The Ketogenic Diet for Seizure Control

Reviewed by: HU Medical Review Board | Last reviewed: November 2023 | Last updated: November 2023

The ketogenic diet, also called the keto diet, was first used in 1921 to treat epilepsy in children. Now, the keto diet is usually recommended for children who have not responded to multiple anti-seizure drugs. It is sometimes recommended for adults with epilepsy. But most doctors recommend that people only stay on the keto diet for a few years and then eventually resume a normal diet.1,2

Many studies show that the keto diet is effective for seizure reduction. Changing the ratio of carbs to fat causes your body to change how it uses food for energy. The goal of changing how your body uses food is to alter the activity in your brain to help decrease seizure activity.1,2

How does the ketogenic diet for epilepsy work?

The keto diet is a very low-carbohydrate (carb) and high-fat diet. Carbs are parts of food that your body breaks down into sugar during digestion. Foods that are high in carbs include bread, pasta, rice, fruit, and starchy vegetables such as potatoes.

When you are following a keto diet, your body does not have enough glucose (sugar) for your brain or other organs to use for energy. In turn, your body adapts and uses a type of metabolism called ketosis. Ketosis uses fat for energy and makes ketone bodies. Your brain then uses these ketones for fuel.1

Experts think that the changes in metabolism caused by ketosis lowers the activity of the nerve cells in the brain to help suppress seizure activity. But despite decades of research to support the keto diet’s effectiveness for helping control seizures, researchers are not sure of the exact way the diet decreases seizure activity.1,3,4

Basics of the keto diet

While the specifics of a keto diet plan can vary slightly for each person, a typical calorie breakdown for a keto diet is:5

  • 75 percent from fat
  • 20 percent from protein
  • 5 percent from carbs

Keeping the correct balance of fat calories to the other nutrients is important. Too many non-fat calories may prevent your body from going into ketosis and getting the benefits of the diet for epilepsy You may have to supplement your diet with vitamins to ensure you are maintaining balanced nutrition.5

It is recommended to work closely with a registered dietitian to help monitor your progress and solve any issues that come up.

When following the keto diet, your doctor will check if the diet is working by monitoring for ketones in your urine or blood. Your doctor or dietitian might adjust your treatment plan based on the number of ketones in your body.1

Foods encouraged

There are a variety of foods that are encouraged on the keto diet, including:1,3-6

  • Meat
  • Fatty fish
  • Eggs
  • Butter, cream, and cheese
  • Nuts and seeds
  • Avocados
  • Healthy oils
  • Low-carb veggies like broccoli, cauliflower, and leafy greens
  • Berries

Foods to avoid

The keto diet recommends avoiding the following foods:1,3-6

  • Sugary foods and beverages
  • Grains and starches
  • Most fruit
  • Beans and legumes
  • Starchy vegetables
  • Sweetened dairy products or condiments like flavored yogurt and salad dressings

Benefits of the keto diet

Potential benefits of the keto diet may include:6

  • Decreased seizure frequency and/or severity
  • Improved insulin resistance
  • Weight loss
  • Slowed progression of some conditions, such as Alzheimer’s disease and multiple sclerosis
  • Reduced inflammation

Research shows that the keto diet may work better for some types of seizures than others. People with the same types of seizures may respond differently to the keto diet as well. However, it is a suitable option for many seizure types and epilepsy syndromes.3,4

Risks and side effects

Despite the potential benefits of this diet, it is not the best fit for everyone. It is a very strict diet, and many people find it hard to accurately follow the guidelines. Without strictly following the diet, your body will not reach or stay in ketosis.6

In addition, some people may experience side effects, such as:6

  • Low blood sugar
  • Excessive weight loss and low body weight
  • High cholesterol or triglycerides
  • Fatigue
  • Nausea and vomiting
  • Constipation
  • Irritability
  • Muscle cramps

Trying a ketogenic diet for epilepsy

The keto diet may offer people with epilepsy who do not adequately respond to anti-seizure medicines another option to help control their seizures. However, the diet can be difficult to stick with and may not be best suited for everyone.

Talk with your doctor or dietitian to see if the keto diet is the right choice for you and guidance for following it.

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