Keto for Epilepsy
Ketogenic Therapies and brain surgery are the only known cures for Epilepsy. Half of the people with epilepsy who try the diet have a seizure reduction of at least 50%. Up to 25% become completely seizure free. In the sections below, we explain how Ketogenic Therapies compare to anti-epileptic medications, how keto’s mechanisms are thought to affect the body, and stories from a few of the thousands of families who have had amazing results by implementing keto for epilepsy.
Clinical Guidelines for Ketogenic Therapies
Pediatric clinical guidelines have been published since 2009. In 2018, and international study group of ketogenic experts provided updated guidelines describing the safe and effective use of ketogenic therapies in clinical management for pediatric epilepsies. Adult specific guidelines were published in 2020. Please click the link to read the abstracts.
A high fat diet leads to a compromised cardiovascular system.
Published studies (1) on long term outcomes do not support this assertion. When undertaken with the guidance of an experienced ketogenic therapy team, cholesterol is monitored regularly and tends to return to normal levels after initiating the diet.
There is no science explaining why a keto diet for epilepsy is so effective.
Since 1995 there have been over 800 scientific and medical papers published detailing both mechanisms and efficacy of the Ketogenic Diet for epilepsy—including two randomized controlled studies (2) (3).
The Ketogenic Diet has other adverse effects.
By far the most common adverse effects of the diet are kidney stones and constipation. Both conditions are easily addressed prophylactically when working with an experienced an experienced ketogenic therapy team. In addition, all anti-seizure medications have adverse effects which can be significant (4).
It is too difficult.
Today there is readily available professional dietary support for patients, and there are hundreds of new and delicious meal plans for people using a Ketogenic Diet. In addition, it has always been our position at The Charlie Foundation that the degree of difficulty decision should rest entirely with the patient or caregiver—not the health care professional.
It is our hope that armed with information you will look further into keto for epilepsy. It is our further hope that you will experience an outcome as wonderful as our inspiration, Charlie Abrahams, and the tens of thousands of people like him. Charlie’s seizures began in 1993. After multiple failed drugs, failed drug combinations, a failed brain surgery, and a prognosis of continued seizures and “progressive retardation,” he started the Ketogenic Diet in 1994. He was on the diet for five years. He has never taken another anti-epileptic medication and he eats whatever he wants. He is a happy pre-school teacher. He has never had another seizure.
Frequently Asked Questions
The Ketogenic Diet is a special high-fat diet that is used for difficult to treat seizures. Heavy cream, butter, plus, nut and olive oils, provide the necessary fat; the diet can also be done dairy-free. The diet also completely eliminates sweets such as candy, cookies, and desserts. Other carbohydrate rich foods such as bread, potatoes, rice, cereals, and pasta are not allowed on the strictest form of the diet (4:1 Classic ratio), but are allowed on more liberal forms of the diet. The Classic ketogenic diet requires that foods be carefully prepared and weighed on a gram scale. Each meal must be eaten in its entirety for the diet to be most effective. The Classic keto for epilepsy diet consists of a ratio in grams of fat to non-fat (protein and carbohydrates) of 4:1 and 3:1. The modified Ketogenic Diet consists of ratios of 2:1 and 1:1. Modified versions of the Classic diet allow more carbohydrate and require less fat.
People with seizures from infancy through the adult years may be helped by the diet. There is no way to predict beforehand whether it will be successful. Traditionally the diet has been used for children with myoclonic, atonic and tonic-clonic seizures. In every decade since the 1920’s, studies consistently show that 50-75% of infants through adults with difficult to control seizures of all types are helped by the diet. Creative recipes have helped to make the diet more palatable in the past few years.
Thirteen randomized trials have been published in the past 10 years and have determined that the Ketogenic Diet is effective in reducing seizure frequency in both children and adults with difficult-to-control epilepsy.
The diet is generally used for a period of up to 3 years in children if it is helpful in reducing or eliminating seizures. A liberal ketogenic diet can be followed indefinitely for older children and adults who are benefitting from it. If the diet is not helpful, it will be stopped within a few months.
The most common adverse effect of the diet is constipation. There are dietary options to prevent this problem including eating high fiber vegetables that are allowed on the diet and drinking enough water. A less common adverse effect is kidney stones. This problem can be prevented by drinking adequate water. There are anti-seizure medications which can cause acidosis and kidney stones which should be monitored very closely when used with the Ketogenic Diet (Zonegran® and Topamax®).
Ketogenic diets can be effective in helping people who are underweight to gain weight and in helping people who are overweight to lose weight.
Most people do not develop high cholesterol levels while on the diet.Lipid levels are drawn prior to starting the diet and at regular intervals throughout the course of the diet. If high cholesterol or lipids develop, the diet can be modified such as including omega-3 fatty acids, probiotics, and fiber.
The Ketogenic Diet can be provided for people with feeding tube using pecial ketogenic formulas or blenderized whole foods. A dietitian will determine the type and amount of formula and supplements to accompany these.
There are blood tests that may be needed to determine if the diet is safe to implement. These include metabolic tests to rule-out fatty acid disorders or a carnitine deficiency.
Think you or a loved one might be a candidate for the Ketogenic Diet?
Types of Ketogenic Diets
There are a variety of diets that will allow you to get into ketosis. The major differentiating factor between them all is the amount of calories that come from protein, carbs and fat, which are what we call “macronutrients”, or nutrients in our food that have a caloric value. The three macronutrients differ in many ways, namely, their caloric values, as well as how the body uses them. Fat is the most calorically dense macronutrient, having 9 calories per gram, compared to 4 calories per gram for both carbs and protein. In a homeostatic state, the body utilizes fat and carbs for energy production, while it uses protein to rebuild the cells of our body. While this is generally the case, an overconsumption of protein can lead the body to break down the excess protein into glucose (which is what carbs break down into)
- Classic Ketogenic Diet
- Modified Ketogenic Diet
- MCT Oil Diet
- Modified Atkins
- Low Glycemic Index Diet (LGIT)
- Intermittent Fasting
Find a Provider
If you think you can benefit from adopting a Ketogenic Diet, we encourage you to consult one of our dietitians, visit a participating hospital, or contact us so that we may guide you towards the best option given your specific needs.