January 12, 2024
Eating keto is more than a fad diet for people with epilepsy. It offers a way to minimize or control seizures.
In fact, studies show that the ketogenic diet – high-fat, low carb – reduces seizure frequency by about 50% in about half the patients on it, similar in effect to adding antiseizure medication.
But why does the keto diet help with epilepsy? Lisa Knopf, MD, a specialist with the Hartford HealthCare Ayer Neuroscience Institute Epilepsy Center, explains.
The reason why it’s effective isn’t entirely clear.
The secret to the keto diet’s effectiveness is in the body’s reaction to low-carbohydrate eating, says Dr. Knopf.
“A ketogenic diet – high-fat, low-carbohydrate – shifts the body into ketosis, where it burns fat for energy instead of carbohydrates… But, we still don’t understand the exact mechanism for why it works,” she explains.
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But there are theories.
Common theories for why this is so include:
- Ketone bodies. Keto encourages the body to produce ketone bodies from fatty substances in the liver. These calm the brain and reduce the chance of seizures.
- Stabilizing brain activity. Ketone bodies may help balance brain chemicals, making it less likely unusual electrical activity will cause seizures.
- Changing energy source. When the body uses ketones instead of glucose from carbohydrates for energy, the brain may be less prone to overactivity.
- Reduced inflammation. Some studies suggest the diet has anti-inflammatory effects. Inflammation, Dr. Knopf says, can be linked to seizures
- Adjusting brain metabolism. The diet changes how the brain uses energy, which might affect nerve cell function and decrease the chance of seizures.
The keto diet can be tough, but these alternatives can help.
Keto, Dr. Knopf says, is strict and can be challenging to follow, especially for people with busy lives.
“The classic ketogenic diet follows a 4:1 ration with 4 grams of fat for every 1 gram of protein/carbohydrate. That translates into getting up to 90% of your daily calories from fat! People can struggle to stick to this,” she says.
Pre-made keto shakes eliminate the weighing and measuring required by keto meal prep and there may be fluid and calorie restrictions.
A number of helpful alternatives to the classic keto diet have also been developed:
- Modified Atkins Diet. The 1:1 ratio (1 gram of fat for every gram of protein and carbohydrate) means 65% of calories come from fat, 25% from protein, and 10% from carbohydrates. There are no restrictions on fluid, calories or protein.
- Low-Glycemic Index Treatment. This allows for more carbs, emphasizing complex carbs less likely to spikes blood sugar levels. While people tolerate this approach better, it does produce a lower level of ketosis, Dr. Knopf says.
Can the keto diet help my epilepsy?
“I recommend the ketogenic diet for certain patients with drug-resistant epilepsy or severe forms of epilepsy that start in childhood and include daily seizures,” Dr. Knopf notes. “It is never a replacement for antiseizure medications, although in some cases doses can be reduced.”
But before you make any dietary changes, be sure to speak with your doctor.
“People with epilepsy should only implement these dietary changes under the supervision of a neurologist and dietician. We sometimes even initiate it in the hospital to monitor labs and get patients into ketosis faster,” she says.
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