Seizures are serious and any changes in diet or treatment must be monitored by your physician. The following information is for educational purposes only and not intended to replace medical diagnosis or care..
If you watched the Meryl Streep movie, First, Do No Harm, you are familiar with the ketogenic (Keto) diet used for epilepsy and other neurological disorders. Based on a true story, it was this diet that finally eliminated the child’s daily seizures that weren’t responding to drugs. (In case you’d like to watch the movie, it is at the end of the post).
The ketogenic high-fat diet includes healthy fats and oils, full-fat dairy, protein, fatty nuts and seeds, low carbohydrate vegetables like leafy greens, and lots of water. Sweets such as cookies, cakes, candy, pastries, ice cream, etc., are always eliminated. The stricter ketogenic diets also remove bread, potatoes, rice, cereals, and pasta.
The classic diet consists of a ratio in grams of fat to non-fat (protein and carbohydrates) of 4:1 and 3:1. The modified ketogenic diet consists of ratios of 2:1 and 1:1.
Anyone of any age who is experiencing seizures may be helped. There is no way to predict beforehand whether it will be successful. Traditionally the diet has been used for children with myoclonic, atonic and tonic-clonic seizures. Studies performed since the 1920s, however, demonstrate that 50-75% of people of all ages are helped.
A metabolic change occurs in the body which affects brain chemistry, but it is unknown how it works to control seizures. The diet works like this:
A calorie level is determined by a dietitian for each child based on their age and activity level. To achieve a desired level of ketosis, the diet is calculated in terms of ratios such as 4:1, 3:1, and 2:1. In a 4:1 ratio, there is 4 times as much fat as there is protein and carbohydrate combined.
The dietitian devises meal plans that complete the required fat, protein and carbohydrate for each meal. Each plan indicates the exact gram weight of each food which must be weighed on a gram scale.
A typical meal includes a small amount of fruit or vegetable, a protein rich food, and a source of fat such as heavy cream and butter or healthy vegetable oil, like coconut or olive oil.
If the child is on more than one anti-seizure medication, one may be reduced as the child starts the ketogenic diet. The remaining seizure medication may be reduced as well if the child’s seizures improve over time. Some children are able to have all drugs completely discontinued.
Medications may act stronger with the ketogenic diet, so close medical monitoring is necessary. This diet is not something to try on your own when seizures or medications are involved!
The diet is started gradually, with increase to the full amount over a 3 – 4 day period or longer. During this time blood sugar and ketone levels are monitored. The diet used to begin with a fasting period, but recent studies have found it unnecessary.
The diet can become effective immediately or can take several months. Each person is unique and has different seizure patterns and frequency. There is usually improvement within the first 10 weeks on the ketogenic diet.
Eating or drinking something that is not part of the diet could trigger a seizure.
Many vitamins and minerals are missing in the diet, which can create deficiencies. Supplements are prescribed for each child while on the ketogenic diet.
The diet is generally used for up to 3 years if it helps to reduce or eliminate seizures. If the diet is not helpful, it is stopped within a few months.
The most common adverse effect of the diet is constipation. To prevent this problem, drink adequate amounts of water and add more (allowed) high fiber vegetables.
A less common adverse effect is kidney stones. This problem can be prevented by drinking more water. There are two anti-seizure medications (Zonegran and Topamax) that can cause acidosis and kidney stones. They should be closely monitored when used with the ketogenic diet.
The ketogenic diet is calculated at a specific calorie level for children. The dietitian keeps track of your child’s growth to determine if a change in calories is needed to ensure normal growth.
Yes, using special ketogenic formulas or blenderized whole foods. A dietitian will determine the type and amount of formula and supplements to accompany these.
There are blood tests that may be needed to determine if the diet is safe to implement. These include metabolic tests to rule out fatty acid disorders or a carnitine deficiency.