Using a keto diet for epilepsy is an ancient concept. The effects were noted in biblical times, when people with epilepsy would fast in order to find relief from chronic brain seizures. “You can look in old scriptures and see that when people would fast, the ‘demons’ would leave them – the demons meaning the seizures,” explains Dr. Mohamad Koubeissi, a neurologist and director of the Epilepsy Center at the George Washington University Hospital.

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People in ancient times didn’t know it, but by fasting they were forcing the body to make chemicals that seem to help control epileptic seizures. Today we generate those chemicals with a ketogenic diet.

Epileptic Seizures

Epileptic seizures are triggered by an imbalance of brain chemicals that either excite or inhibit brain activity.

“When there’s some kind of irritation or some kind of excitation or inhibition imbalance, the ‘excitatory’ activity starts to spread like fire in a forest to involve more brain areas. As it spreads, it causes a seizure,” Koubeissi explains. “If seizures are untreated, they can happen again and again.”

Medication is often enough to manage epileptic seizures. But Koubeissi says about a third of people with epilepsy have seizures that are resistant to treatment. This is where a keto diet for epilepsy often comes into play.

The Benefits of Ketosis

The keto diet for epilepsy is very high in fat, moderate in protein and extremely low in carbohydrates such as fruits, vegetables and grains – which turn into glucose, the body’s main energy source.

Without glucose, the body believes it’s fighting starvation. The liver transforms stored fat into chemicals called ketone bodies, which are consumed by the brain and body as energy.

This state of “ketosis” has a benefit for people with epilepsy. About 50% of patients who follow the keto diet for epilepsy experience at least a 50% reduction in seizures. “One of the theories is that ketones make more of the chemicals that calm down the brain and decrease epileptic activity and also decrease some of the chemicals that can naturally increase the likelihood of seizures happening,” says Dr. Ahmed Abdelmoity, a neurologist and chief of the section of epilepsy and clinical neurophysiology at Children’s Mercy Kansas City.

Other benefits may include:

A reduction in seizure medication.

More alertness.

Better participation in school.

Who’s a Candidate?

Doctors usually recommend a keto diet for epilepsy when medications aren’t working. “We use the ketogenic diet for children and adults with epilepsy, typically when they have not responded to two or more antiseizeure drugs,” says Dr. Eric Kossoff, a neurologist and medical director of the Pediatric Ketogenic Diet Program at Johns Hopkins Medicine.

Doctors may also prescribe a keto diet for specific types of epilepsy. One example is when a child is born with glucose transporter protein deficiency syndrome, a genetic condition that keeps “transporters” in the blood vessels from delivering blood sugar to the brain. “For this type of disease,” Koubeissi says, “the keto diet cures the seizures because now you’re telling brain you can’t get sugar because you lack the ‘taxi cabs’ to deliver it, but we can send you ketone bodies that will replace that need.”

Types of Keto Diets for Epilepsy

Four types of diets are used to help reduce seizures in people with epilepsy.

In children, the most common keto diet for epilepsy is either:

A classic ketogenic diet. According to dietitian Lindsey Thompson, a ketogenic dietitian in the Comprehensive Epilepsy Center and nutrition manager at Children's Mercy Kansas City, "80% to 90% of calories come from fat, about 10% come from protein and the rest come from carbohydrates like fruits or vegetables.”

According to dietitian Lindsey Thompson, a ketogenic dietitian in the Comprehensive Epilepsy Center and nutrition manager at Children's Mercy Kansas City, "80% to 90% of calories come from fat, about 10% come from protein and the rest come from carbohydrates like fruits or vegetables.” A medium chain triglyceride or MCT diet. “The MCT diet uses MCT oil fats, as they are very ketogenic, and then that allows for a bit more carbohydrates,” Kossoff says.

For those diets, a hospital stay is usually needed. “Children are traditionally admitted to the hospital for two to three days in order to switch their foods over from regular to ketogenic, check their labs (such as blood sugar and ketone levels), educate their parents as to how to weigh and measure foods, and make sure they tolerate the switch without side effects,” Kossoff explains.

In teenagers and adults, the more common keto diet for epilepsy is either:

A modified Atkins Diet, a less restrictive version of the classic ketogenic diet that’s been shown to be effective in controlling seizures in children and adults.

A low glycemic index treatment, which allows carbohydrates (below a 55 on the glycemic index) that don’t raise blood sugar too quickly.

Results for all of the diets usually show up within a month. “However, for some it can take up to three months,” Kossoff says.

What Does the Diet Look Like?

A classic keto diet for epilepsy relies on a steady intake of fat. “One of the big components is drinking heavy whipping cream instead of milk. We dilute it and add vanilla extract or stevia or some type of non nutritive sweetener,” Thompson says. Other sources of fat include butter, vegetable or coconut oils, butter and meat (including processed red meat).

Too much protein or too many carbs can throw ketosis off track, so nutrient ratios must be carefully calculated for each individual. Thompson says that a day’s menu might look like this:

Breakfast: scrambled egg mixed with whipping cream and butter, with a few strawberries on the side and diluted whipping cream to drink.

scrambled egg mixed with whipping cream and butter, with a few strawberries on the side and diluted whipping cream to drink. Lunch: spaghetti squash with a red sauce high in olive oil, some hamburger meat and diluted whipping cream to drink.

spaghetti squash with a red sauce high in olive oil, some hamburger meat and diluted whipping cream to drink. Dinner: some type of meat with gravy or cream sauce (like Salisbury steak) with green beans and diluted whipping cream to drink.

Snacks might be cheese cubes and nuts, avocados, or oil popped popcorn topped with melted butter.

Side Effects

Considering all of the fat on the keto diet for epilepsy, you might think cholesterol levels and clogged arteries would be top concerns. But they’re lower on the list. “When you’re altering the metabolism as a main source of energy, you’re not storing cholesterol; you’re burning fat, the main source of energy,” Abdelmoity says.

Bigger concerns on a keto diet for epilepsy include:

Constipation.

Very low blood sugar.

Too much acid in the blood (acidosis).

Weight loss.

Low bone density and osteoporosis.

Kidney stones.

Abdelmoity says the risks for those conditions are monitored and often corrected before they start causing problems. “That’s part of the importance of following the diet with a reputable center that has published research and trained staff including neurologists, nurses, dietitians, social workers and a trained chef educator to help families prepare a keto diet with specific ratios,” Abdelmoity says.