Leena Watts
Diet and nutrition can play a role in managing epilepsy and seizures. While there is little evidence that diet directly affects seizures, a balanced diet with adequate hydration can help maintain energy levels and reduce the risk of seizures. Certain diets, such as the ketogenic diet and the modified Atkins diet, are recommended for people with epilepsy who do not respond well to medication or surgery. These diets are typically high in healthy fats and low in carbohydrates and sugar, which can cause spikes in blood sugar levels and increase the risk of seizures. It is important to note that dietary changes should be made under medical supervision, and a doctor or dietitian can help determine the best approach for an individual's needs.
| Characteristics | Values |
|---|---|
| Diets that may help with seizures | Ketogenic diet, Modified Atkins diet, Low glycemic index diet |
| Who should follow these diets | People with epilepsy, especially those with drug-resistant epilepsy or reflex epilepsy |
| Foods to avoid | Sugary foods, refined foods, caffeine, alcohol, high-carbohydrate foods |
| Foods to include | High-fat foods, protein, fruits, vegetables, omega-3 and omega-6 fatty acids |
| Other considerations | Consult a doctor or dietitian before starting any diet, ensure adequate hydration, be mindful of medication interactions |
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Ketogenic diet
The ketogenic diet is a high-fat, low-carbohydrate, controlled-protein diet that has been used to treat epilepsy since the 1920s. The diet is typically recommended for children whose seizures have not responded to several different seizure medications. The "classic" ketogenic diet is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. Foods are weighed and measured, and the total calories are matched to the number of calories the person needs.
The name "ketogenic" refers to the production of ketones in the body (keto = ketone; genic = producing). Ketones are formed when the body uses fat for energy instead of carbohydrates. The diet is carefully monitored by a dietitian to ensure that it is adapted to the patient's dietary preferences and needs. Before starting the diet, the patient should maintain a seizure diary and undergo a series of laboratory evaluations, including an electroencephalogram (EEG) and a magnetic resonance image (MRI) of the brain.
Several studies have shown that the ketogenic diet can reduce or prevent seizures in 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 children become seizure-free. The diet may also lead to other benefits, such as increased alertness, awareness, and responsiveness.
The ketogenic diet may not work for everyone, and it is not recommended for those with severe feeding problems or conditions where a high-fat diet would be problematic. Additionally, the restricted food choices make it challenging for adults to follow, and it is usually not recommended for this reason. However, the modified Atkins diet is a less restrictive alternative that has been shown to be as effective as the classic ketogenic diet in reducing seizure frequency.
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Modified Atkins diet
The Modified Atkins Diet (MAD) is a less restrictive variation of the ketogenic diet. It was developed in the United States in 1970 by Robert C. Atkins, initially for weight loss. The diet is “modified” in that the induction phase of the diet, which limits carbohydrates, is maintained indefinitely, and fat intake is encouraged rather than simply allowed. The goal of the modified version is seizure control, rather than weight loss.
The Modified Atkins Diet consists of about 65% fat, 25% protein, and 10% carbohydrates. It does not restrict calories, protein, or fluids. It is started on an outpatient basis without a fast and does not require food to be weighed. People on the diet may need to take supplements as recommended by their healthcare provider.
The Modified Atkins Diet has been shown to be effective in reducing seizures in people with drug-resistant epilepsy. Several studies have shown that the diet is associated with a 50% or greater reduction in seizure frequency compared to a usual diet. The diet has been found to be about as effective as the ketogenic diet in reducing seizure frequency in children and adolescents after three and six months of use.
It is important to note that the Modified Atkins Diet should be followed under medical supervision. It is also crucial to maintain a balanced diet and ensure sufficient essential nutrient intake, as food and diet do not replace medications.
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Foods to avoid
While there is little evidence that diet directly affects seizures, a balanced diet is important for overall health and can help to reduce some seizure triggers. Eating regular, well-balanced meals can help to keep blood sugar levels stable and energy levels steady, which may help to reduce the risk of seizures.
For those with epilepsy, certain foods may need to be avoided or limited. These include foods that are high in sugar, have a high glycemic index, and cause energy peaks and slumps. Extreme high or low blood sugar, missing meals, and sudden spikes or crashes of blood sugar can increase the risk of seizures.
Foods and drinks that contain stimulants, such as caffeine and chocolate, may also need to be avoided as they can interfere with epilepsy medication or other nervous system pathways. Alcohol can also increase the risk of seizures and create risk factors through interactions with medications.
A diet high in salt may also be problematic as it can cause an electrolyte imbalance in the body by increasing sodium levels, which could disrupt electrical signaling in the brain and potentially lead to a seizure.
In rare cases of reflex epilepsy, seizures may be triggered by specific foods, flashing lights, loud noises, or the taste or smell of certain foods. While there is no high-quality evidence, some people believe that colourings and preservatives, such as monosodium glutamate (MSG) or artificial sweeteners, can trigger seizures.
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Balanced diet
While a balanced diet may not directly affect seizures, it is important for overall health and can help reduce some seizure triggers. A balanced diet can help maintain steady energy levels and provide the body with essential nutrients to function optimally. It can also help to regulate blood sugar levels and ensure proper hydration, both of which are important factors in seizure management.
A balanced diet typically includes a variety of nutritious foods from different food groups, such as carbohydrates, fats, proteins, vegetables, fruits, and fluids. The NHS Eatwell Guide provides recommendations on the proportions of each food group to include in a healthy, balanced diet. It is important to note that dietary changes should be discussed with a doctor or dietitian, especially for individuals with epilepsy or seizure disorders.
For individuals with epilepsy, a balanced diet can contribute to overall health and epilepsy management. While most people with epilepsy can eat a wide variety of foods without affecting their seizures, certain foods may be seizure triggers for those with rare types of epilepsy, such as reflex epilepsy. Foods with high sugar content, a high glycemic index, or stimulants like caffeine and alcohol may increase the risk of seizures by interfering with medication or affecting blood sugar levels. Therefore, a balanced diet that avoids specific triggers and maintains stable blood sugar and energy levels can be beneficial for individuals with epilepsy.
In some cases, doctors may recommend specific diets, such as the ketogenic _(keto)_ diet or the modified Atkins diet, to help reduce seizure frequency. These diets are typically suggested when seizures are not adequately controlled by medication or when medication side effects are a concern. The keto diet is a strict regimen that is high in fat and low in carbohydrates, designed to induce a state of ketosis where the body uses fat for energy. The modified Atkins diet is a less restrictive alternative that offers similar seizure reduction results, consisting of about 65% fat, 25% protein, and 10% carbohydrates. It is important to note that these specialized diets should be followed under medical supervision and may require supplementation to ensure adequate nutrient intake.
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Lifestyle changes
While medication is the primary treatment for epilepsy, certain lifestyle changes can help manage the condition and reduce the frequency of seizures. These include dietary modifications, adequate hydration, regular sleep, and avoiding potential triggers. Here are some detailed instructions for each of these lifestyle changes:
Dietary Modifications:
- A ketogenic diet is a specialised high-fat, low-carbohydrate, and low-protein diet that has been shown to help control seizures, especially in children with drug-resistant epilepsy. It is important to note that this diet should be carefully monitored by a physician and a dietitian. The ketogenic diet includes high-fat foods like mayonnaise, butter, and heavy cream, small portions of fruits, cheese, meat, fish, and poultry. It is crucial to avoid sugar and carefully measure and weigh food portions.
- A modified Atkins diet is a less restrictive alternative to the ketogenic diet, offering similar seizure reduction results. It consists of about 65% fat, 25% protein, and 10% carbohydrates. This diet does not require the weighing of food or restrictions on calories, protein, or liquids. However, supplements may be recommended by a healthcare provider.
- In general, it is recommended to limit sugary foods and prioritise whole foods, fruits, and vegetables with high fibre content and a low glycemic index. These dietary changes can help manage blood sugar spikes and improve overall health.
Hydration:
Staying well-hydrated is essential for individuals with epilepsy. Alcoholic drinks should be avoided or limited as they can increase the risk of seizures and cause dehydration.
Sleep:
Maintaining a regular sleep pattern can help reduce the risk of seizures. Getting adequate sleep allows the brain to recover and function well, which may positively impact seizure management.
Trigger Avoidance:
Certain triggers, such as flashing lights, loud noises, and specific food ingredients, can induce seizures in individuals with reflex epilepsy. It is important to identify and avoid these triggers. Common dietary triggers may include caffeine (found in coffee, tea, energy drinks, etc.), alcohol, high amounts of salt, and foods with a high glycemic index that can cause energy peaks and slumps.
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Frequently asked questions
The ketogenic diet is a high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. The diet is intended to induce a metabolic state called ketosis, which causes the body to use substances called ketones (broken down from fats) for energy instead of glucose. This diet is usually recommended for children whose seizures do not respond to medications, but growing evidence supports its use in adults as well.
Foods that are high in sugar and have a high glycemic index (quickly raising blood sugar) can be problematic. Extreme high or low blood sugar can increase the risk of seizures. Foods that contain stimulants, such as caffeine and alcohol, may also trigger seizures by interfering with epilepsy medication.
Yes, a modified Atkins diet is another option that has been found to be effective in reducing seizure frequency. This diet consists of about 65% fat, 25% protein, and 10% carbohydrates. Unlike the ketogenic diet, it does not require food to be weighed and has fewer restrictions.
