How diets can help treat Epilepsy
In today’s world, where chronic conditions like epilepsy pose significant challenges to individuals and their families, exploring alternative treatments provides new options for adults and children in treating epilepsy. Among the various approaches, dietary therapies have gained attention for their potential in managing epilepsy and in particular the ketogenic (keto) diets have effectively treated both adults and children with drug-resistant (refractory) epilepsy.
Ketogenic (Keto) diets for Epilepsy
Maintaining a balanced diet isn’t just about fulfilling nutritional needs; it can also play a crucial role in managing health conditions. Dietary interventions have been used for centuries to alleviate symptoms and improve overall well-being.
Among the various dietary approaches, the ketogenic diet has emerged as a powerful tool in managing epilepsy. This high-fat, low-carbohydrate diet induces a metabolic state called ketosis, which is believed to reduce seizure frequency and severity.
There are five versions of the ketogenic diet used to treat epilepsy. The original, now known as the Classic Ketogenic Diet, was created in 1923 by Dr. Russell Wilder of the Mayo Clinic as a treatment for epilepsy. This original diet was followed by more recent types known as the Modified Ketogenic Diet, the Medium Chain Triglyceride (MCT) Diet, the Modified Atkins Diet, and the Low-Glycemic Index Treatment (LGIT). The various types of ketogenic diets have been used for years and have been studied in people with epilepsy who have failed to achieve seizure control with anti-seizure medications.
Click here to find out more about the five versions of the Keto Diet
How do ketogenic diets reduce seizures?
Although the way in which ketogenic diets work is still not completely understood, it has been used since the 1920s. Several theories have been suggested:
An increase in ketones
The ketones produced when the body uses fat as fuel instead of carbohydrates can prevent seizures by:
the amount of chemicals in the brain that prevent the neurons from firing (neurons send information messages throughout the brain and central nervous system).
- Increasing the production of energy in the brain, making a more stable neuron.
- Stopping neurons from firing through the opening of certain ion channels in the cells. Ion channels are small, gated pathways that allow ions (such as sodium and potassium) to move in and out of cells.
- Less energy production because of ketones, compared to that of carbohydrates, shows anti-epileptic effects.
An increase in Polyunsaturated Fatty Acids
Polyunsaturated Fatty Acids (PUFAs) are a type of fat that comes from your diet and make up approximately half of the fat content found in the brain. PUFAs help control the way neurons in the central nervous system work. An increase in these PUFAs can lead to:
- The activation of specific proteins in the body that play critical roles in inflammation and a stable environment (homeostasis).
- The control of certain ion channels that stop the firing of neurons
Prevention of cell death
Having a seizure can cause damage or even the death of cells in the nervous system. Ketogenic diets increase the levels of a particular gene that protects these cells from dying.
Change in the microbes found in the intestine.
Ketones change the bacteria found in the intestines, increasing the number of good bacteria. This change has a positive effect on certain chemicals in the blood and brain.
How to choose the right ketogenic diet for Epilepsy
Starting and maintaining a ketogenic diet involves a joint team approach from neurologists, nutritionists, and primary care providers. Choosing the right diet is based on several factors, including, age, type of epilepsy, current medications, comorbidities, nutritional health, and treatment response.
While evidence has shown that the classic Keto Diwt is slightly more effective at treating epilepsy than other versions, it is not as well-tolerated due to its restrictive nature and side effects. The classic Keto Diet may be easier to administer to children, but the modified Keto Diet, Medium Chain Triglyceride, and Modified Atkins Diet variations are more tolerable, flexible, and have fewer adverse effects. Low-Glycemic Index Treatment is also less restrictive and more favorable; however, there is not enough information regarding the safety and tolerability of the diet.
Who Can Benefit from Dietary Therapies?
Not everyone with epilepsy is a suitable candidate for dietary interventions. Factors such as seizure frequency, age, and medical history influence the likelihood of success. It’s essential to consult with a healthcare professional to determine eligibility and develop a personalized treatment plan.
Who should avoid the keto diet?
Patients should avoid ketogenic diets if they have any of the following conditions:
- Liver failure
- Kidney disease
- Type 1 diabetes
- Pregnancy
- Breastfeeding
- Irregular heartbeats
- Stroke
- Heart attack or heart failure
- Respiratory infections or failure
- Elderly
- Substance abuse
- Mental disorders
- Cancer
- Increased levels of uric acid
- Abnormal cholesterol levels
- Other rare disorders
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Frequently Asked Questions (FAQs)
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How long should someone be on the keto diet?
To determine the efficacy of ketogenic diets, patients should try the diet for at least three months from the time ketones are found in the body. Patients should also be seen regularly, ideally every three months, to monitor progress, discuss concerns or adverse effects, and adjust the diet (if needed).
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Are dietary therapies suitable for everyone with epilepsy?
Dietary therapies may not be suitable for everyone and should be discussed with a healthcare professional to determine eligibility.
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Can dietary therapies be used alongside medications for epilepsy?
Yes, dietary therapies can be used in combination with medications as part of a comprehensive treatment plan.
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Are there any side effects of the keto diet for epilepsy?
Side effects can occur in all five versions of the ketogenic diet; however, it has been reported that stricter versions result in a higher rate of side effects. [6]
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How long does it take to see results from dietary interventions for epilepsy?
The timeline for seeing improvements can vary depending on individual factors, but some individuals may experience positive effects within a few weeks to months.
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Are there any alternatives to the ketogenic diet for epilepsy management?
Beyond the traditional ketogenic diet, several variations have been developed to suit different needs and preferences. These include the Modified Atkins diet and the Low Glycemic Index Treatment (LGIT), each offering unique benefits for individuals with epilepsy.
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How can I implement a dietary therapy safely?
While dietary therapies can be effective, they also require careful implementation and monitoring. Healthcare professionals play a crucial role in guiding patients through the process, ensuring safety and efficacy.
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What are the challenges and considerations?
Despite their potential benefits, dietary therapies come with challenges such as dietary restrictions and lifestyle adjustments. It’s important for individuals and their families to be aware of these challenges and seek support when needed.
Treatments and Therapies
Learn about the medications, surgeries, and alternative therapies used to treat epilepsy and seizures.
References:
- https://charliefoundation.org/learn-about-ketosis/
- https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/keto-diet-timeline.html
- Operto FF, Matricardi S, Pastorino GMG, Verrotti A, Coppola G. The Ketogenic Diet for the Treatment of Mood Disorders in Comorbidity With Epilepsy in Children and Adolescents. Front Pharmacol. 2020 Nov 24;11:578396. doi: 10.3389/fphar.2020.578396. PMID: 33381032; PMCID: PMC7768824.
- Kossoff, E.H., Zupec-Kania, B.A., Auvin, S., Ballaban-Gil, K.R., Christina Bergqvist, A., Blackford, R., Buchhalter, J.R., Caraballo, R.H., Cross, J.H., Dahlin, M.G., Donner, E.J., Guzel, O., Jehle, R.S., Klepper, J., Kang, H.-C., Lambrechts, D.A., Liu, Y.C., Nathan, J.K., Nordli, D.R., Jr, Pfeifer, H.H., Rho, J.M., Scheffer, I.E., Sharma, S., Stafstrom, C.E., Thiele, E.A., Turner, Z., Vaccarezza, M.M., van der Louw, E.J., Veggiotti, P., Wheless, J.W., Wirrell, E.C., , and (2018), Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open, 3: 175-192. https://doi.org/10.1002/epi4.12225
- Wells J, Swaminathan A, Paseka J, Hanson C. Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy-A Review. Nutrients. 2020;12(6):1809. Published 2020 Jun 17. doi:10.3390/nu12061809
- Goswami JN, Sharma S. Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management. Neuropsychiatr Dis Treat. 2019;15:3273-3285. Published 2019 Nov 25. doi:10.2147/NDT.S201862