The ketogenic diet is a high fat, low carbohydrate, controlled protein diet that has been used since the 1920s for the management of epilepsy. The following sections will provide you with an overview of the ketogenic diet and how it may help to improve seizure control in some children and adults.
Drug resistant epilepsy
The ketogenic diet is an option for the management of epilepsy for 20-30% of children whose seizures do not respond to taking two or more antiepileptic drugs The diet has also worked for adults who do not respond to medication and there are developments for its use in other neurological disorders (see below).
Other neurological disorders where the keto diet is applied
For those with the metabolic conditions Glucose Transporter type 1 (Glut-1 DS) and pyruvate dehydrogenase deficiency syndrome (PDHD), the ketogenic diet is used as first line management and you will be advised to continue with it long term.
The ketogenic diet is not effective for everyone, 50 – 60% of children undergoing a supervised ketogenic diet will have 50% or more reduction in seizures and 15% of those whom it is beneficial will become seizure free. Other reported benefits of following the ketogenic diet are medication reduction leading to reduced side effects caused by antiepileptic medications and cognitive improvements. You should determine your own personal goals for the diet along with your dietitian and ketogenic team to ascertain whether the diet is working for you.
The exact mechanism by which the KD can be successful in the dietary management of drug resistant epilepsy are not fully understood. The aim is to change the way your body works by encouraging it to use fat instead of carbohydrate as its main source of energy. When carbohydrate is eaten, it is broken down (metabolised) by the body to produce glucose to fuel your brain and other body cells. When the body breaks down fat it produces ketone bodies instead of glucose as the main energy source.
Will I need to continue with my medication?
You will likely have to continue with your medication when starting the diet. However, if the diet is helpful in the management of your epilepsy, your ketogenic team may review the amount of medication that you need, and may recommend they be slowly withdrawn.
What to eat on the ketogenic diet
The ketogenic diet is the complete opposite to what you may think of as a healthy balanced diet. It is a special diet which is very high in fat, low in carbohydrate and with enough protein for growth and repair of body tissues.
High fat diet
It is very important you eat enough of the foods high in fat to enable your body use this for energy by producing sufficient ketones. The majority of your energy requirements will come from fats e.g. olive oil, sunflower oil, coconut oil, butter, margarine, mayonnaise, cream cheese, double cream, also from high fat products available on prescription.
Low carbs (carbohydrates)
The ketogenic diet involves eating only very small amounts of carbohydrate foods (sugars & starches) e.g. chocolate, sweets, crisps, milk, yogurt, bread, potato, pasta, fruit etc.. This stops glucose being used as an energy source and the body uses fat to produce ketones for energy instead.
Moderate protein intake
Protein is important for growth and repair of body tissues and your dietitian will ensure enough good quality protein based foods are included everyday e.g. red meat, chicken, fish, eggs and cheese.
Does everyone follow the same ketogenic diet?
The ketogenic diet is tailored to meet individual requirements. It may require some adjustment or ‘fine tuning’ to make it just right for you to achieve the best level of ketones to help with seizure reduction. If the ketogenic diet is effective after an initial 3-month trial period, people with drug resistant epilepsy usually stay on it for up to 2 years, then may be advised to return to a normal diet. However, if necessary, you can stay on the diet for longer. For information about the different types of ketogenic diet click here.
Medical and nutritional supervision
It is very important that the ketogenic diet is undertaken alongside medical and nutritional supervision. For more detailed information about the ketogenic diet please refer to your ketogenic team.