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The Ketogenic Diet and Epilepsy

Image for ketogenic diet articleSome seizures in children have no known cause. If these seizures happen more than once, it may be called epilepsy. Medicine can help to control or stop seizures for most. Others may need more help to control their seizures.

The Ketogenic Diet may help. It is most helpful with epilepsy that does not respond well to medicine. The diet has lower amounts of carbohydrates and higher amounts of fat than the typical diet. It can be a hard diet to keep up with. However, the benefits of seizure control may be worth it.

The diet may first be tried for up to 3 months to see if it works. The diet does not need to be permanent. If your child remains seizure-free for 2 years with the diet, your child may be slowly brought back to a more normal diet.

Getting to Know the Ketogenic Diet  ^

Background

The ketogenic diet is a high fat, low carbohydrate diet. The exact amounts and types of fat can vary.

In general, the diet is made up of 3 to 4 parts fat and 1 part carbohydrate and protein. There are also forms of the diet. For example, one uses medium chain triglycerides as a main source of fat. You and your child's doctor and dietitian will work to create a diet that meets your child's needs.

How it Works

Glucose is the easiest source of energy for the body. Most of the glucose comes from carbohydrates that we eat. Once the glucose is burned off, the body uses fat as a source of energy. The use of fat creates a by-product called ketones. The ketones may reduce or eliminate seizures. It is not clear why this happens.

The body will also use body fat for fuel when you fast. Fasting is not a reasonable long term option.

Making the Change  ^

Degree of Difficulty

Any diet that requires limits and change is hard. The range of food in this diet is somewhat limited. Some find it easier than others to follow this plan. To get the most benefit, it is important to follow the diet as close as possible.

The switch to this diet will be monitored by a doctor. Your child will also be tested on a regular basis to look for side effects. If your child is not seeing a benefit, then the diet will be stopped. Other treatments will be tried.

Let's Eat!

Focus on what can be eaten, rather than what cannot be eaten. Keep in mind that the ketogenic diet is fat-based. So, fatty foods rule the menu. You can be as creative as you want as long as you are mindful of what your child can eat. Here is a list of possible menu items:

  • Eggs
  • Meats, such as bacon, steak, or hamburger
  • Full-fat dairy low in carbohydrates
  • Full-fat condiments, such as mayonnaise, oil, or butter
  • Vegetables high in fiber
  • Limited servings of fruit

What to Expect  ^

There is more to the diet than just the food. The fat-based menu does have side effects that may appear within a few days. The good news is they are short term and should disappear as your child's body gets used to the diet. Keep an eye on your child's progress and discuss it with your child's doctor.

Common Side Effects

  • Constipation
  • Nausea and vomiting
  • Irritability
  • Sleepiness
  • Dehydration—encourage your child to drink often

Unusual, Rare, or Serious Side Effects

Heart Disease

A high-fat diet may increase the risk of heart disease as an adult. Although the diet leads to higher levels of fat in the blood, the diet has not been proven to be unsafe. For many, the benefit of reducing or eliminating seizures outweigh the potential of a possible harm developing later in life.

RESOURCES:

The Epilepsy Foundation
http://www.epilepsyfoundation.org

Kids Health—Nemours Foundation
http://kidshealth.org

CANADIAN RESOURCES:

The Center for Epilepsy and Seizure Education
http://epilepsy.ca

Epilepsy Ontario
http://www.epilepsyontario.org

REFERENCES:

Classic ketogenic and modified ketogenic. The Charlie Foundation website. Available at: http://www.charliefoundation.org/explore-ketogenic-diet/explore-2/classic-ketogenic. Accessed October 11, 2016.

Epilepsy. Kids Health—Nemours Foundation website. Available at http://kidshealth.org/parent/medical/brain/epilepsy.html. Updated June 2016. Accessed October 11, 2016.

Epilepsy: frequently asked questions. Centers for Disease Control and Prevention website. Available at http://www.cdc.gov/epilepsy/basics/faqs.htm. Updated July 18, 2016. Accessed October 11, 2016.

Ketogenic diet in children. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T270057/Ketogenic-diet-in-children. Updated May 12, 2016. Accessed October 11, 2016.

Kwiterovich P, Vining E, Pyzik P, et al. Effect of a high-fat ketogenic diet on plasma levels of lipids, lipoproteins, and apolipoproteins in children. JAMA. 2003;290:912-920.

Lefevere F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: A systematic review of efficacy. Pediatrics. 2000;105:e46.

LGS: dietary treatments. Epilepsy Foundation website. Available at http://www.epilepsy.com/information/lennox-gastaut-syndrome/treatment-overview/lgs-dietary-treatments. Accessed October 11, 2016.

Nephrolithiasis. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Updated July 12, 2016. Accessed October 11, 2016.

What is the ketogenic diet? The Charlie Foundation website. Available at: http://www.charliefoundation.org/explore-ketogenic-diet/explore-1/introducing-the-diet. Accessed October 11, 2016.

5/14/2008 DynaMed Plus Systematic Literature Surveillancehttp://www.dynamed.com/topics/dmp~AN~T270057/Ketogenic-diet-in-children: Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 May 2. [Epub ahead of print]

Last reviewed October 2017 by Michael Woods, MD  Last Updated: 8/23/2018