Ketogenic Diet for Epilepsy
The classic ketogenic diet is a special diet with a high amount of fat and a low amount of carbs. This is usually used for treating epilepsy in children that do not respond to medications.
How did the use of the ketogenic diet evolve?
People in ancient Rome thought that evil spirits caused epilepsy. So, they made the epileptic patients starve so that these spirits would starve and leave their bodies. It indeed worked! Thereafter, many ancient Greek physicians, including Hippocrates, used fasting to cure medical illnesses, including epilepsy. This practice continued for centuries to come.
In the early 1900s, many physicians in Paris and the United States also used fasting to cure illnesses. A breakthrough in the story of the ketogenic diet arose by Dr. Russel Wilder of Mayo Clinic in 1921, who noted that the similar effects to that of fasting, which is the production of more ketones, could be achieved by a diet with low carbohydrates and high fat. He named this diet the “Ketogenic diet”, - the diet that produces ketones. This was considered a relieving discovery since fasting was painful and hard to sustain, and the ketogenic diet created an ideal alternative for that. Since then, this diet has been used to treat epilepsy patients.
However, the discovery of Diphenylhydantoin in 1938 by Merritt and Putnam, at a time only Bromide and Phenobarbital were used for epilepsy, caused everyone to stick to the new antiepileptic medicines deviating from the ketogenic diet. So, the place of the ketogenic diet in treating epilepsy was no more. It seemed that people loved the idea of controlling epilepsy with medications rather than sticking to a hard-to-follow diet. With time, dieticians and doctors lost interest in the ketogenic diet.
In 1971, Dr Peter Huttenlocher, at the University of Chicago introduced a medium-chain triglyceride oil diet (MCT oil), a less restricting and helpful diet which again did not gain much attention.
Seventy-three years later, in 1994, a two-year-old boy named Charlie from California suffered severe epilepsy for which nothing worked, including epilepsy surgery. Out of desperation, his father went to the medical library, where he found a guidebook on epilepsy treatment for parents. He read about this mysterious diet called the ketogenic diet that continued to work for centuries. With so many obstacles, Charlie’s father, with the help of a dietician at Johns Hopkins Hospital in Baltimore, managed to treat the little boy Charlie with this diet. It worked, and Charlie was cured. This held a lot of fame in the media, and this miraculous story was aired on national TV in 1994 in the series Dateline.
Since then, Charlie's family established Charlie’s foundation, which continues to work on the Ketogenic diet. Since then, the amount of research on the ketogenic diet has increased and the Ketogenic diet is being used extensively for treating epilepsy worldwide.
What happens with a ketogenic diet?
Following a ketogenic diet takes your body to a state of ketosis. Our body's primary natural energy source, maintained by a normal diet, is carbohydrates. Ketosis is a metabolic state in which the body uses fat in place of carbohydrates to produce energy. Practicing intermittent fasting together with the ketogenic diet facilitates entering ketosis. While there are many ways of practicing intermittent fasting, the most commonly used method is limiting your food intake to 8 hours per day and fasting for the rest of the day which is 16 hours.
How can ketogenic diet help with epilepsy?
The brain can get energy only from glucose and ketone bodies. GLUT transporters are essential to transport glucose to brain cells. Genetic mutations causing GLUT deficiency prevent glucose from entering the brain and the brain will be devoid of its energy source. These kids will have developmental delays and refractory seizures that do not respond to any medication. In these cases, the Ketogenic diet provides the solution, producing enough Ketones so that the brain continues to mature and develop.
The ketogenic diet reduces the amount of excitatory neurotransmitter glutamate in the brain and enhances the synthesis of GABA, making the brain less susceptible to seizures. The diet also reduced brain inflammation protecting it from seizures.
Also, certain other conditions, including infantile spasms, Dravet syndrome, and Rett syndrome can be treated with a Ketogenic diet.
What are the other benefits of ketogenic diet?
A ketogenic diet not only helps epilepsy but many other medical conditions, including heart diseases, certain brain diseases, obesity, PCOS, diabetes and non-alcoholic fatty liver disease. It helps reduce inflammation, supports weight loss, and improves cognitive functions.
What are the contraindications for Ketogenic diet?
The ketogenic diet does not suit everyone. Kids with genetic mutations affecting the metabolism of lipids and other substrates like ketone bodies will not be able to follow a ketogenic diet. However, in general, the diet can be considered if there are no interfering metabolic diseases.
What are the side effects of ketogenic diet?
Together with a lot of advantages, this diet has many side effects as well. It is hard on the stomach with all the fat. When used in children (especially in the case of treating epilepsy), it can cause growth issues as it limits carbs. It can cause kidney stones, constipation, bad breath, fatigue, and dizziness.
What to keep in mind?
Ketogenic diet is a fairly strict diet. You might need to limit your diet to certain food items in certain proportions. You should not cheat when following a ketogenic diet as a treatment for epilepsy. A single bite of sugar can reduce the quality of your diet, put you out of ketosis, and trigger breakthrough seizures.
Due to its strict nature, the ketogenic diet needs to be administered under direct medical supervision by a doctor and an experienced dietician, especially when it’s used to treat epilepsy. Charlie Foundation has so many resources on this on its website.
A new variation of the diet has emerged recently that uses less strict diets including the modified Atkins Diet and the Low Glycemic index diet that provide good therapeutic success with less strict adherence which makes it more applicable especially for adults.