Since the 1920s it’s
been observed that a very high fat with very low protein and low carbohydrate
diets benefited children whose epilepsy initially failed to respond to
anticonvulsant medications (ACM). Adult epilepsy patients have found that
following such a ketogenic diet can help their seizures, too. However, these
adults had to deal with very, very strict diets for the ketogenic diet to be
effective. They would say, “What, no bread? No sugar?” But, when properly following the diet, they
often said, “I haven’t had a seizure since I started the diet. I used to be
debilitated by them.”
In the 1990s
interest in the ketogenic diet resurfaced after the promising newer ACMs did
not prevent enough seizures. The exact mechanisms for this diet’s effectiveness
are not known.
Ketones are
chemicals created in the liver from fat and fatty acids and act as fuel for the
brain that can pass through the blood-brain barrier (a microscopic-diffusion
barrier, which impedes influx of most compounds from the blood into the brain. A
2015 analysis of 12 relevant studies found about half of adult patients who
follow the classic ketogenic diet (where they eat four grams of fat for every
gram of carbohydrates and/or protein) experience at least a 50 percent
reduction in seizures. 1 Even if they were a little less strict in
following the diet, the restricted diet was still beneficial in some reduction
in their seizures.
Ketones are an
alternative form of energy. Normally, the body’s primary fuel source is glucose
coming from carbohydrates (fruit, vegetables and grains and sodas and sweets).
The typical American adult derives half of their daily calories from
carbohydrates. Fasting causes the liver to convert stored fat into ketones
which supply energy to our cells. A state of KETOSIS in our body is created
when the diet consists of AT LEAST 90% of calories derived from fat (generous
ingestion of butter, mayonnaise, and heavy cream) and only 4% from
carbohydrates and 6% from protein. An iteration of the modified Atkins diet
also limits carbs but involves less fat with no restrictions of proteins. This
diet can be more palatable and easier for adults to continue. Typically, about
half of adult patients give up the diet within 6 months because of side effects
that can include constipation and kidney stones. Many stopped the ketogenic
diet if the onerous diet didn’t reduce their seizures as hoped.
One patient whose
seizures were reduced following the modified Atkins diet said her favorite meal
is hot chicken wings minus the barbecue sauce (too much carbohydrate sugar).
I invite you to
learn more about ketogenic diets and epilepsy by consulting with your
neurologist and especially with a nutritionist.
1. Fang Ye, Xiao-Jia Li, Wan-Lin Jiang, et.al. Efficacy
of and Patient Compliance with a Ketogenic Diet in Adults with Intractable
Epilepsy: A Meta-Analysis Journal of Clinical Neurology 2015; 11(1):
26-31.
Lance Fogan, M.D. is Clinical Professor of
Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting
emotional family medical
drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first
novel. Aside from acclamation on internet bookstore sites, U.S. Report
of Books, and the Hollywood Book Review, DINGS has been advertised in a recent
Publishers Weekly, New York Times Book Review and the Los Angeles Times
Calendar section. DINGS teaches epilepsy and is now available in eBook,
audiobook, and soft and hard cover editions.
