The keto diet is low in carbohydrates and protein and very high in fat. Evidence suggests that it can reduce the frequency of seizures, and some people with epilepsy who follow the diet stop experiencing seizures altogether.
Typically, people who try the diet for this purpose are also taking antiepileptic medications.
However, the keto diet may be especially effective for children with refractory epilepsy, which does not respond to medical treatment. Modified versions of the diet may be more suitable for adolescents and adults.
It is crucial to note that a medical professional should monitor anyone using a keto diet to help control epilepsy. This is to ensure that the person is dieting safely and getting the most benefits. Medical supervision is especially important for infants and other children.
In this article, we explore the potential benefits of the keto diet for adults and children with epilepsy.
According to a 2019 review, the keto diet appears to reduce or prevent seizures in children and adults with drug resistant — or refractory — epilepsy.
The Epilepsy Foundation recommend the diet as a potential treatment for refractory epilepsy.
They report that more than half of children with refractory epilepsy who follow a ketogenic diet experience at least a 50% reduction in the number of seizures. Moreover, according to the same source, about 10–15% of these children stop experiencing seizures.
How does it work?
When a person is on the keto diet, their body does not receive enough carbohydrates to burn for energy, so it must use fat instead.
Burning fat for fuel causes acids called ketones to build up in the body. When this occurs, the body is in ketosis. To achieve this, a person must adhere to the diet for a significant period.
Ketosis also occurs during periods of fasting. As a 2013 study notes, people have used fasting as a seizure treatment for centuries, and scientists documented the effects of this approach into the 1920s. Even so, experts are still unsure how, precisely, ketosis or the keto diet helps people with epilepsy.
Epilepsy is a metabolic disease, and one theory is that the keto diet works by altering a person’s metabolism.
Neurons, or hyperexcitable nerve cells, in the brain may contribute to the onset of seizures. The keto diet leads to metabolic changes in the blood and cerebrospinal fluid, and these changes, along with other factors, may decrease the excitability of neurons. This could have a stabilizing effect on seizures, according to experts.
The keto diet can take time to have an effect. In order to see the benefits, people should continue with it for at least 3 months after reaching ketosis.
It is very important that a healthcare professional monitors anyone using a keto diet for treatment. They can ensure that the diet is having safe effects and that the person’s body is really going into ketosis.
Both children and adults with drug resistant epilepsy can benefit from a keto diet. It may be especially helpful for people with certain types of epilepsy, including:
- Doose syndrome
- Dravet syndrome
- glucose transporter type 1, or GLUT-1, deficiency
- infantile spasms
- Rett syndrome
- tuberous sclerosis complex
The diet may also be effective for children with focal seizures.
Children
Children of any age can follow a keto diet. Under the strict supervision of a doctor, a formula only keto diet may help control seizures in infants.
Parents and other caregivers should receive guidance on meal planning and cooking, and they should be aware of potential adverse reactions to the diet.
Adolescents and adults
Doctors often do not recommend the classic keto diet to adolescents and adults because it can be difficult to maintain. They may instead recommend a modified keto diet that is more palatable and convenient.
Experts suggest that around 30–40% of adults with epilepsy who follow a keto diet experience at least a 50% reduction in seizures.
However, fewer than 10% of these adults achieve a 90% reduction in seizures or stop experiencing them.
Anyone intending to use the keto diet to control epilepsy should be aware of the risks and possible additional benefits.
Other benefits
A modified keto diet may provide benefits beyond epilepsy management. Adults on the diet may experience improvements in:
- alertness
- concentration
- psychological function
- the quality of life
Risks
Children and adults who follow keto diets must see their doctor or dietitian at least every 3 months. These regular visits are important for monitoring progress and growth and checking for any adverse effects of the diet.
Risks of a keto diet include:
Since the diet allows for few fruits, vegetables, grains, and other nutritious foods, supplementation with a carbohydrate-free multivitamin is essential.
Once a person has maintained control over their seizures for some time, their doctor may suggest coming off the diet. Doctors usually recommend doing so after a period of 2 years.
It is important to come off the diet gradually, over a period of several months or longer. Suddenly stopping the diet can cause seizures to get worse.
Some modified versions of the keto diet for epilepsy include:
- The modified Atkins diet: This is also very low in carbohydrates and high in fat. It does, however, allow for a greater choice of foods. It is important to count carbohydrates and ensure that the body is receiving enough calories from fats.
- The low-glycemic index diet: This diet also has a high fat allowance, but it permits more protein than the keto diet.
- The medium-chain triglyceride (MCT) diet: This is similar to the classic keto diet, but each meal tends to include fat from MCTs, such as those in oils or emulsions. It allows more freedom when choosing carbohydrate and protein sources.
At present, there is no evidence that any type of food generally triggers epilepsy seizures.
There is a rare type of epilepsy, called reflex epilepsy, in which certain foods can trigger seizures. These triggers vary from person to person.
Some people with epilepsy report that specific food additives can trigger seizures. Potential triggers include:
Some drinks can contribute to seizures or affect epilepsy medications.
These beverages may contain:
- Alcohol: Alcohol can trigger seizures in some people. Anyone who believes that this is a trigger should avoid it.
- Caffeine: Some research indicates that caffeine increases the risk of seizures, but that continued use may protect against seizures in some cases. Caffeine may also make some medications for epilepsy less effective, especially topiramate.
- Grapefruit juice and pomegranate juice: These may increase the risk of adverse reactions to some epilepsy medications, including carbamazepine, diazepam, and midazolam.
Anyone with concerns about how foods or drinks may be affecting their seizures or medications should speak to a doctor.
The keto diet may be an effective treatment for people with drug resistant epilepsy.
While the diet can be suitable for people of any age, children and infants may experience the greatest benefits because they can stick to the diet most easily.
Adolescents and adults may do better on a modified version of the keto diet, such as the modified Atkins diet or the low-glycemic index diet.
A healthcare provider should carefully monitor anyone using a keto diet as a treatment. This is especially crucial for children and particularly infants.
A doctor and dietitian can observe a person’s progress, recommend supplements, and check for adverse effects.