Background: 

The medical ketogenic diet is an established, effective non-pharmacologic treatment for intractable childhood and adulthood epilepsy. The ketogenic diet is a special diet that is very high in fat, low in carbohydrates and has adequate protein. It can be an option for people who eat by mouth or via tube feeding.

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There have been 4 randomized, controlled trials focusing on the efficacy of the ketogenic diet compared to continued medications or a placebo arm, which have led to recognition of the ketogenic diet as a valid, scientifically based treatment (1). 

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Statistics: 

The consensus of all of the major ketogenic clinics across the world is that ~40-50% of children/adolescents with epilepsy who try the ketogenic diet will see a 50% reduction in their seizures. Additionally, ~10-15% of those with epilepsy become seizure-free (1, 2). 

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Types of the Ketogenic Diet: 

There are 4 major ketogenic diets: the classic ketogenic diet, the Modified Atkins Diet (MAD), the Medium Chain Triglyceride diet (MCT), and the Low Glycemic Index Treatment (LGIT). 

• The classic ketogenic diet is prescribed using the term “ratios”. A ketogenic ratio describes the amount of fat in a meal in comparison to the amount of carbohydrate and protein given. For instance, a classic ketogenic diet is a 4:1 ratio, which means for every 4 grams of fat there will be 1 gram of protein and carbohydrate combined. 

• The MAD diet is a more flexible form of the ketogenic diet, most often thought of in terms of “macros” or macronutrients (fat, protein, and carbohydrate). Specific ‘macro’ goals are determined by the dietitian, and each client may track their meals using an online tool if desired. 

• The MCT and LGIT diets are also more flexible like the MAD diet but focus on specific fats and carbohydrates, respectively. 

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Who can benefit?

The ketogenic diets can effectively treat epilepsy in individuals from infancy through adulthood. 

The consensus group, created combining experience from all of the major ketogenic clinics around the world, recommend that ketogenic diet therapies should be offered to a child after an average of 2 to 3 anti-epileptic drugs have failed to control seizures. 

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There is also emerging evidence for using the ketogenic diet for other neurological and medical conditions such as brain cancer among others.   

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Disclaimer: Please seek medical supervision before starting the ketogenic diet. 

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References: 

1. Kossoff, Eric H.; Zupec-Kania, Beth et al. Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group. Epilepsia Open. 2018 Jun; 3(2): 175–192. PMID: 29881797

2. Epilepsy.com

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