Madeleine Hull
The ketogenic diet is a high-fat, low-carbohydrate meal plan that has been used to treat epilepsy since the 1920s. The diet is designed to manage seizures in patients who have not responded to medication. While the ketogenic diet is not endorsed by all hospitals, it is recommended by some, including Johns Hopkins Hospital, Great Ormond Street Hospital, and Cleveland Clinic. The diet is usually prescribed by a physician and monitored by a dietitian, and it often involves a period of fasting before it is begun.
| Characteristics | Values |
|---|---|
| Number of hospitals recommending the ketogenic diet for epilepsy | At least 3 (Johns Hopkins Hospital), Cleveland Clinic, Great Ormond Street Hospital |
| Types of hospitals | Pediatric epilepsy centres, non-profit academic medical centres |
| Ketogenic diet characteristics | High-fat, low-carbohydrate, controlled protein |
| Dietary treatment recommended when | At least 2 suitable medications have been tried and not worked |
| Who should the diet be followed with | Support of an experienced epilepsy specialist and dietitian/food specialist |
| Who should the diet be discussed with | Healthcare provider, GP, paediatrician/neurologist |
| Who should monitor the diet | A neurologist, a registered dietitian specializing in the ketogenic diet |
| Who the diet is recommended for | Children with refractory (treatment-resistant) epilepsy, adults with epilepsy |
| Success rate | Studies show about a third of children with epilepsy 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. |
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What You'll Learn
Ketogenic diet as an alternative to medication
The ketogenic diet is a well-known, alternative treatment for epilepsy that has been used since the 1920s. It is a high-fat, low-carbohydrate diet that is designed to control seizures by inducing a state of ketosis. This switches the body's metabolism from burning glucose for energy to using ketone bodies. The diet is often recommended for children with refractory (treatment-resistant) epilepsy, but it can also benefit adults with epilepsy.
The ketogenic diet is a very strict and restrictive meal plan that requires a high level of commitment and patience, especially in the beginning. It is typically recommended when at least two suitable medications have been tried and have not worked. The diet is usually prescribed by a physician and carefully monitored by a dietitian to ensure it is nutritionally balanced. The patient's meal ratio is calculated, and they are educated on how to maintain the diet. The diet can be started in hospital with a fasting period of 18 to 24 hours, although this is not necessary.
There are several variations of the ketogenic diet, including the Classic Ketogenic Diet (CKD), the Modified Ketogenic Diet, the Medium Chain Triglyceride (MCT) Diet, the Modified Atkins Diet (MAD), and the Low-Glycemic Index Treatment (LGIT). The classic diet is the most restrictive, with a ratio of 4:1 or 4 grams of fat for every 1 gram of protein and carbohydrate. The modified Atkins diet is less restrictive and generally follows a ratio of 1:1. The MCT diet focuses on consuming MCT fats, which can make up 60% of a person's calorie intake.
Studies have shown that the ketogenic diet can be effective in reducing seizures. Research shows that the diet may reduce the number of seizures by more than half after three months. A clinical trial at Great Ormond Street Hospital in 2008 showed that around 4 in 10 children who started the ketogenic diet had reduced seizures and were able to reduce their anti-seizure medication. Other studies have shown that around a third of children with epilepsy who follow the diet will have at least a 90% reduction in seizures, while another third will experience a reduction of between 50% and 90%. Some people have even reported becoming completely seizure-free on the diet.
The ketogenic diet for epilepsy is a well-established alternative treatment that has been shown to be effective in reducing seizures. It is important to note that the diet should only be followed under the supervision of a trained medical specialist and a dietitian to ensure it is safe and nutritionally balanced.
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Ketogenic diet for adults with epilepsy
The ketogenic diet is a high-fat, low-carbohydrate meal plan designed to help manage seizures in people with epilepsy. It has been used as a treatment for epilepsy since the 1920s and is usually considered when two suitable medications have been tried and proven unsuccessful. The diet is typically used in children whose seizures have not responded to several different medications, but it can also be effective in adults.
The diet is carefully monitored by a physician and a dietitian to ensure it is nutritionally balanced. The dietitian calculates the diet, including foods the patient likes, and recommends any necessary vitamin and mineral supplements. The ketogenic diet can be adapted to different cultures and for people with allergies or those on modified texture diets.
There is growing evidence supporting the use of ketogenic diets in the management of drug-resistant epilepsy in adults. A 2011 review of dietary treatments in adults showed that 49% of 206 patients experienced a ≥50% seizure reduction, with 13% becoming seizure-free. A subsequent meta-analysis of 12 studies found that the efficacy rates of the classic ketogenic diet in adult intractable epilepsy ranged from 13 to 70 percent, with a combined efficacy rate of 52%.
However, the classic ketogenic diet is not usually recommended for adults because the restricted food choices make it hard to follow. The modified Atkins diet is generally considered more suitable for adults as it is less restrictive and allows for more protein. A major barrier to the use of ketogenic diets in adults is the lack of access to the treatment, as very few epilepsy centres offer ketogenic diets to adult patients.
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Ketogenic diet for children with epilepsy
The ketogenic diet is a high-fat, low-carbohydrate, controlled-protein diet that has been used to treat epilepsy since the 1920s. It is usually considered only when at least two suitable medications have been tried and proven unsuccessful. The diet is nutritionally unbalanced, and children following it will need vitamin and mineral supplements. It is typically recommended for children whose seizures have not responded to several different medications.
The diet is carefully monitored by a dietitian and prescribed by a physician. It is usually started in a hospital, where the child is admitted for 4-5 days while their body starts producing ketones. During this time, the child's family is educated about the diet. The diet is very strict, and even a small snack high in carbohydrates can stop ketosis. All foods must be weighed using a food scale, and the child's meals must be planned.
The ketogenic diet has proven effective in managing seizures. Several studies have shown that the diet can reduce or prevent seizures in many children whose seizures could not be controlled by medications. Over half of the children who go on the diet experience at least a 50% reduction in seizures, and some become seizure-free. A clinical trial at Great Ormond Street Hospital in 2008 showed that around 4 in 10 children who started the ketogenic diet had reduced seizures and were able to reduce their anti-seizure medication.
The diet works by causing the body to produce ketones, which are formed when the body uses fat for energy. Normally, the body uses carbohydrates for fuel, but because the ketogenic diet is very low in carbohydrates, fats become the primary energy source. Ketones are not dangerous and can be detected in the urine, blood, and breath.
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Ketogenic diet for pregnant people with epilepsy
The ketogenic diet is a high-fat, low-carbohydrate diet that has been used to treat epilepsy since the 1920s. It is typically recommended for children with refractory epilepsy whose seizures have not responded to several different medications. The diet is carefully monitored by a physician and a
Pregnant people with epilepsy may also benefit from the ketogenic diet as a non-pharmacological therapy. A 2014 study reported that 45% of adolescents and adults with epilepsy experienced a reduction in seizure frequency of 50% or greater on the ketogenic diet. Another study from 2017 suggested that the keto diet may help pregnant people control seizures and use lower doses of epilepsy drugs during pregnancy. However, it is important to note that the safety of this approach has not been established, and further monitoring is needed to identify potential long-term side effects.
Case studies have shown that the ketogenic diet may be effective in reducing seizure frequency during pregnancy. In one case, a 27-year-old pregnant woman followed the classic ketogenic diet with a medium-chain triglyceride (MCT) emulsion and a carbohydrate restriction of 75 grams, later reduced to 47 grams. This resulted in decreased seizure frequency and more seizure-free days. Mild side effects included intolerance to MCT, reduced serum carnitine and vitamin levels, and mild hyperlipidemia.
In another case, a 36-year-old pregnant woman was treated with a modified Atkins diet, a less restrictive form of the ketogenic diet, with a 20-gram carbohydrate restriction and lamotrigine. Prior to pregnancy, this resulted in a reduction of seizure frequency to once per month. During pregnancy, the carbohydrate intake was increased to 30 grams, and when seizures increased, the lamotrigine dose was doubled. Urine ketones decreased during the second trimester, and the child was born with bilateral ear deformities of unknown significance but normal neurodevelopment at eight months.
While the ketogenic diet may offer benefits for pregnant people with epilepsy, it is important to consult with a healthcare provider before starting any new diet, especially during pregnancy. A healthcare provider can determine if the keto diet is safe for an individual and provide guidance on meal planning and nutritional considerations.
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Ketogenic diet as a short-term treatment
The ketogenic diet is a high-fat, low-carbohydrate meal plan designed to manage seizures in people with epilepsy. It is usually considered when medications have failed to produce the desired results. The diet has been used to treat epilepsy since the 1920s and is an established treatment option for children with hard-to-control epilepsy. It can also benefit adults with epilepsy.
The ketogenic diet works by changing the way the brain gets energy to function. Normally, the body uses glucose from carbohydrates as its primary source of energy. However, the ketogenic diet restricts carbohydrates, causing the body to use fats as its primary fuel instead. This leads to the production of ketones, which have been linked to improved seizure control.
The classic ketogenic diet is a strict and highly structured meal plan that requires careful monitoring by a physician and a dietitian. It is typically high in fat, low in carbohydrates, and moderate in protein. The modified Atkins diet is another option that is less restrictive and allows for more flexibility in protein intake.
As a short-term treatment, the ketogenic diet has been shown to be effective in reducing seizures. Research indicates that the diet may reduce seizure frequency by more than half after just three months. Some people even report becoming seizure-free on this meal plan. The diet can be adapted to different cultural diets and individual preferences, making it accessible to a wide range of people.
However, it is important to note that the ketogenic diet may not work for everyone and is not suitable for those with severe feeding problems or conditions where a high-fat diet could be detrimental. Common side effects at the start of treatment include constipation, hunger, vomiting, and lack of energy. These tend to decrease over time and can be avoided with careful monitoring. It is crucial to work closely with a healthcare provider to ensure the safety and effectiveness of the ketogenic diet as a short-term treatment for epilepsy.
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Frequently asked questions
The ketogenic diet is a high-fat, low-carbohydrate meal plan designed to manage seizures in people with epilepsy. It is generally used when other treatments have failed to produce the desired results.
While the exact number of hospitals recommending the ketogenic diet for epilepsy is unclear, several hospitals and medical centres are known to endorse it. These include Johns Hopkins Hospital, Cleveland Clinic, Great Ormond Street Hospital, and the Mayo Clinic.
The ketogenic diet has been shown to reduce seizures in many people with epilepsy. Studies indicate that about a third of children with epilepsy on the ketogenic diet experience a 90% reduction in seizures, while another third see a 50-90% decrease. Some individuals even become seizure-free. The diet may also provide other benefits, such as increased alertness, awareness, and responsiveness.
The ketogenic diet is very restrictive and must be carefully monitored by trained medical specialists, including neurologists and licensed dietitians. It may cause fatigue and weakness initially, and individuals may need to take vitamin and mineral supplements to compensate for nutrient deficiencies. It is important to maintain a state of ketosis by keeping daily carbohydrate intake low.
