The ketogenic diet was developed in the 1920’s as a treatment for childhood epilepsy. On this article we’ll discover what makes keto an effective epilepsy treatment and just how it can be implemented to help to control seizures.
What is Epilepsy?
The word epilepsy means ‘more than one seizure.’ Statistics show that one in every twenty-six people have epilepsy. There are many causes of epilepsy. The majority of children who have an epileptic seizure, will not have another one. Figures indicate that between 30 and 40 percent of children will have recurring seizures. For this reason, most neurologists do not start children on medication after the first seizure.
Once a child has a second seizure, there is a 70 percent chance that a third one will follow. There are no medications that will cure epilepsy. The best they can do is to control them. There are a growing number of medications for epilepsy available. As of 2019 there are about twenty options. This compares with four options a dozen years ago.
About 10 percent of people do not respond to any type of epilepsy medication.
How the Keto Diet Fits In?
For hundreds of years fasting has been used as a treatment for epilepsy. Fasting was known to eliminate glucose from the body and force the body to switch to burning stored body fat for energy.
In the process ketone bodies are released into the bloodstream.
With the explosive growth of the ketogenic diet in the 1990’s, it began to be used extensively around the world as a treatment for epilepsy. There have been many studies into the effects of the keto diet on epilepsy. The results indicate that just over half of children with epilepsy will have their seizures improve by 50 percent. About a third of them will have a 90 percent improvement. Between 10 and 15 percent of them will be cured entirely.
The keto diet is often used in tandem with medications. It does not work with everyone, however. But, even a 25 percent improvement in seizures will make a dramatic lifestyle improvement for both children and adults.
Even in children where the actual number of seizures is not altered, the keto diet helps. It will shorten the length of seizures. They may also be less intense or occur only at night time.
When Should You Use the Keto Diet?
Experts recommend trying out two or three different types of medication before putting an epileptic child on the keto diet. If the medications do a good job of controlling the seizures and there are not any side effects, then the diet will not be necessary.
However, children with infantile spasms are an exception to this rule. They should be put on the keto diet straight away.
If, after, going on medication, seizures continue to occur at a rate of about once a week, then the person should be put on the keto diet. One of the great benefits of the keto diet is that it doesn’t carry the side effects that come with medication.
The researchers do not know exactly why the ketogenic diet works for epilepsy. But there is no doubting that it does work. In fact, the success of keto for epilepsy has led to new drugs being used. These include D-2 which blocks glucose. However there appears to be no single mechanism by which the ketogenic diet improves epilepsy.
When an epilepsy patient goes on the keto diet the body is tricked into thinking that it is going on a fast. It is deprived of carbs while being given moderate protein and high amounts of fats. The body quickly depletes its glycogen stores and turns to fat as its alternative energy source.
Types of Epilepsy that Keto Helps With
Research has shown that the Standard Ketogenic Diet can improve the following types of epilepsy.
Rett syndrome: This a rare, genetic disorder of the grey matter of the brain that forms after birth. 80% of Rett syndrome patients experience seizures.
Infantile spasms: This for of seizure usually occurs between 3-12 months after birth. There are three categories of epileptic seizures, that patients experience. Often all three occur at the same time.
Dravet syndrome: This is a rare genetic epileptic brain dysfunction that starts within the first year of birth.
Tuberous sclerosis complex: This is a genetic disorder where tumors are formed on the eyes, brain, kidney, lungs, and skin. Tumors on the brain can lead to several problems, including seizures.
GLUT1 deficiency syndrome: This disorder usually includes frequent seizures starting within the first months after birth.
Doose syndrome: This involves myoclonic-atonic seizures (a type of generalized seizure) that occur between seven months and six years old.
Keto for Epilepsy in Action
The keto diet for epilepsy is a medical treatment for controlling seizures by switching the body’s primary energy source from being a glucose based to a fat based energy system. Carbs make up between 50 and 70 percent of the diet of the average person.
The body converts these carbohydrates to blood glucose. The body then uses this glucose to produce energy. But when the body’s supply of glucose is limited, it turns to stored body fat and the fat that we eat to produce energy.
When there is a severely depleted supply of glucose, as when a person fasts, the body then burns fat for energy. The muscles of the body only store a 24-36 hour supply of glucose. When that energy source is depleted, the body will then use stored body fat.
The keto diet was developed to simulate the metabolic response that takes place when we are fasting. But, unlike fasting, the keto dieter also takes in exogenous fat through food. This allows the person to keep using body fat as their primary source of energy for the long term.
When the body utilizes stored body fat for energy, it leaves a residue which are known as ketone bodies. These ketones build up in the blood. There are three types of ketones:
- Beta-hydroxybutyric acid
- Acetoacetic acid
Beta-hydroxybutyric acid can be used by the liver and the brain as a source of energy. Acetoacetic acid is released from the body through our urine. Acetone is excreted through the breath.
Researchers at Johns Hopkins University are world leaders in the use of the ketogenic diet for epilepsy control. They have found that the most useful method involves beginning with a 24 hour fast and then gently introducing the keto diet.
The John Hopkins researchers have produced a couple of sample diets to guide the introduction to the ketogenic diet.
Sample Meal Plans
Breakfast Plan A
- Scrambled eggs with butter
- Diluted cream
Breakfast Plan B
- Scrambled eggs with butter
- Melon slices
- Vanilla cream shake
Lunch Plan A
- Spaghetti squash with butter and parmesan cheese
- Lettuce leaf with mayonnaise
- Orange diet soda mixed with whipped cream
Lunch Plan B
- Tuna with mayonnaise
- Celery with cucumber sticks
- Sugarless Jell-O with whipped cream
- Hot dog slices with ketchup
- Asparagus with butter
- Chopped lettuce with mayonnaise
- Vanilla cream ice pop
- Broiled chicken breast
- Chopped lettuce with mayonnaise
- Cinnamon apple slice with butter topped with vanilla ice cream
Ketogenic Diet VS MAD Diet
The Modified Atkins Diet (MAD) was introduced by researchers at Johns Hopkins University in the early 2000s. It was a less restrictive version of the Standard Ketogenic Diet (SKG). It began with a macronutrient ratio of 2:1. This means that it had twice as many fats as carbs and proteins combined.
The diet included a product that ws create at Johns Hopkins called Ketocal. This pre-made formula is high in fat and has been shown to be an effective aid in controlling seizures.
After four weeks, the macro ratio is adjusted to a 1:1 ratio. Carbs are limited to between 10 and 20 net grams per day. As the diet progresses adjustments in carbs can be made up or down according to the results achieved.
A key difference between MAD and the keto diet is that there is no limit on protein and fats on MAD. There is also no formal measurement of foods. That makes MAD less formal and easier to comply with, especially for busy families. Carbs are counted using formal USDA food guidelines as outlined in carb counting books and online resources.
Despite their differences, MAD and the Standard Ketogenic Diet are quite similar. Both are predicated on the body’s ability to burn fat for energy rather than glucose. Both are low carb and high fat. In both cases the focus is not so much on such ‘healthy’ foods as whole grains and more of an emphasis on such fats as heavy whipping cream, avocado and nuts.
On the other hand, some people found the ketogenic diet easier because it doesn’t involve any guesswork. You don’t have to wonder how much fat is enough or whether you are getting too many calories. In the end it depends if you prefer the regimented approach of the ketogenic diet or the free-wheeling approach of MAD.
The Standard Ketogenic Diet is best for:
- Infants – children under the age of two should be on the SKG rather than MAD primarily because they have a greater need for carbohydrates. They also required a more rigid approach to their diet because they are in a vital stage of brain growth and development.
- Children with developmental delays – it can be a real challenge to get kids to stop eating sugary foods. However, those with developmental delays have been shown to be less concerned with how their food compares.
- People who are looking for more direction – often parents who are implementing the keto diet for their epileptic children benefit from the restrictions of the keto diet.
The MAD diet is best for:
- Those who prefer a less restrictive way to cook and prepare meals – rather than telling you to include a specific number of grams of fat, on MAD you will simply be told to use a generous amount of fat.
- Adults and older children – MAD provides you with a greater range of choice, which makes it easier for teens and adults to stick with.
- Children who need more freedom – children who have behavioral problems will probably be more likely to stick to MAD than the keto diet.
- People who often eat out at restaurants and social functions – it is easier to adapt MAD to these situations.
- You are a long way from a Keto clinic or there is a long waiting list for clinical supervision of the standard ketogenic diet.
Myths about Keto and Epilepsy
Myth: The keto diet will completely control all seizures.
Reality: About 10 percent of all children will become seizure free. Others will be able to reduce the number of medications that they take. A little over half the people who go on the keto diet for epilepsy will derive benefits to improve their condition.
Myth: If I put my child on the keto diet, they will get rid of all the side effects of the medication they have been taking.
Reality: There is no guarantee that your doctor will take your child off medication when he or she goes on the keto diet. The usual scenario is that they initially use both and then the doctor monitors the situation. If he decides to go off the medication then the side effects of that medication will wear off.
Myth; We can try keto for a few weeks. If it doesn’t work, we will go back to medication.
Reality: You should commit to the keto diet for a minimum of three months. It takes that long to do it justice.
Myth: The keto diet is all natural whereas medications are not.
Reality: The keto diet does have potential side effects, such as keto headache and keto flu (not to mention keto breath).
Summing It Up
The ketogenic diet is a proven and accepted treatment for epilepsy, especially among. Researchers don’t fully understand how keto suppresses seizures, but it is believed to be related to the buildup of ketones in the blood. A ketogenic diet for epilepsy should always be undertaken under medical supervision. Some people may prefer to follow the MAD diet, which is less restrictive than the Standard Keto Diet.