Keto Diet for Epilepsy

What is the ketogenic diet for epilepsy

The keto diet for epilepsy is a high fat, low carbohydrate, and adequate protein diet. It works by changing the body’s metabolism to help manage epilepsy symptoms.

Normally, the body uses glucose for its energy source. Glucose comes from carbohydrates in foods like sugar, bread, or pasta. The ketogenic diet uses ketones made from fats instead of glucose for the energy source. This process is called ketosis.

keto=ketone
genic= producing

The word “ketogenic” means that ketones are made in the body. This means that the body is in ketosis and produces ketones while on the diet.

How effective is the medical ketogenic diet?

The keto diet was introduced as an alternative way to manage epilepsy over 100 years ago. Since that time, there have been many studies that show that this diet successfully helps manage epilepsy symptoms.¹⁻⁴
For children on the ketogenic diet:

50% or more will have improvement in epilepsy symptoms
34% had fewer seizures¹
15% had no seizures²

For adults on the keto diet:

53% had improvement in epilepsy symptoms³
13% had resolution of epilepsy symptoms⁴

The keto diet may also be successful in managing adults and children that have other epilepsy-related conditions.²

These other epilepsy-related conditions include:

Myoclonic-astatic epilepsy (also called Doose syndrome)
Rett syndrome
Glucose transporter-1 (GLUT-1) deficiency syndrome
Pyruvate dehydrogenate deficiency
Tuberous sclerosis complex
Dravet syndrome
Super refractory status epilepticus
Children on all-liquid or formula keto diet (taken orally or through a feeding tube)

What are the benefits of the medical ketogenic diet?

About 30% of adults and 25% of children on AEDs still have epilepsy symptoms⁵. So, for many people with intractable or refractory epilepsy, the keto diet can help improve their quality of life. The keto diet has been found to be successful in many people. It can help manage their epilepsy symptoms.

10-15% of individuals will have complete resolution of their epilepsy symptoms

1 in 3 will have at least 90% improvement in their epilepsy symptoms

50% of individuals will have at least 50% improvement in their epilepsy symptoms

Improved sleep, quality of life, behaviour

What are the different types of keto diets?

There are several different kinds of keto diets for epilepsy. All are low in carbohydrates and high in fat. Your doctor will work with you to select the most appropriate diet for you. The different types of keto diet include:

Classical Ketogenic Diet: known as the original medical ketogenic diet for epilepsy that was invented over 100 years ago. It is the most restrictive of all the medical keto diets. Careful measurements calories, fluids, protein, fat and carbohydrates.
Modified Ketogenic Diet: a lower ratio version of the classical keto diet. It is less strict than the classical keto diet, as ratios are typically a 1:1 or a 2:1.
Medium-chain triglyceride diet (MCT): similar to the classical keto diet. On this diet, a special type of oil that is called medium chain triglyceride oil (or MCT oil) is consumed. Instead of eating fats found in normal foods, a person uses MCT oil as a fat supplement. Sometimes more carbohydrates are allowed on this diet than the other diets.
Modified Atkins diet (MAD): more flexible than the classical keto diet. Focus is on the amount of carbohydrates consumed. Fat is encouraged, and more protein may be allowed on the modified Atkins diet. Portion sizes are used to determine the amount of food eaten. It can be used for older children and adults.
Low glycemic index treatment (LGIT): a more liberal version of the ketogenic diet. It focuses on how carbohydrates affect the level of glucose in the blood. It allows for more carbohydrates to be consumed. These carbohydrates are limited to those with a low glycemic index (a glycemic index ≤50). Approximate portion sizes are used. Fats are ~60% of the caloric intake and protein is ~30% of the calories consumed.

What are the side effects of the keto diet?

The ketogenic diet has side effects. But it has fewer side effects than most of the AEDs that are available today. Many of these side effects are short-term, and will subside once the body has adjusted to the diet.

The possible side effects include:

No weight gain or weight loss
Decreased growth
High cholesterol
Constipation, diarrhea, vomiting, or other gastrointestinal symptoms
Gastroesophageal reflux
Kidney stones
Acidosis
Fainting or lack of energy
Muscle cramps
Hunger
Taste problems
Menstrual cycle irregularities

What is the ketogenic ratio?

In the typical North American diet, the majority of calories consumed are from carbohydrates. However, the keto diet strictly limits the amount of carbohydrates and protein consumed.

The ketogenic diet ratio is the ratio of fat to combined carbohydrates and protein. A dietitian determines the ratio for each individual based on age, weight, and epilepsy condition.

A 4:1 ketogenic diet ratio:

4 grams of fat are consumed for every 1 gram of combined carbohydrate and protein consumed
This means about 90% of calories consumed are from fat

A 3:1 ketogenic diet ratio:

3 grams of fat are consumed for every 1 gram of combined carbohydrate and protein consumed
About 87% of calories consumed are from fat

When is the medical ketogenic diet recommended?

The ketogenic diet is primarily recommended for children and adults with intractable epilepsy. It can also help those who may suffer from other epilepsy-related conditions. Please consult with your healthcare professional to know if the keto diet is right for you.

How do I start the medical Ketogenic Diet

Starting a ketogenic diet is a process that takes time. It cannot be done alone. First, you need to visit a ketogenic diet center to be evaluated.
Starting and staying on the diet is a team effort that involves the entire family and your assigned ketogenic diet team (including a dietitian, neurologist, and others).
Typically, the classic ketogenic diet is started over a 3-day period – either in the hospital or at home on an outpatient basis. Either way the person starting the diet will be closely monitored and receive a lengthy education about the diet.

How long will it take to know if the keto diet is working?

The diet should be tried for at least 3 months to see if it is working. For some individuals, improvements happen soon after starting. But for others, it may take longer. Sometimes diet adjustments are needed. The actual length of time will be determined by your healthcare professional.

If the diet is working, it may be recommended to stay on the diet for at least 2-3 years
Some children stay on the diet through adolescence
In some medical conditions, the diet may be life-long.

Children and adults can remain on the diet for many years and sometimes for life. The decision to come off or remain on the diet depends on your response to the diet, your epilepsy symptoms, side effects, and how easy or burdensome the diet is to daily life. How long you continue on the diet will be determined by you and your ketogenic team.

Is there any special testing or monitoring required?

Once the diet has started, you will meet regularly with your doctor or dietitian to ensure that nutritional and developmental needs are fully met. Monitoring for potential side effects is routinely assessed. Adjustments to the diet may be made depending on results. To monitor for ketosis, ketone levels in the urine can also be checked easily at home using keto strips as well as in the blood at the hospital. Regular monitoring of laboratory values such as vitamin and mineral levels, as well as electrolyte levels will occur at your routine clinic appointments.

References

Freeman JM, Vining EP, Pillas DJ, Pyzik PL, Casey JC, Kelly LM. The efficacy of the ketogenic diet-1998: a prospective evaluation of intervention in 150 children. Pediatrics. 1998 Dec;102(6):1358-63. Available from: https://pubmed.ncbi.nlm.nih.gov/9832569/
Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the international ketogenic diet study group. Epilepsia. 2009;50(2):304-317. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1528-1167.2008.01765.x
Liu H, Yang Y, Wang Y, et al. Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies. Epilepsia Open. 2018;3:9-17.
Barborka CJ. Epilepsy in adults: results of treatment by ketogenic diet in one hundred cases. Archives of Neurology & Psychiatry. 1930 May 1;23(5):904-14. Available from: https://jamanetwork.com/journals/archneurpsyc/article-abstract/644550
Epilepsy Foundation. Drug-Resistant Epilepsy [Internet]. 2020 [updated 2020 October 5; cited 2021 May 15]. Available from: https://www.epilepsy.com/learn/drug-resistant-epilepsy

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