, it is important to prepare meals carefully and avoid all other sources of carbohydrates. An experienced dietitian calculates the diet and works to include foods the patient likes, ensuring it is nutritionally balanced.
There are several variants of the ketogenic diet, including the classic ketogenic diet (CKD), the medium-chain triglyceride diet (MCTD), the modified Atkins diet (MAD), and the low glycemic index treatment (LGID). The choice of diet depends on individual needs and considerations, such as the patient's age and tolerance for restrictive diets. The MAD, for example, may be preferred for patients who cannot tolerate the more restrictive CKD as it allows for a more flexible ratio of fat to carbohydrates and protein, typically 1:1 or 65% fat, 25% protein, and 10% carbohydrate.
The ketogenic diet has been shown to be effective in reducing seizures and improving alertness, awareness, and responsiveness in patients with epilepsy. In a clinical trial, around 38% of children who started the ketogenic diet experienced reduced seizures and were able to reduce their anti-seizure medication. Another study found that 37.5% of adults with refractory focal or generalized convulsions achieved a ≥50% seizure reduction after one month on a ketogenic formula. However, it is important to note that the diet may not work for everyone, and side effects such as constipation, hunger, vomiting, and lack of energy may occur, especially at the start of treatment.
The ketogenic diet is typically monitored by a medical team, including a dietitian and a neurologist, to ensure the patient's growth, health, and epilepsy are on track. Blood and urine tests are performed regularly, and the patient is followed up with at least once every three months. If seizures have been well-controlled for a significant period, usually two years, the doctor may suggest discontinuing the diet gradually over several months or longer. However, seizures may worsen if the diet is stopped abruptly, and some families choose to remain on the ketogenic diet long-term.
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The effectiveness of the diet for different age groups
The ketogenic diet has been used to treat epilepsy since the 1920s. It is a high-fat, low-carbohydrate diet that alters the body's metabolism, using fat as the primary fuel source instead of glucose. This change in metabolism may affect how much energy is available for neurons to activate a seizure. The diet has been shown to be particularly helpful for some epilepsy conditions and can be used in all age groups.
Infants
Recent studies have shown that infants can be successfully started on the ketogenic diet. The classic ketogenic diet should be used at first and maintained for as long as possible. The diet works well for infants with focal seizures, but may not lead to an immediate seizure-free result.
Children
The ketogenic diet is typically started in the hospital. The child usually begins by fasting (except for water) under close medical supervision for 18-24 hours, before slowly increasing the calories or the ratio of fat to carbohydrates. The diet is usually recommended for children whose seizures have not responded to several different seizure medicines. Children who are on the ketogenic diet continue to take seizure medicines, although they may be able to take smaller doses or fewer medicines. Children given ketogenic diets may be up to three times more likely to achieve seizure freedom and up to six times more likely to experience a 50% or greater reduction in seizure frequency compared to children given their usual care.
Adolescents and adults
The classic ketogenic diet is usually not recommended for adults, mostly because the restricted food choices make it hard to follow. However, the modified Atkins diet (MAD) is an effective alternative for adolescents and adults. The MAD does not require the strict weighing of food and may be a good option for patients who are unable to tolerate the more restrictive classic ketogenic diet. In adults, no participants in one study experienced seizure freedom, but seizure reduction was more likely on the MAD than on a regular diet.
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Side effects of the diet
The ketogenic diet is a special high-fat, low-carbohydrate diet that has been used since the 1920s to treat epilepsy. It is usually considered when at least two suitable medications have been tried and proven unsuccessful. While the diet is effective in reducing seizures, it has several side effects.
During the initiation phase of the diet, common side effects include vomiting, hypoglycemia, metabolic acidosis, and refusal of the diet. The most common side effects that occur once the diet is underway are gastrointestinal, involving constipation, diarrhea, vomiting, and gastroesophageal reflux. Other side effects involve the hepatic, cardiovascular, renal, dermatological, hematologic, and bone systems.
Some of the less common side effects, occurring in 1 in 20 children, include high cholesterol, kidney stones, growth slowing, and gastrointestinal upset. Additionally, children on the diet for over 6 years may experience lower bone mineral density, leading to an increased risk of bone fractures.
Some rare and serious side effects include pancreatitis, protein-losing enteropathy, prolonged QT interval, cardiomyopathy, and changes in the basal ganglia. These serious complications may require immediate cessation of the diet.
The ketogenic diet also has negative social consequences due to the severe dietary restrictions, which may render it difficult to implement or maintain. It is typically offered only at specialized centers for epilepsy, where a team of consultants can work with families and children on dietary therapy.
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How to start the diet
The ketogenic diet is a complex medical therapy that often requires significant behaviour changes. It is a very high-fat, very low-carbohydrate, controlled-protein diet that has been used since the 1920s to treat epilepsy. It is a good alternative for non-surgical pharmacoresistant patients with epilepsy of any age.
To start the diet, it is important to consult with a healthcare professional to determine eligibility and develop a personalised treatment plan. Patients should avoid the ketogenic diet if they have certain conditions, such as severe feeding problems or a condition where a high-fat diet would be detrimental. Factors such as seizure frequency, age, and medical history influence the likelihood of success.
If the patient is eligible, the next step is to discuss the potential risks and benefits of the diet with a neurologist. In some cases, other treatment options may offer greater therapeutic benefits. The patient's medical history and medication will be reviewed to ensure the diet is appropriate.
After this, the patient will be admitted to the hospital for around four to five days to begin the diet. During this time, the patient will be closely monitored for potential side effects, and the diet will be adjusted to balance effectiveness and tolerability. The patient will be encouraged to consume only carbohydrate-free fluids.
Following discharge from the hospital, the diet will be maintained at home. Regular follow-up visits with the neurologist and dietitian will be scheduled to monitor and adjust the diet, typically every one to three months. It is important to stick to the diet as prescribed, as deviating even for one meal may reduce its effectiveness.
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The history of the diet
The Ketogenic Diet (KD) has been used as a treatment for intractable epilepsy since the 1920s. It was first proposed as a dietary treatment by Dr Russel M. Wilder, a physician at the Mayo Clinic in Minnesota. Wilder suggested that a specific diet could produce similar benefits to fasting, which was already recorded in the Hippocratic collection as the only therapeutic measure against epilepsy.
In the early 1920s, Drs. Stanley Cobb and W.G. Lennox of Harvard Medical School observed the effects of starvation as a treatment for epilepsy, noting that seizure improvement typically occurred after 2–3 days. Wilder studied a series of patients with epilepsy and demonstrated results equivalent to fasting that were maintained for a much longer period.
The KD is a high-fat, low-carbohydrate, and low-protein diet that alters the body's metabolism to use fats as a primary fuel source instead of carbohydrates. The classic KD has a fat-to-carbohydrate ratio of 4:1, which can be altered to 3:1 for moderate metabolism activity. The diet typically provides 90% of calories from fat, with the remaining 10% coming from proteins and carbohydrates.
The KD has been shown to be effective in treating epilepsy in children and adults, with some studies reporting a significant reduction in seizure frequency. It is often considered a last-resort treatment, but there is growing evidence that it should be used earlier in patients with well-defined indications. The diet is usually started in the hospital, with the patient fasting under close medical supervision for 18-24 hours before slowly introducing the new diet. It is important to note that the KD should be monitored by a healthcare provider, especially in the long term, as it may have side effects and may not be suitable for everyone.
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Frequently asked questions
The Ketogenic Diet (KD) is a high-fat, low-carbohydrate diet that can be used to treat epilepsy. The diet lowers the amount of carbs you eat and teaches your body to burn fat for energy instead.
The Ketogenic Diet works by altering the metabolism to use fats as a primary fuel source. Studies suggest that changes to your metabolism may affect how much energy is available for your neurons to activate a seizure under the keto diet.
The Ketogenic Diet can be used to treat epilepsy in both adults and children. However, infants need close monitoring. The diet is suitable for many different seizure types and epilepsy syndromes, but it may not work for everyone.
The length of time someone with epilepsy follows the Ketogenic Diet depends on their individual situation and response to the treatment. Some people may follow the diet for a few years if it helps manage their epilepsy well. If seizures have been controlled for some time, usually 2 years, a doctor might suggest discontinuing the diet.
