Ketogenic Diet for Epilepsy

The ketogenic or “keto” diet is a high-fat, low-carbohydrate, and moderate-protein eating plan used to help control seizures in people with epilepsy. It isn’t just a trend for weight loss; it’s a medically supervised treatment prescribed by a doctor and carefully managed by a dietitian. This diet is usually considered when regular anti-seizure drugs haven’t worked well enough, especially for people with epilepsy that is hard to treat. By cutting down on carbohydrates, the body starts using fat for energy instead of glucose. This causes a change called ketosis. This shift in energy use in the brain is believed to help lower the number and seriousness of seizures, giving an important option for people whose seizures are not managed by medicine alone.

What Is the Ketogenic Diet for Epilepsy?

The ketogenic diet for epilepsy is a specific meal plan that changes how your body gets energy. Instead of using carbohydrates for energy, this diet restricts carbs so the body burns fat instead. This fat burning creates ketones, which act as fuel for the brain. The goal is to keep the body in a steady state of ketosis, since this has been shown to help prevent seizures.

This isn’t a simple diet change; it is a medical treatment. The traditional “classic” ketogenic diet is strict, with exact amounts of calories, fluids, and proteins. All foods are weighed to get the right mix of nutrients. Because of the detail involved and the chance of missing key nutrients, the diet must be supervised by healthcare professionals, including a doctor and a dietitian.

Ketogenic Diet vs. Typical Diets

Most people get most of their energy from carbs found in foods like bread, pasta, and sugar. These carbs become glucose, which is the usual fuel for the body and brain. The ketogenic diet is very different. It provides a lot of fat, very few carbs, and a controlled amount of protein. For example, about 90% of calories might come from fat in the classic ketogenic diet, which is much higher than common eating patterns. With carbs so low, the body adapts to using fat for energy and makes ketones to feed the brain.

Unlike general healthy eating advice, the ketogenic diet is carefully measured and must be followed closely. Every meal needs careful preparation, and even small mistakes can affect how well the diet works. Standard diets don’t usually require this kind of detail or have major impacts on body chemistry, making the ketogenic diet a real medical treatment, not just a choice about lifestyle.

History of the Ketogenic Diet in Epilepsy

People have used diet to help with epilepsy for thousands of years. Ancient writings, like those from Hippocrates, mention using fasting to help people with epilepsy. This idea inspired modern versions of dietary therapy.

The current form of the ketogenic diet started in the 1920s. Doctors noticed that when people fasted, seizures often got better. Based on this, Dr. Russel M. Wilder at the Mayo Clinic developed a diet that could copy the effects of fasting by creating ketones in the body. He named it the “ketogenic diet” and found that it could help control seizures like fasting, but could be used longer. The recipe created by Dr. Wilder and further described by Dr. Peterman is similar to what is used today. This approach has continued to be used for epilepsy, especially when other treatments fail.

Why Use the Ketogenic Diet for Epilepsy?

The ketogenic diet is usually tried when medicines for seizures don’t work well enough. Many people, especially children, still have seizures even after trying many medications. In these cases, the ketogenic diet can make a big difference, lowering how often seizures happen and, sometimes, stopping them completely.

The diet works by changing how the brain uses energy, making it harder for seizures to start. Even though researchers are still learning exactly how it works, the strong link between food, energy use, and the brain has made this diet an important option for those whose seizures are hard to manage.

Who Might Benefit from the Ketogenic Diet?

The ketogenic diet is mainly for people whose seizures aren’t well controlled by medicines. It’s most often recommended for children with hard-to-treat epilepsy, but some adults can benefit too. Originally, the strict version of the diet was mostly for kids, but newer, easier versions like the Modified Atkins Diet mean more teens and adults can try dietary approaches.

Anyone with epilepsy might be considered for the diet, unless they have other health problems that would make it unsafe, such as certain metabolism disorders. It’s often a good choice for those who can’t have epilepsy surgery. Some people hope to eventually stop or lower their medicine after starting the diet. For many, this approach can be life-changing.

Epilepsy Types Most Helped by the Diet

Some kinds of epilepsy and seizure types respond better to the ketogenic diet than others. The diet has been shown to help with:

• Infantile spasms
• Rett syndrome
• Tuberous sclerosis complex
• Dravet syndrome
• Doose syndrome
• GLUT-1 deficiency

For certain rare metabolism diseases, like GLUT-1 deficiency syndrome and pyruvate dehydrogenase deficiency, the diet is the main treatment. It can also help with focal seizures in kids and is used for many different seizure types. Even infants, including those fed by tube, may benefit from the diet. Its wide range of use makes it an important tool for all ages with different seizure types.

How Does the Ketogenic Diet Help Lower Seizures?

Scientists don’t know every detail about why the ketogenic diet helps with seizures, but research shows it changes metabolism and brain chemistry in ways that help stop or reduce seizures. The switch from using sugar to fat for energy leads to a range of changes that help calm brain activity.

Ketone Bodies and Their Effects

A main effect of the ketogenic diet is raising ketone levels in the body. With less carbohydrate, the body starts using fat for fuel, creating ketones in the liver. These ketones, such as acetoacetate and β-hydroxybutyrate, are then used by the brain. The higher these levels, the more often people see better seizure control. Some research suggests ketones may lower certain brain signals that start seizures or make the brain’s energy use more steady, reducing the chance of a seizure occurring.

Effects on Brain Chemistry and Energy

The ketogenic diet doesn’t only create ketones. It also changes the brain’s energy use and balances important chemicals. Usually, the brain runs on glucose (sugar), which is quick fuel. The switch to using ketones provides a more steady supply of energy. This makes it harder for the brain to have the bursts of activity that cause seizures.

The diet may also raise levels of GABA, the main calming chemical in the brain, and improve how cells produce energy. This can help slow down overly active nerves that cause seizures and make the brain more stable overall.

Gut Health and Inflammation

Newer studies suggest the ketogenic diet may help by changing the types of bacteria in the gut and lowering inflammation. The diet can increase certain helpful bacteria and lower the number of others, which may change chemicals that reach the brain and help control seizures.

It also seems to reduce chemicals in the body that cause inflammation, which can make seizures worse. By lowering these, the diet may quiet excessive brain activity, showing that its benefits go beyond just energy use in the brain.

Types of Ketogenic Diets for Epilepsy

The basic idea of a high-fat, low-carbohydrate diet is the same, but there are different versions of the ketogenic diet. These options give more flexibility and help more people stick with the diet while still helping control seizures. A healthcare team helps decide which diet is best, based on each person’s needs.

Classic Ketogenic Diet

This is the original and strictest version. It uses a calculated ratio of fat to carbs/protein, usually 4:1. That means for every 4 grams of fat, there is 1 gram of carbohydrates and protein combined – about 90% of calories are from fat. Each meal must be weighed and measured, and the dietitian gives very exact guidelines. Because it is so restrictive, it’s usually for children and started in a hospital or clinic under direct supervision.

Medium Chain Triglyceride (MCT) Diet

The MCT diet uses special fats called medium-chain triglycerides, which produce ketones more quickly. This lets people eat more carbohydrates and protein than with the classic diet. MCT oil is usually given as a supplement, and people can have a slightly wider variety of foods. This version can be easier for some to follow and often helps people stick with the diet longer.

Modified Atkins Diet (MAD)

The Modified Atkins Diet is less strict than the classic diet but still aims for high fat and limited carbs. Food doesn’t need to be weighed as precisely, fewer calories are counted, and people have more freedom With what they eat, though high-fat intake is still encouraged and carbs are limited to about 10-20 grams per day. It was designed for older children and adults who found the classic diet difficult, but who still need seizure control from a low-carb, high-fat approach.

Low Glycemic Index Treatment (LGIT)

The LGIT allows a somewhat higher amount of carbohydrate than the classic diet but focuses on carbs that have a low effect on blood sugar. Fats comprise about 60% of calories, protein 30%, and carbs 10%. Because it allows more regular food and is easier to follow, this option works for some people, yet still helps many people reduce seizures.

Starting the Ketogenic Diet for Epilepsy

Starting the ketogenic diet for epilepsy is a planned and supervised process. It requires careful review and guidance from a doctor and dietitian and involves a step-by-step plan to make sure the diet is safe and meets each person’s needs. It should never be started without help from medical professionals.

Before Starting: Evaluation and Planning

• Physical checkup to look for problems that might make the diet unsafe
• Nutrition review, including a 3-day food diary and checking for food allergies
• Measure weight, height, and BMI to help set calorie and fluid needs
• Lab tests: blood count, electrolytes, kidney and liver function, cholesterol, vitamins (especially D and B vitamins), and minerals
• EEG or brain scan might be needed
• Keep a seizure diary to record how often seizures happen before starting
• Counseling with the family to talk about what to expect and possible side effects

How the Diet Is Started

Beginning the diet is often done in a hospital, especially for children, to monitor for any problems. Some centers used to start with a short fast of about 18-24 hours, but fasting isn’t always needed. Most places now start the diet slowly, increasing the ratio of fat to carbs over several days or weeks.

• Close monitoring ensures meals are carb-free and medicines don’t contain hidden sugars
• The body starts to make ketones after a few days
• Patients may feel tired or sluggish in the first days as the body switches to fat for fuel
• The team gives full instructions on how to plan meals and what to watch out for

Foods and Meal Planning

Planning meals for the diet is very detailed. For the classic diet, all foods are weighed. High-fat foods such as butter, cream, mayonnaise, and oils are encouraged. Carbs are limited, so grains, most fruits, starchy vegetables, and processed foods are avoided. A dietitian helps figure out meal plans that fit the diet but still match the person’s tastes. Modified versions may allow more flexible portion sizes and foods like certain nuts, seeds, and low-starch vegetables.

Monitoring Progress on the Ketogenic Diet

Once on the diet, regular check-ins with nurses, doctors, and dietitians are needed to make sure the diet is working and to address any problems. Progress is watched using both physical checkups and laboratory tests.

Tracking Seizures and Clinical Checkups

• Keep a daily record of seizures: number, type, and duration
• Doctors check on overall health, mood, alertness, and growth (especially in kids)
• Regular visits are usually every 1 to 3 months

Laboratory Monitoring

• Check blood and urine for ketone levels
• Blood tests to monitor cholesterol, kidney, and liver function, and check for vitamin and mineral deficiencies
• Adjust supplements as needed (calcium, vitamin D, B vitamins, selenium etc.)
• Screen for kidney stones with ultrasound, if needed

How Well Does the Ketogenic Diet Work for Epilepsy?

Many studies show the ketogenic diet can cut down the number of seizures for people whose seizures aren’t managed with medicine, and sometimes it stops seizures completely. Success rates vary, and not everyone sees major improvements, but the diet can offer real hope, especially when other options have failed.

Results in Children and Adults

• In children, more than 50% may have their seizures cut in half or better, and about 10-15% may become seizure-free
• In adults, about half may see fewer seizures; a smaller percentage can become seizure-free, especially with the less strict modified diets
• Formula-only diets often work well for young children or infants

How Long to Continue the Diet?

• Usually, the diet is tried for at least 3 months before making judgments on effectiveness
• If it works well, doctors may advise staying on it for around 2 years
• Coming off the diet is done slowly, over several months
• Some people may choose to stay on the diet for longer if their seizures are still much less frequent

Risks and Side Effects of the Ketogenic Diet

The ketogenic diet can cause side effects, which may appear soon after starting or develop over time. Most side effects are mild and go away as the body gets used to the new diet, but some risks require careful monitoring by a doctor and dietitian.

Common Side Effects

• Tiredness or sluggishness at first, especially in children just starting the diet
• Stomach issues like constipation, diarrhea, nausea, or belly pain
• Increased hunger at the beginning
• Many feel more alert and energetic after getting used to the diet

Possible Long-Term Risks and Prevention

• Kidney stones – regular checks and drinking enough fluid can help prevent this
• High cholesterol – usually levels go back to normal after some time, but should be watched
• Constipation – managed by adjusting diets and sometimes using fiber supplements
• Slowed growth in children and weaker bones (reduced bone density), so extra calcium and vitamin D are usually added
• Regular blood tests and doctor visits can catch problems early, and taking supplements helps cover any nutritional gaps

How Does the Diet Interact with Seizure Medicines?

The ketogenic diet is almost always used along with anti-seizure medicines, not as a total replacement. Medicines should never be stopped or changed quickly without advice from a doctor. The diet may make it possible to use less medicine if seizures improve with treatment.

Making Changes to Medicine

• People usually keep taking their seizure medicines at first
• Doctors will check medicines for hidden sugars
• Any changes to medicine doses are only made after seeing how the diet is working – this is done slowly and only under medical supervision

Can Medicine Be Reduced?

• If the diet controls seizures, it may be possible to lower medicine doses after 1-2 months
• This decision is made carefully by the doctor, looking at seizure control and overall health
• Some people may be able to get by with fewer medicines, but the diet usually works best as part of an overall treatment plan

Finding Support and Resources for the Ketogenic Diet

Managing the ketogenic diet can be stressful, but many resources and support groups can help patients and families. You shouldn’t try this diet on your own – expert help is needed for the best results.

Where to Find Help

• Special epilepsy centers and hospitals often have diet programs
• Specialist teams include neurologists, dietitians, and nurses with experience in managing the ketogenic diet
• Examples: Johns Hopkins Medicine has long experience and offers help for children and adults; many similar centers exist worldwide
• Some centers offer remote consultations or second opinions

Helpful Tools and Information

• Parent-run organizations like The Charlie Foundation and Matthew’s Friends offer advice and connect families
• Websites such as Epilepsy.com and publications like “The Ketogenic Diet: A Treatment for Children and Others with Epilepsy” give detailed advice
• Webinars and interviews with leading doctors explain how the diet works and what to expect
• Meal plans, recipes, and food lists are frequently available from hospitals or support groups