The ketogenic diet is an extremely effective dietary intervention used in the treatment of epilepsy.1 One of the oldest treatments for epilepsy (in use since the 1920s), the ketonic diet is a customized low-carb, high-fat diet.
In recent years, pediatric neurologists, epileptologist’s, and general neurologists have shown renewed interest in the use of the ketogenic diet for the management of drug-resistant epilepsies, especially among children and adolescents.2
What Is The Ketogenic Diet?
The ketogenic diet is a medical treatment for epilepsy that is usually considered only when at least two suitable medications have proven ineffective.34
An individualized and structured meal plan, the ketogenic diet advocates a high fat, low carbohydrate, and a controlled protein diet. It usually includes 80% fat, 15% protein, and 5% carbohydrate; the ratio of fat to carbohydrate plus protein ranges from 2:1 to 4:1.5
The intake of grains, bread, pasta, and starchy fruits and vegetables is reduced. Instead, the consumption of butter, cream, oils, and other fatty foods is increased. There are different forms of ketogenic diet and you will need the help of an experienced dietitian to guide you through the diet.
The types of foods to be eaten and the way each diet is structured are slightly different. Most of the fat in the classic, most commonly used ketogenic diet is provided as long-chain triglycerides. A variant of the classic ketogenic diet is the medium-chain triglyceride diet. This diet is also considered a low glycemic therapy and results in steady glucose levels.6
Mechanism Of Action Of Ketogenic Diet
Epilepsy is a neurological disorder in which nerve cell activity in the brain becomes disrupted, leading to repeated seizures, unusual sensations, and, sometimes, loss of consciousness.
It can be caused by a variety of conditions, including head trauma, infection, brain tumor, stroke, and some unidentifiable causes as well. The ketogenic diet is believed to trigger biochemical changes which remove seizure-causing short circuits in the signaling system of the brain.
It imitates the metabolism of fasting and relies on a fundamental change in the brain’s metabolism wherein ketone replaces glucose as the source of energy (keto = ketone, genic = producing). Higher levels of ketone are believed to help in seizure control.7
Who Is The Diet Suitable For?
The ketogenic diet may not work for all children, but is suitable for many different seizure types and epilepsy syndromes, including myoclonic astatic epilepsy, Dravet syndrome, infantile spasms (West syndrome), and tuberous sclerosis.8
Safety And Efficacy Of Ketogenic Diet
According to research studies, the ketogenic diet is relatively safe for long-term. The efficacy of the diet has been proved by various studies.9
For instance, in a study conducted at Hopkins Children’s Centre, 101 patients aged 2 to 26 years were treated with the ketogenic diet for a minimum of 16 months and for up to eight years (between 1993 and 2008). Their observation showed that nearly 80 percent of the patients remained either seizure-free or had their seizures reduced by half. Most patients’ seizures did not worsen even years after stopping the diet.10
According to other studies, the ketogenic diet has proved to be effective in the control of difficult-to-control seizures in children. The diet often allows the decrease or discontinuation of medication eventually and has been found to be more effective than many of the newer anti-convulsants used for treatment.11
Ketogenic Diet Side-Effects
The ketogenic diet is highly effective, but it can be complicated and sometimes difficult to maintain. It can have the following side effects:12
- A temporary rise in cholesterol levels.
- Can lead to kidney stones in rare cases.
- Cause digestive problems, such as diarrhea, constipation, nausea, vomiting, and heartburn.
- Reduce energy levels.
- Slow down growth rate in children.
- Trigger vitamin and mineral deficiencies.
The ketogenic diet can be considered as an alternative therapy for children with difficult-to-control seizures. Despite challenges in implementing the treatment, the ketogenic diet has significant potential as a powerful tool for fighting epilepsy.
The diet’s current success rate, when properly executed, greatly exceeds that of medications which have recently become available. Its side effects, both cognitive and allergic, appear fewer than most available medications. However, everyone on the diet needs close supervision by a doctor and a dietitian.
|↑1||Epilepsy, NHS Choices, Your Health, Your Choices.|
|↑2||Barañano, Kristin W., and Adam L. Hartman. “The ketogenic diet: uses in epilepsy and other neurologic illnesses.” Current treatment options in neurology 10, no. 6 (2008): 410-419.|
|↑3||Bailey, Elizabeth E., Heidi H. Pfeifer, and Elizabeth A. Thiele. “The use of diet in the treatment of epilepsy.” Epilepsy & Behavior 6, no. 1 (2005): 4-8.|
|↑4||Freeman, John, Pierangelo Veggiotti, Giovanni Lanzi, Anna Tagliabue, and Emilio Perucca. “The ketogenic diet: from molecular mechanisms to clinical effects.” Epilepsy Res 68, no. 2 (2006): 145-80.|
|↑5||Hee Seo, Joo, Young Mock Lee, Joon Soo Lee, Hoon Chul Kang, and Heung Dong Kim. “Efficacy and tolerability of the ketogenic diet according to lipid: nonlipid ratios—comparison of 3: 1 with 4: 1 diet.” Epilepsia 48, no. 4 (2007): 801-805.|
|↑6||Ketogenic Diet, Epilepsy Society, UK.|
|↑7||Huttenlocher, Peter R. “Ketonemia and seizures: metabolic and anticonvulsant effects of two ketogenic diets in childhood epilepsy.” Pediatric research 10, no. 5 (1976): 536-540.|
|↑8||NINDS Epilepsy Information Page, National Institute Of Neurological Disorders And Stroke.|
|↑9||Freeman, John M., Eileen PG Vining, Diana J. Pillas, Paula L. Pyzik, and Jane C. Casey. “The efficacy of the ketogenic diet—1998: a prospective evaluation of intervention in 150 children.” Pediatrics 102, no. 6 (1998): 1358-1363.|
|↑10||Adult Epilepsy Diet Center, Johns Hopkins Medicine.|
|↑11||Ross, Diana L., Kenneth F. Swaiman, Fernando Torres, and Jessie Hansen. “Early biochemical and EEG correlates of the ketogenic diet in children with atypical absence epilepsy.” Pediatric neurology 1, no. 2 (1985): 104-108.|
|↑12||[Rogovik, Alexander L., and Ran D. Goldman. “Ketogenic diet for treatment of epilepsy.” Canadian Family Physician 56, no. 6 (2010): 540-542.|