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?

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.
epilepsy and keto diet

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 Studies show that increased glucose
  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

Is keto good for epilepsy?

The keto diet has been proven to reduce epileptic seizure frequency.

How long can you stay in ketosis safely?

As long as you have a healthy liver, you can stay in ketosis since it produces the amount of glucose your body needs via gluconeogenesis.

What happens if I eat no carbs for a month?

If you eat no carbs for a month, you will achieve the metabolic state of ketosis, which will help you lose weight and regulate your blood glucose levels, resulting in various health benefits.

References

1Wheless J. W. (2008). History of the ketogenic diet. Epilepsia, 49 Suppl 8, 3–5. https://doi.org/10.1111/j.1528-1167.2008.01821.x

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

6Grochowska, K., & Przeliorz, A. (2022). The Effect of the Ketogenic Diet on the Therapy of Neurodegenerative Diseases and Its Impact on Improving Cognitive Functions. Dementia and Geriatric Cognitive Disorders EXTRA, 12(2), 100-106. https://doi.org/10.1159/000524331

7Choi, Y. J., Jeon, M., & Shin, S. (2020). Impact of a Ketogenic Diet on Metabolic Parameters in Patients with Obesity or Overweight and with or without Type 2 Diabetes: A Meta-Analysis of Randomized Controlled Trials. Nutrients, 12(7). https://doi.org/10.3390/nu12072005

8White, H., & Venkatesh, B. (2011). Clinical review: Ketones and brain injury. Critical Care, 15(2), 219. https://doi.org/10.1186/cc10020

9Jiang, Z., Yin, X., Wang, M., Chen, T., Wang, Y., Gao, Z., & Wang, Z. (2022). Effects of Ketogenic Diet on Neuroinflammation in Neurodegenerative Diseases. Aging and Disease, 13(4), 1146-1165. https://doi.org/10.14336/AD.2021.1217

10Polito, R., La Torre, M. E., Moscatelli, F., Cibelli, G., Valenzano, A., Panaro, M. A., Monda, M., Messina, A., Monda, V., Pisanelli, D., Sessa, F., Messina, G., & Porro, C. (2023). The Ketogenic Diet and Neuroinflammation: The Action of Beta-Hydroxybutyrate in a Microglial Cell Line. International Journal of Molecular Sciences, 24(4). https://doi.org/10.3390/ijms24043102

11Newman, J. C., & Verdin, E. (2017). β-Hydroxybutyrate: A Signaling Metabolite. Annual Review of Nutrition, 37, 51. https://doi.org/10.1146/annurev-nutr-071816-064916

12Hasan-Olive, M. M., Lauritzen, K. H., Ali, M., Rasmussen, L. J., Storm-Mathisen, J., & Bergersen, L. H. (2019). A Ketogenic Diet Improves Mitochondrial Biogenesis and Bioenergetics via the PGC1α-SIRT3-UCP2 Axis. Neurochemical research, 44(1), 22–37. https://doi.org/10.1007/s11064-018-2588-6

13Vezzani, A. (2005). Inflammation and Epilepsy. Epilepsy Currents, 5(1), 1-6. https://doi.org/10.1111/j.1535-7597.2005.05101.x

14Pinto A, Bonucci A, Maggi E, Corsi M, Businaro R. Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease. Antioxidants (Basel). 2018 Apr 28;7(5):63. doi: 10.3390/antiox7050063. PMID: 29710809; PMCID: PMC5981249.

15Stafstrom, C. E. (2003). Hyperglycemia Lowers Seizure Threshold. Epilepsy Currents, 3(4), 148-149. https://doi.org/10.1046/j.1535-7597.2003.03415.x

16LaManna JC, Salem N, Puchowicz M, Erokwu B, Koppaka S, Flask C, Lee Z. Ketones suppress brain glucose consumption. Adv Exp Med Biol. 2009;645:301-6. doi: 10.1007/978-0-387-85998-9_45. PMID: 19227486; PMCID: PMC2874681.

17Baltyde D, De Toffol B, Nacher M, Sabbah N. Epileptic seizures during Non-Ketotic Hyperglycemia (NKH) in French Guiana: A retrospective study. Front Endocrinol (Lausanne). 2022 Aug 18;13:946642. doi: 10.3389/fendo.2022.946642. PMID: 36060985; PMCID: PMC9433648.

18Ułamek-Kozioł, M., Czuczwar, S. J., Januszewski, S., & Pluta, R. (2019). Ketogenic Diet and Epilepsy. Nutrients, 11(10). https://doi.org/10.3390/nu11102510

19Hallböök, T., Sjölander, A., Åmark, P., Miranda, M., Bjurulf, B., & Dahlin, M. (2015). Effectiveness of the ketogenic diet used to treat resistant childhood epilepsy in Scandinavia. European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society, 19(1), 29–36. https://doi.org/10.1016/j.ejpn.2014.09.005

20Groesbeck, D. K., Bluml, R. M., & Kossoff, E. H. (2006). Long-term use of the ketogenic diet in the treatment of epilepsy. Developmental medicine and child neurology, 48(12), 978–981. https://doi.org/10.1017/S0012162206002143

21Goswami JN, Sharma S. Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management. Neuropsychiatr Dis Treat. 2019 Nov 25;15:3273-3285. doi: 10.2147/NDT.S201862. PMID: 31819454; PMCID: PMC6883945.

22Lee E, Kang HC, Kim HD. Ketogenic Diet for Children with Epilepsy: A Practical Meal Plan in a Hospital. Clin Nutr Res. 2016 Jan;5(1):60-3. doi: 10.7762/cnr.2016.5.1.60. Epub 2016 Jan 29. Erratum in: Clin Nutr Res. 2016 Apr;5(2):141. PMID: 26839878; PMCID: PMC4731863.

23Ye, F., Li, J., Jiang, L., Sun, B., & Liu, J. (2015). Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis. Journal of Clinical Neurology (Seoul, Korea), 11(1), 26-31. https://doi.org/10.3988/jcn.2015.11.1.26

24Meira, A., Romão, T. T., Krüger, L. T., & Paiva Pires, M. E. (2019). Ketogenic Diet and Epilepsy: What We Know So Far. Frontiers in Neuroscience, 13. https://doi.org/10.3389/fnins.2019.00005

Mag. Stephan Lederer, MSc. is an author and blogger from Austria who writes in-depth content about health and nutrition. His book series on Interval Fasting landed #1 on the bestseller list in the German Amazon marketplace in 15 categories.

Stephan is a true man of science, having earned multiple diplomas and master's degrees in various fields. He has made it his mission to bridge the gap between conventional wisdom and scientific knowledge. He precisely reviews the content and sources of this blog for currency and accuracy.

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