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.
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
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:
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).
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:
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.
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.
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.
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.
Patients should avoid ketogenic diets if they have any of the following conditions:
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).
Dietary therapies may not be suitable for everyone and should be discussed with a healthcare professional to determine eligibility.
Yes, dietary therapies can be used in combination with medications as part of a comprehensive treatment plan.
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]
The timeline for seeing improvements can vary depending on individual factors, but some individuals may experience positive effects within a few weeks to months.
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.
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.
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.