Epilepsy and Ketogenic Diet

Quick Answer

The medical ketogenic diet is a scientifically proven treatment for drug-resistant epilepsy, capable of reducing seizures by 50% or more in 50-60% of children and 30-40% of adults. It relies on very high fat ratio (80-90%) to induce ketosis, must be implemented under strict medical and nutritional supervision.

What is Epilepsy?

Epilepsy is a chronic neurological disorder characterized by recurrent seizures resulting from abnormal electrical activity in the brain. It affects about 50 million people worldwide. Although anti-epileptic drugs control seizures in about 70% of patients, 30% suffer from drug-resistant epilepsy, making the ketogenic diet an important therapeutic option.

Main Seizure Types:

Generalized seizures: Affect both sides of the brain (grand mal, absence seizures)
Partial (focal) seizures: Start in a specific area of the brain
Mixed seizures: Combine characteristics of both types

What is the Medical Ketogenic Diet?

The medical ketogenic diet for epilepsy is completely different from the popular ketogenic diet for weight loss. It is a precise medical treatment requiring specific calculations and intensive monitoring. Used since the 1920s, it has become an internationally recognized treatment for resistant epilepsy.

How Does the Ketogenic Diet Work Against Epilepsy?

Although the exact mechanisms are not fully understood, research points to several mechanisms:

Ketones as alternative brain fuel: Provide more stable energy than glucose
Reducing neuronal excitability: Ketones increase GABA (calming neurotransmitter) and decrease glutamate (excitatory transmitter)
Improving mitochondrial function: More efficient energy production for nerve cells
Reducing oxidative stress: Protecting brain cells from damage
Stabilizing nerve cell membranes: Making cells less susceptible to abnormal electrical activity

Types of Ketogenic Diet for Epilepsy

1. Classic Ketogenic Diet (Classic KD):

The most restrictive and effective version, uses 4:1 or 3:1 ratio (4 or 3 parts fat to 1 part protein and carbohydrates combined).

Composition: 90% fat, 6% protein, 4% carbohydrates

Best for: Children with severe resistant epilepsy, some rare syndromes

2. MCT Diet (Medium-Chain Triglycerides):

Uses medium-chain oils (like coconut oil) that produce ketones more efficiently, allowing greater amounts of protein and carbohydrates.

Composition: 60-70% calories from MCT, allows more flexibility

Best for: Older children and adults, those who find classic diet difficult

3. Modified Atkins Diet (MAD):

Less restrictive, doesn't require precise calorie calculations, limits carbohydrates (10-20g daily) and encourages fats.

Composition: 65-70% fat, 25-30% protein, 5-10% carbohydrates

Best for: Adults, teenagers, those needing more flexible approach

4. Low Glycemic Index Treatment (LGIT):

Most flexible, allows 40-60g carbohydrates daily but from low glycemic index sources.

Composition: 60% fat, 20-30% protein, 10-20% carbohydrates (low GI)

Best for: Those who find other types difficult, as first or transitional step

Who Benefits from Ketogenic Diet?

Cases Most Likely to Benefit:

Children with drug-resistant epilepsy: Failed 2-3 or more medications
Specific epilepsy syndromes: Dravet syndrome, tuberous sclerosis, Doose syndrome, GLUT1 deficiency
Infantile spasms (West syndrome)
Lennox-Gastaut syndrome
Certain mitochondrial enzyme deficiencies

Success Rates:

50-60% of children experience 50% or more reduction in seizures
10-30% become completely seizure-free
30-40% of adults respond positively
Results typically appear within 1-3 months

How to Implement Ketogenic Diet for Epilepsy

Preparation Phase (2-4 weeks before start):

Comprehensive medical evaluation: blood tests, urine, kidney and liver function
Multidisciplinary consultation: neurologist, dietitian, pharmacist
Family education: comprehensive understanding of diet and requirements
Medication adjustment: some medications contain hidden carbohydrates
Meal planning: preparing food lists and calculating recipes

Initiation Phase:

Traditional gradual method:

Day 1-2: Fasting (for children) or severe carbohydrate reduction (for adults) in hospital
Day 3: Introduce one ketogenic meal at 1:1 ratio
Day 4: Increase to 2:1 ratio
Day 5: Increase to 3:1 or 4:1 ratio (target ratio)
Continuous monitoring: Urine/blood ketones, blood sugar, general condition

Modern gradual method: Starting gradually without fasting or hospital stay, over 1-2 weeks, has become more common and safer.

Maintenance Phase (long-term):

Regular follow-up: every 1-3 months
Periodic tests: complete blood count, electrolytes, liver and kidney function, medication levels
Growth monitoring: for children (height, weight, bone density)
Adjustments as needed: calories, ratios, supplements
Continuous support: nutritional, psychological, social

Main Dietary Components

Healthy Fat Sources:

Oils: MCT oil, coconut oil, olive oil, avocado oil
Avocado: Excellent source of healthy fats and fiber
Nuts and seeds: In limited calculated amounts (almonds, walnuts, chia seeds)
Butter and cream: Full-fat
Fatty meats: Salmon, marbled beef
Egg yolk

Proteins (in moderate calculated amounts):

Chicken, turkey
Fish
Beef, lamb
Eggs
Cheese (low-carb)

Carbohydrates (very limited, carefully selected):

Leafy vegetables: spinach, lettuce, kale
Low-carb vegetables: broccoli, cauliflower, zucchini, cucumber
Berries (in very small amounts)

Necessary Supplements:

Ketogenic diet for epilepsy requires daily supplements:

Vitamins: Comprehensive multivitamin without sugar
Minerals: Calcium, magnesium, potassium, zinc
Vitamin D: To maintain bone health
Carnitine: To support fat metabolism (in some cases)
Citrate: For kidney stone prevention

Challenges and Side Effects

Common Side Effects (especially initially):

Constipation: Most common, treated by increasing fluids and allowed fiber
Hypoglycemia: Especially in first days
Acidosis: Monitored with regular tests
Diarrhea: Especially with MCT oil
Low energy and lethargy: Temporary during adaptation period
Nausea and vomiting: Initially
Food refusal: Especially in children

Long-term Side Effects (potential):

Kidney stones: 3-7% of patients
Growth retardation in children: if calories not precisely calculated
Osteoporosis: requires calcium and vitamin D supplements
High cholesterol: in some cases
Nutrient deficiencies: prevented by supplements and monitoring

How to Manage Challenges:

Precise and regular medical monitoring
Adjusting diet type (e.g., from classic to MCT)
Using natural or medical laxatives
Creativity in recipes to improve food acceptance
Psychological and family support

Examples of Medical Ketogenic Meals

Important Note:

These are general examples only. Medical ketogenic diet requires precise calculations for each meal based on individual needs and must be prepared under supervision of specialized dietitian.

Breakfast (Classic 4:1 diet):

Omelet cooked in MCT oil and butter, with heavy cream, and few strawberry slices

Lunch (MCT diet):

Chicken with full-fat mayonnaise, green salad with olive oil, avocado

Dinner (Modified Atkins diet):

Salmon cooked in butter, steamed broccoli with coconut oil, green salad

Snacks:

Ketogenic shake (cream, MCT oil, low-carb protein powder), calculated amounts of nuts, cheese

Treatment Duration and Discontinuation

Usually, continuing ketogenic diet for at least two years is recommended if effective. After that, if patient becomes seizure-free, gradual discontinuation over 3-6 months can be attempted under precise medical supervision.

Success Rates After Discontinuation:

About 20-30% remain seizure-free after stopping diet
40-50% retain partial improvement
If seizures return, returning to diet may be recommended

Ketogenic Diet for Epilepsy in Adults

While most research is on children, ketogenic diet can be effective for adults too, but with lower response rates (30-40%). Usually more flexible types (MAD or LGIT) are used for adults for easier compliance.

Adult-Specific Challenges:

Long-term compliance harder due to lifestyle and responsibilities
Social interactions and work
Impact on other medications
Need for greater self-management

Medical Disclaimer

The information provided in this article is for educational purposes only and does not replace professional medical consultation. The medical ketogenic diet for epilepsy is a complex medical treatment requiring intensive medical and nutritional supervision from a specialized team. Never start this diet on your own without medical supervision. Improper implementation can be dangerous. All decisions regarding epilepsy treatment must be made in consultation with the treating neurologist.

For Specialized Nutritional Consultations

Dr. Mai Obeid - Clinical Dietitian

For appointments and inquiries: +961 81 337 132