The ketogenic diet is a high fat, low carbohydrate, adequate protein diet 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.

Approximately 30% of those with epilepsy have a form where their seizures cannot be managed effectively with medications. The ketogenic diet may be an option. There are also developments for its use in other neurological disorders (see below).

Reference:
Kossof EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the international ketogenic diet study group. Epilepsia. 2009; 50(2):304-317.
 

Glucose Transporter Type 1 Deficiency (Glut-1 Deficiency) and Pyruvate Dehydrogenase Deficiency (PDH], are inherited metabolic conditions where the ketogenic diet is recommended for life.   

The ketogenic diet does not work for everyone. Between 50-60% of children following a supervised ketogenic diet will have 50% or more reduction in seizures. 15% of those who benefit from it will become seizure free. Other reported benefits of following the ketogenic diet include medication reduction and cognitive improvements. Patients should discuss their own personal goals for the diet along with their dietitian and ketogenic team to determine whether the diet is working.

The exact mechanism by which the ketogenic diet can have a positive effect on drug resistant epilepsy is not fully understood. The aim is to change the way the 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 by the body to produce glucose to fuel the brain and other body cells. When the body breaks down fat it produces ketone bodies instead of glucose as the main energy source.

High fat diet

It is very important for you to eat all of  the high fat foods in your ketogenic diet so that your body will produce enough ketones. The majority of your energy requirements will come from fats e.g. olive oil, sunflower oil, coconut oil, butter, margarine, mayonnaise, cream cheese, heavy cream, and possibly from ketogenic formulas prescribed for you.

Low carbs (carbohydrates)

The ketogenic diet involves eating only very small amounts of carbohydrate foods (sugars & starches) e.g. chocolate, sweets, chips, milk, yogurt, bread, potato, pasta, fruit etc. This stops glucose from being used as an energy source; the body uses fat to produce ketones for energy instead.

Moderate protein intake

Protein is important for growth and repair of body tissues. Your dietitian and ketogenic team will make sure enough good quality protein based foods are included in your daily ketogenic meal plan (e.g. meat, chicken, fish, and eggs).

The ketogenic diet is tailored to meet individual requirements. Some adjustment or ‘fine tuning’ may be needed to make it just right for you to achieve the necessary 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. At this point, your ketogenic team may advise you to transition back to a regular diet.  You will want to discuss with them what is best for your individualized plan of care.

It is very important that the ketogenic diet is followed under close medical and nutritional supervision. For more detailed information about the ketogenic diet please refer to your ketogenic team.