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The Ketogenic Diet and Epilepsy: Does It Really Work?
Some seizures in children have no known cause. If these unprovoked seizures recur it may be called epilepsy. Seizures can be stressful for the child and family. Medication can be an effective treatment for some, but others may need more help to control their seizures.
A special diet called the Ketogenic Diet may help manage epilepsy in children, particularly with epilepsy that is resistant to medication. The diet requires significantly lower amount of carbohydrates and high amounts of fat. It can be a difficult diet to maintain but for some children the seizure control may be worth the effort. Most doctors will have a person try the diet for up to 3 months to see if it works. If your child responds well to the diet and remains seizure-free for 2 years, your child may also slowly be transitioned to a more normal diet.
Getting to Know the Ketogenic Diet
Treatment of epilepsy was generally ineffective in the early 1900's. In the 1920s, it was found that fasting could reduce the number of seizures but it was not clear why. Fortunately, anti-seizure medications were developed that helped the majority of people with epilepsy. As a result, dietary treatments lost popularity as a main treatment option for epilepsy.
The ketogenic diet is a high fat, low carbohydrate diet.. The classic diet is made up of 3 parts fat and 1 part carbohydrate and protein. There are variations of the diet, like one that uses medium chain triglycerides as a primary source of fat. You and your child's doctor and dietitian will make adjustments to your child's diet as needed.
How it Works
The diet mimics some effects of fasting on the body. Glucose (sugar) is the easiest source of energy for the body. Most of the glucose comes from carbohydrates that we eat. Once the glucose is burned off, the body uses fat as a source of energy. The use of fat creates a by-product called ketones. For reasons not completely understood, the ketones may reduce or eliminate seizures. Your body will also use body fat for fuel when you fast but fasting is clearly not a long term option. Having a diet with a high amount fat will have a similar effect of increasing ketone production.
Making the Change
Degree of Difficulty
Any dietary change is difficult. The range of food in this diet is somewhat limited, some find it easier than others to complete the process. To get the most benefit, it is important to follow the diet as closely as possible.
The transition to this diet will be monitored by a doctor. Your child will also be tested on a regular basis to look for side effects and maintain body function. If your child is not seeing a benefit your doctor may stop the diet and try alternative treatments.
What kinds of foods will your child be able to eat? Focus on what can be eaten, rather that what cannot be eaten. Keep in mind that the ketogenic diet is fat-based, so fatty foods rule the menu. You can be as creative as you want as long as you are mindful of what your child can eat. Here is a list of possible menu items:
- Meats, such as bacon, steak, or hamburger
- Full-fat dairy low in carbohydrates
- Full-fat condiments, such as mayonnaise, oil, or butter
- Vegetables high in fiber
- Limited servings of fruit
What to Expect
There is more to the diet than just the food. The fat-based menu does have side effects that may appear within a few days. The good news is they are short term and should disappear as your child's body adjusts to the diet. Keep an eye on your child's progress and discuss it with your child's doctor.
Common Side Effects
- Nausea and vomiting
- Dehydration—make sure your child has adequate fluid intake
Unusual, Rare, or Serious Side Effects
Heart disease as an adult is the biggest potentially harmful side effect of eating a high-fat diet. Cholesterol and triglycerides are fats in the blood. High levels can increase the risk of future heart disease. Although the diet leads to significant elevations of fatty substances in the blood, the diet has not been proven to be unsafe. For many, the benefit of reducing or eliminating seizures outweigh the potential of a possible harm developing later in life.
The Epilepsy Foundation
Kids Health—Nemours Foundation
The Center for Epilepsy and Seizure Education
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Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 7, 2014. Accessed October 23, 2014.
What is the ketogenic diet? The Charlie Foundation website. Available at: http://www.charliefoundation.org/explore-ketogenic-diet/explore-1/introducing-the-diet. Accessed October 23, 2014.
5/14/2008 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Neal EG, Chaffe H, Schwartz RH, et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 May 2. [Epub ahead of print]
- Reviewer: Michael Woods, MD
- Review Date: 10/2014
- Update Date: 10/23/2014