Ketogenic diet for epilepsy

Treatment Overview

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When the body burns (metabolizes) fat, it creates substances called ketones. The ketogenic diet tries to force the body to use more fat for energy instead of sugar (glucose) by increasing fat and restricting carbohydrates. It is not yet clear how or why the ketogenic diet prevents or reduces seizures, but it has been shown to be effective in reducing epileptic seizures in some children.¹

The ketogenic diet provides 4 grams of fat for every 1 gram of protein and carbohydrate. People on a ketogenic diet have to eat mostly fatty foods, such as butter, cream, and peanut butter. Foods such as bread, pasta, fruits, and vegetables have to be severely limited, and the person's total calories and fluids are also restricted. At every meal, the food has to be measured carefully so that the right amounts of each food are given; even a slight departure from the diet can ruin its effect.

What To Expect After Treatment

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A person usually has to fast the day and night before starting the diet. The diet is gradually introduced over several days, so that the body can get used to the dramatic change. The person may feel tired and lack energy during the first few days.

Children are usually admitted to a hospital or epilepsy center when starting the diet so that they can be monitored. The ketogenic diet should always be given under the supervision of a doctor and a dietitian.

Why It Is Done

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The ketogenic diet may sometimes be used to treat children with severe seizures who have not responded to antiepileptic medications. It has been especially effective in treating seizures related to Lennox-Gastaut syndrome. It may be a good choice for a child when other treatments have failed to control seizures.

How Well It Works

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Doctors are not sure why the ketogenic diet helps prevent seizures, but the diet has prevented epileptic seizures in many children who did not respond to treatment with antiepileptic medications, including children with Lennox-Gastaut syndrome. Another benefit of the ketogenic diet for some children is that it may reduce or end the need for medication and thus avoid the side effects that result from medication.

A review of the results from numerous studies of the ketogenic diet found that over half of children with seizures that don't respond to medications who follow the ketogenic diet have a 50% or greater decrease in seizures.¹ Some children have an even greater reduction.

No one knows why the ketogenic diet prevents seizures in some children and not in others, or why it has been more successful with children than with adults. If you have a child with uncontrolled epilepsy, you may wish to discuss with your child's doctor whether a ketogenic diet might be an option.

Risks

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The ketogenic diet may cause side effects in some people. These are not usually serious but may include:

• Dehydration.
• Constipation.
• Vomiting.
• High cholesterol level.
• Kidney stones.
• Behavior changes.
• Slower growth rates in children.

People on the ketogenic diet may develop vitamin and mineral deficiencies unless they take vitamin and mineral supplements. The diet does not supply adequate amounts of the vitamins and minerals the body needs.

Everyone on the diet needs close supervision by a doctor and a dietitian.

What To Think About

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Despite the success of the ketogenic diet in some children, many doctors remain skeptical of its use. It may pose other health risks to your child, and it is extremely hard to follow. Until more is known about how the ketogenic diet works and what its effects are, some doctors may not recommend using it. If you are thinking about having your child try the ketogenic diet, keep in mind that it has several drawbacks:

• For the diet to prevent seizures, your child has to follow it exactly. The amounts and types of foods eaten have to be measured precisely, and preparing meals can take a lot of time.
• The diet does not work for some children, no matter how closely they follow it.
• The ketogenic diet is not a healthy eating plan for children or adults.
• It does not taste very good.
• People on the diet usually need to take vitamin and mineral supplements.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

References

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Citations

1. Jarrar RG, Buchhalter JR (2003). Therapeutics in pediatric epilepsy, part 1: The new antiepileptic drugs and the ketogenic diet. Mayo Clinical Procedures, 78(3): 359–370.

Credits

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Author	Monica Rhodes
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman
Primary Medical Reviewer	Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer	Steven C. Schachter, MD - Neurology
Last Updated	November 11, 2005