Epilepsy is a neurological disorder characterized by seizures. Any person of any age can develop the condition, which affects around 3.4 million people in the United States. Diet may help control seizures in people resistant to medication; the ketogenic diet is the most common diet discussed by nutritionists and people trying to treat their symptoms today. Though popular these days for many reasons, varieties of the keto diet have been used since the 1920s to help control seizures, particularly in children.

Epilepsy and Diet

Experts suggest people with epilepsy follow the same guidelines as most people: a balanced diet that includes carbohydrates, protein, and fats, with fruits and vegetables for vitamins and minerals. There is not a lot of research into the impact of this diet on seizures, but it can lead to better sleep and a more active lifestyle. For some people, quality sleep helps reduce the risk of seizures. Some people with reflex epilepsy have food-triggered seizures and need to avoid artificial sweeteners and other problematic foods.

Studies on Diet and Epilepsy

The ketogenic diet is the most studied in relation to epilepsy. One study in Lancet Neural in 2008 showed a significant decrease in seizure activity in children fed a keto diet, compared to the control group. Seven percent of the subjects had more than a 90% reduction in seizures. Studies on the diet’s impact on adults are small but promising. One indicates that more than half of participants had a 50% or greater reduction in seizures when eating a keto diet.

What is the Ketogenic Diet?

The ketogenic diet is extremely low in carbohydrates and high in fat. The diet used to treat epilepsy is different from the one popular today for weight control and other general benefits. The ketogenic diet for epilepsy generally has a higher fat ratio, with up to 90% of calories coming from fat. A weight-loss version of the diet may include cheat days, but eating any extra carbohydrates can lead to seizures in people with epilepsy.

How Does Keto Affect the Body?

Usually, the body uses glucose, provided by carbohydrates, for energy. A ketogenic diet does not provide enough glucose, so the body begins to burn fat instead. This alternative process creates ketones, byproducts of the breakdown of fatty acids. Though the exact mechanism by which ketogenic diets can alleviate epilepsy symptoms is unknown, scientists believe ketones may possess strong anticonvulsant effects. Others believe a specific fatty acid may be involved in preventing seizures.

Starting a Ketogenic Diet

Any individual planning to start a ketogenic diet — especially for the treatment of a disease or disorder — should do so under the care of a medical practitioner. Dietitians can monitor nutrition and teach participants what to eat and how to prepare food, and a neurologist will monitor medications, which may need adjustment. Children are generally admitted into a ketogenic diet center in a hospital to start the diet and the protocol may commence with a 24-hour fast to burn away remaining glucose. Centers also monitor seizures during the initial stages of the diet and ensure medications are carbohydrate-free.

Eating Keto at Home

The keto diet takes a big commitment from families to ensure carbohydrates are not available. Foods must be measured and tracked so that it is clear how many carbohydrates are being eaten. Fats generally come from butter, oils, mayonnaise, and cream. High-carbohydrate foods such as bread and rice most likely exceed the maximum carb allowances and so are often avoided completely. Eating out becomes quite difficult on a strict ketogenic diet.

The Ketogenic Diet and Medication

The ketogenic diet is generally recommended for children for whom multiple seizure medications have failed. In general, however, doctors aim to continue with medications while patients are on the keto diet, with the two treatments complementing each other. A neurologist continues to monitor medication and seizures while a person is on the diet. The diet does not always provide all vitamins and minerals required; some individuals may require supplements.

Side Effects of the Ketogenic Diet

The ketogenic diet is not without side effects, both short- and long-term. People may feel tired while the body adapts to burning fat, and may also experience persistent hunger and nausea or vomiting. Long-term, those on the keto diet may experience constipation due to a lack of fiber. Kidney stones, bone weakness, high cholesterol and slowed growth are other possible side effects. On the positive side, many people report increased energy and alertness once their bodies have acclimated to the diet.

Stopping the Keto Diet

Doctors may recommend coming off the diet if an individual’s seizures have been controlled for two years or more. Carbohydrates are reintroduced slowly while seizure activity is closely tracked. Some people may be able to transition to a less restrictive but still low-carb way of eating, while others can return to a normal, balanced diet. In some instances, people remain seizure-free after returning to a regular diet.

Other Dietary Options

Less restrictive dietary options that are easier to follow do exist for people with epilepsy, although they are not as well-researched as the ketogenic diet. The low-glycemic index treatment centers around eating low GI foods, carbohydrates that raise blood glucose only minimally. Experts believe this diet works for some because it lowers glucose in the blood and brain cells. The modified Atkins diet is another popular option. It is similar to the ketogenic diet, but does not restrict protein and only measures carbs.