Boy with a bowl

The ketogenic diet is a high-fat, low-carbohydrate, adequate-protein, medical dietary therapy. The ketogenic diet is used to control seizures in patients with epilepsy that does not respond to anti-epileptic drugs, which is sometimes called “drug resistant epilepsy” or “refractory epilepsy”. The ketogenic diet may also be considered for patients who experience significant side effects from their anti-epileptic drugs.

The ketogenic diet is a precise and carefully calculated medical diet, which requires monitoring under the supervision of an experienced ketogenic diet team, usually consisting of a Neurologist, Dietitian and Nurse.

Traditionally, the ketogenic diet is started slowly over several days in hospital. Although, many of the traditional aspects of the ketogenic diet have been challenged in recent years, and hospitalisation may not be required for some individuals. Hence the ketogenic diet should only be attempted under the strict supervision of a healthcare professional.

It is important to note the ketogenic diet may not be appropriate for all individuals with epilepsy, therefore the suitability of the diet should be discussed with your individual healthcare professional.

The ketogenic diet was originally designed to copy the effects of fasting. Fasting has been used to help control seizures in individuals with epilepsy since biblical times. While fasting may help to control seizures, it cannot be used long term because the body will eventually run out of energy stores, leading to starvation.

In 1921, Dr. R.M. Wilder, a physician from the USA, suggested the metabolic state of fasting could be maintained for a long period of time with a “ketogenic diet” that copied starvation by limiting carbohydrate and providing high amounts of fat in the diet1. Unlike a person in starvation who will burn body fat for energy, a person on the ketogenic will burn fat from their diet, allowing them to remain in a fat-burning metabolic state over an extended period of time.

The ketogenic diet was widely used to manage epilepsy throughout the 1920’s and 1930’s. After the introduction of a new class of anti-epileptic drugs in the late 1930’s, the ketogenic diet began to fall out of favour and the focus of epilepsy research shifted to anti-epileptic drug therapies. The use of the ketogenic diet continued to decline until the 1990’s, when public and clinical interest in the ketogenic diet re-emerged steadily.

Today, research on the ketogenic diet is being published at a rate never seen before2. There is a significant amount of evidence to show seizure improvement in approximately half of children on the ketogenic diet. For the estimated 30% of individuals with epilepsy that are unresponsive to anti-epileptic drugs, the ketogenic diet offers hope3.

References:

  1. Turner Z & Kossoff EH. The Ketogenic and Atkins Diets: Recipes for Seizure Control. Practical Gastroenterology. 2006 Jun : 53-64.
  2. Morandi G, et al. A bibliometric study of scientific literature on the dietary therapies for epilepsy in Scopus. Nutritional Neurosciences. 2014 Mar 17.
  3. Brodie MJ. Diagnosing and predicting refractory epilepsy. Acta Neurol Scand Suppl 2005;181:36-9.