Epilepsy and Keto Diet: How It Can Reduce Seizures

Epilepsy and the keto diet have been a match for more than 100 years. A clinical ketogenic diet is one of the best natural ways to reduce epileptic seizures for children and adults.

In this comprehensive article, we will cover the basics of the keto diet, what it does to the body, how it helps with epilepsy, and its possible side effects to help you set your expectations.

Key Takeaways:

• The keto diet was invented in the 1920s to help children with epilepsy.
• Studies have proven the efficacy of keto in reducing seizures.
• Keto improves neuronal activity, brain metabolism, mitochondrial function, anti-inflammatory effects, and GABAergic Transmission.
• Clinical keto diets for epilepsy are very high in fat (90% of calories).

Table of Contents:

• What Is a Keto Diet?
• Who May Benefit from a Keto Diet?
• What Happens in Your Body on Keto?
• How Does the Ketogenic Diet Help Epilepsy?
• How Effective Is the Keto Diet for Managing Seizures?
• Are There Any Side Effects?
• What Does a Keto Diet for Epilepsy Look Like?
• What Happens When Your Child Starts a Ketogenic Diet?
• Can Adults Do the Keto Diet for Epilepsy on Their Own?
• How Long Can I Do the Keto Diet for Epilepsy?
• The Bottom Line

What Is a Keto Diet?

The ketogenic diet is a high-fat, low-carbohydrate, and moderate-protein eating plan designed to induce a metabolic state known as ketosis.

In ketosis, the body shifts from its default reliance on glucose for energy to utilizing ketones produced from the breakdown of fats. This shift in energy substrate not only aids in weight loss but has also shown promise in addressing various health conditions, including epilepsy.

The macronutrient distribution in a standard ketogenic diet typically consists of approximately 70-75% fat, 20-25% protein, and 5-10% carbohydrates.

The keto diet aims to mimic the fasting state, which is historically known to have therapeutic effects.

Who May Benefit from a Keto Diet?

The keto diet has proven its effect in benefiting the following population:

1. Individuals with Epilepsy: The ketogenic diet was invented in the 1920s to manage epilepsy,^1, particularly in cases where seizures are not adequately controlled with medication. Research suggests that the diet’s impact on brain metabolism and neurotransmitter activity contributes to its anticonvulsant effects.
2. Those Seeking Weight Management: The ketogenic diet has gained popularity for weight loss due to its ability to induce ketosis,² leading to increased fat burning. Reduced carbohydrate intake and improved insulin sensitivity³ may contribute to effective weight management.
3. Individuals with Type 2 Diabetes: Research indicates that the ketogenic diet may improve insulin sensitivity and blood sugar control, making it a potential adjunct therapy for individuals with type 2 diabetes.⁴ The diet’s carbohydrate restriction helps stabilize blood glucose levels.
4. People with Neurodegenerative Disorders: Preliminary research suggests that the ketogenic diet may have neuroprotective effects, making it a topic of interest in neurodegenerative disorders such as Alzheimer’s⁵ and Parkinson’s disease.⁶
5. Those with Metabolic Syndrome: The ketogenic diet may be beneficial for individuals with metabolic syndrome,⁷ a cluster of conditions including high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. The diet’s effects on weight, insulin sensitivity, and lipid profiles contribute to its potential benefits.
6. People Seeking Enhanced Cognitive Performance: Some individuals adopt the ketogenic diet for potential cognitive benefits. Ketones are an alternative fuel source for the brain and may provide sustained mental clarity and focus.

What Happens in Your Body on Keto?

The keto diet induces ketosis, which affects the body positively. Here are some of the basic changes the body goes through during ketosis:

1. Shift in Energy Source: In a ketogenic state, the scarcity of carbohydrates prompts a metabolic shift. The liver converts fats into ketone bodies, namely beta-hydroxybutyrate (BHB), acetoacetate, and acetone.
2. Enhanced Brain Metabolism: The brain, a glucose-hungry organ, readily utilizes ketones as an energy⁸ substrate during ketosis. This metabolic adaptation is crucial in epilepsy, as it may contribute to the diet’s anticonvulsant and neuroprotective effects.
3. Reduced Inflammation: The keto diet actively reduces chronic inflammation,⁹ which is implicated in various health conditions, including neurological disorders like epilepsy.
4. Stabilized Blood Sugar Levels: Stable blood sugar levels contribute to better overall metabolic health and may mitigate factors that trigger seizures in some cases.

How Does the Ketogenic Diet Help Epilepsy?

The keto diet has been successfully helping individuals with epilepsy for decades now, and here’s some of the scientific explanation behind this phenomenon:

1. Stabilizing Neuronal Activity: Ketones, particularly beta-hydroxybutyrate (BHB), are believed to play a role in stabilizing neuronal activity.¹⁰ This stabilization may occur through various mechanisms, including the modulation of ion channels¹¹ and neurotransmitter release.
2. Enhancing Mitochondrial Function: The brain is highly dependent on the energy produced by the mitochondria, and the ketogenic diet has been shown to enhance mitochondrial function and biogenesis,¹² potentially preventing epilepsy.
3. Anti-Inflammatory Effects: Chronic inflammation is implicated in the pathogenesis of epilepsy.¹³ The ketogenic diet’s anti-inflammatory effects, attributed to the reduction of pro-inflammatory markers,¹⁴ may create an environment less conducive to seizure development.
4. Altering Brain Metabolism: Animal studies associate increased glucose levels with seizure exacerbation.¹⁵ The shift in brain metabolism from glucose to ketones¹⁶ appears to have a therapeutic impact on epilepsy.¹⁷
5. Modulating GABAergic Transmission: Gamma-aminobutyric acid (GABA) is a neurotransmitter that plays a crucial role in inhibiting neuronal excitability.¹⁸ The ketogenic diet may enhance GABAergic transmission, promoting a calming effect on the brain and potentially reducing the likelihood of seizures.

How Effective Is the Keto Diet for Managing Seizures?

Clinical studies have consistently demonstrated the efficacy of the ketogenic diet in reducing seizure frequency in various forms of epilepsy, especially in children.

One of the most compelling aspects of the ketogenic diet is its potential benefit for individuals with drug-resistant epilepsy—those who do not respond well to conventional antiepileptic medications.

In a 2019 study including children with drug-resistant epilepsy, 70% of those who maintained the keto diet for one year experienced seizure control¹⁸ with only 3.7% experiencing nausea and vomiting.

According to a collaborative retrospective study of 315 children on the keto diet,¹⁹ no child had an increased seizure frequency, more than 50% experienced more than 50% of seizure reduction, and 16% were seizure-free after 6 months of being on the keto diet.

Moreover, the ketogenic diet is not merely a short-term solution; its effects can be sustained over time. Some individuals experience ongoing seizure reduction, allowing for improved quality of life.

In a 2006 study on the effects of a 6-year keto diet among 28 children with epilepsy, 24 children experienced more than a 90% decrease in seizures,²⁰ and 22 parents reported satisfaction with the diet’s efficacy.

Most clinical studies conclude the positive effects of the keto diet among children with epilepsy. While side effects were also noted, they were most likely manageable and non-life threatening.

Are There Any Side Effects?

There are side effects of the keto diet, especially among children. Here’s a quick overview of the most commonly reported adverse effects²¹ and contraindications:

• Gastrointestinal changes: Children who begin the keto diet may experience gastrointestinal side effects such as nausea, vomiting, diarrhea, abdominal discomfort, worsening of gastroesophageal reflux, and constipation, particularly during the starting phase.
• Metabolic Function Changes: Biochemical changes may include hypercholesterolemia, hypertriglyceridemia, and decreased low-density lipoprotein (LDL) levels.
• Renal Issues: Although rare, children on KD treatment may develop renal calculi, which may be reduced by co-administration of oral citrates.
• Growth: Some studies reported decreased linear growth among children on the keto diet for more than six months, but some studies also reported no changes in children’s height and weight.
• Bone health: Children on multiple anti-seizure medications may experience decreased vitamin D levels, leading to decreased bone density.
• Contraindications: The keto diet or any low-carbohydrate diet can be fatal for children with metabolic disorders that impair energy generation from lipids.

What Does a Keto Diet for Epilepsy Look Like?

The keto diet, especially for children with epilepsy, looks different than the healthy adult keto diet. Let’s take, for instance, this study on a hospital-based keto diet:²²

They followed a keto diet that allows 85-95% of daily calories, 90% fat, 6-8% protein, and remaining carbohydrates. For example, a five-year-old child with a specific energy goal of 1,200 kcal with a 4:1 fat-to-nonfat ratio would require 120g of fat, 18g of protein, and 12g of carbohydrates.

The dieticians eliminated carbohydrate-rich meals, including rice, bread, grains, and simple sugars, and calculated the proper amount of meat, fish, low-carb vegetables, milk, or fat sources. Snacks were allowed if they fit into the calorie count and ratio.

What Happens When Your Child Starts a Ketogenic Diet?

As the child adapts to the ketogenic diet, there is an expected transition period where the body adjusts to utilizing ketones for energy. In this phase, your child may experience a few temporary symptoms, including keto flu, weight loss, dehydration, and electrolyte imbalance.

Your child needs to be under strict monitoring with their physician to help resolve any symptoms. Additionally, emphasizing nutrient-rich foods in the child’s diet supports growth and development.

Can Adults Do the Keto Diet for Epilepsy on Their Own?

Whether treating epilepsy in children or adults, medical supervision is crucial, and doing it on your own is unwise. Even in clinical trials, adults with epilepsy who underwent the keto diet always started their keto diet in the hospital by a dietician.²³

Knowing one’s medical baseline is vital before starting any form of treatment, including more natural approaches like the keto diet. Moreover, your healthcare practitioner needs to do a thorough history taking on past and current health conditions.

How Long Can I Do the Keto Diet for Epilepsy?

Studies suggest doing the keto diet for at least 3 months²⁴ to start seeing improvements. Meanwhile, results on a long-term keto diet of up to two years state beneficial changes for its subjects with continuous reduction in seizures.

There are also studies encompassing subjects who have been doing the keto diet for as long as 6 years with a 90% decrease in seizure occurrence.²⁰ These data suggest that doing keto for a long time benefits those suffering from epilepsy.

The Bottom Line

The keto diet has demonstrated its versatility, extending beyond its origins as an epilepsy management tool. Whether aiming for seizure control, weight management, improved metabolic health, or cognitive benefits, the keto diet holds promise for diverse individuals.

Before embarking on this dietary journey, consulting with healthcare professionals ensures personalized guidance, monitoring, and optimizing benefits based on individual needs.

Frequently Asked Questions

References

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²Ting, R., Dugré, N., Allan, G. M., & Lindblad, A. J. (2018). Ketogenic diet for weight loss. Canadian Family Physician, 64(12), 906. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371871/

³Paoli, A., Bianco, A., Moro, T., Mota, J. F., & Coelho-Ravagnani, C. F. (2023). The Effects of Ketogenic Diet on Insulin Sensitivity and Weight Loss, Which Came First: The Chicken or the Egg? Nutrients, 15(14). https://doi.org/10.3390/nu15143120

⁴Tinguely, D., Gross, J., & Kosinski, C. (2021). Efficacy of Ketogenic Diets on Type 2 Diabetes: A Systematic Review. Current Diabetes Reports, 21(9). https://doi.org/10.1007/s11892-021-01399-z

⁵Tabaie, E. A., Reddy, A. J., & Brahmbhatt, H. (2022). A narrative review on the effects of a ketogenic diet on patients with Alzheimer’s disease. AIMS Public Health, 9(1), 185-193. https://doi.org/10.3934/publichealth.2022014

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