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.

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 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 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


  1. 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/
  2. 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
  3. 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.
  4. 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
  5. 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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