Introduction to the Ketogenic Diet Therapy for Epilepsy

 

What is the ketogenic diet therapy? 

The ketogenic diet is a medical diet that contains low carbohydrate, high fat, and moderate protein content. The diet is decided to induce the body metabolism into the metabolic state called ketosis. 

 

How does the ketogenic diet work? 

The ketogenic diet has multiple mechanisms to alleviate and eliminate seizures including, but not limited to, the following: 

• Provide an alternative energy fuel to the brain and increase brain energy production, which result in the brain becoming more “resilient” to seizures. 
• Alter the chemicals (neurotransmitters) in the brain and reduce brain excitation. 
• Reduce inflammation in the brain. 
• Possible neuroprotection (protection against a loss of brain cells) 
• Potentially change in gene expression in the brain through an epigenetic process which may result in a sustained benefit (sustained seizure freedom) even after the diet discontinued 

How well does the ketogenic diet work to control seizures? 

Because seizures and epilepsy are different in each individual person, the efficacy of the dietary therapy may not be the same for everyone. However, studies have shown that approximately 60% of patients will respond to the therapy with seizure frequency reduced more than 50%.  Additionally, 15-20% of patients with epilepsy, who do not respond to medications, can become seizure-free on the ketogenic diet, and able to discontinue the medications. 
 

 

Who would benefit from the ketogenic diet therapy? 

Most people with epilepsy can benefit from the ketogenic diet therapy, especially ones whose seizures do not respond to medications. Moreover, patients with certain epilepsy diagnoses may have a significant and remarkable response to the ketogenic diet therapy and therefore should consider the therapy early, such as: 

• Glucose transporter 1 deficiency syndrome  
• Pyruvate dehydrogenase deficiency  
• Epilepsy with myoclonic-atonic seizures (Doose syndrome) 
• Infantile Epileptic Spasms Syndrome (IESS) 
• Developmental and Epileptic Encephalopathy (DEE) 
• Infants with epilepsy 
• Epilepsy due to a genetic disorder 

Types of the ketogenic diet therapy

There are at least 3 main types of the dietary therapy that induce the body into ketosis and have been proven to be effective in management of epilepsy. 
 

Type	Dietary content	Characteristics
Classic Ketogenic Diet	The common ratio of fat: non-fat (carbohydrate + protein) = 4:1 or 3:1 ratio	Strict diet that needs to be measured precisely.  All the menus must be verified by a specialist dietitian.  Induced ketosis the fastest and highest. Thought to be the most effective diet
Modified Atkin’s Diet	Increased fat intake, very low carbohydrate, regular protein consumption	More flexible, emphasize on carbohydrate counting and increasing fat intake
Medium Chain Triglyceride Diet (MCT diet)	Utilize medium chain triglyceride (MCT) as a main fat component as MCT can directly convert to ketone bodies the fastest (most ketogenic)	Use MCT as a main fat component, allows most carbohydrate consumption

 

When you consider the ketogenic diet therapy… 

The ketogenic diet therapy is NOT the same as “keto diet for weight loss”. It is a medical treatment and requires a multidisciplinary team approach and expert supervision to prevent potential adverse effects, such as kidney stones, vitamin/mineral deficiency, poor growth, and liver problems etc., and to ensure the success and safety of the patients.  If you or your family are interested in the ketogenic diet therapy for treatment of epilepsy, please consult an epileptologist (a neurologist with special training in epilepsy management) and a specialist ketogenic dietitian. 


By Dr. Chalongchai Phitsanuwong, FAAP, FAES