It has been known for decades that the ketogenic diet is an effective treatment for children with intractable epilepsy. However, doctors are reluctant to prescribe the ketogenic diet for adults with epilepsy. With the ketogenic diet gaining momentum and popularity within the weight loss community, many people with epilepsy are starting to wonder if they should try the ketogenic diet for adult epilepsy.
My response would be an emphatic, “YES!” The ketogenic diet has been studied and shown to be effective. Even if your doctor doesn’t recommend doing a ketogenic diet, it is a much healthier diet than the standard American diet. You have the freedom to choose to be very relaxed with it or very strict with it. The worst thing that could possibly happen is that it would start preventing seizures and you may need less medication. I take that back, the worst thing that could happen is that you become so healthy that you feel every side effect of your medication. However, your health will gradually improve and you can alert your doctor to monitor and reduce your medication as time progresses.
History of Ketogenic Diet with Epilepsy
The history of treating people with epilepsy dates back to 1920 when Dr. Galen, a New York physician, reported at the American Medical Association convention that he had immense success treating epilepsy by initiating a program of fasting. In the 1920s, the only pharmaceutical interventions available included phenobarbital and bromides. Dr. Galen was treating a patient who had aggressive seizures. On the second day of fasting, the child’s seizures subsided. They did not return over the next two years as he followed up. Further studies confirmed the effectiveness of fasting as an effective treatment for seizures. The ketogenic diet is a way to mimic fasting.
Fasting is one way to trigger the state of ketosis. As a person enters ketosis, his body begins to use fat instead of carbohydrates as a fuel. The body begins to produce ketones, which becomes an alternative source of calories to power the brain.
To this day, a ketogenic diet, meaning a diet that is designed to increase the availability of fat while decreasing the availability of carbohydrate, remains an important tool that can be utilized in the treatment of children with epilepsy who do not have a full response to medication.
Over the years, as more and more anti-convulsant therapies became available, doctors started to prescribe anti-convulsants as the first line of treatment. Only when children didn’t respond to anti-convulsants was a ketogenic diet discussed. The reason for this is that it is easier for parents to implement a drug regimen than it is to get compliance with a strict diet.
Recently, a report appearing in the journal, Neurology, revealed that a ketogenic diet is also profoundly helpful in adults as well as children in terms of treating epilepsy. The research found that there was a reduction of about 50% in 32% of patients treated with a ketogenic diet. There was a reduction of seizures in 29% of patients who followed the modified Atkins diet. Nine percent of the patients on the ketogenic diet had a greater than 90% reduction in the frequency of their seizures.
Both the ketogenic diet and the modified Atkins diet are designed so that your take in approximately 75% of your calories from fats. The study indicated that resolution of seizures came quickly with both diets, within a few days to weeks. The most common side effect of treating adults with epilepsy with the ketogenic diet was weight loss.
It is important to note that only 60-65% of patients taking medication to become completely seizure free using the medication. Thirty-five percent of people with epilepsy are resistant to the effects of medication.
Implementing a ketogenic diet can improve your seizure control, whether you are on medication or not. This diet can and should be considered as long as there are no evident metabolic or mitochondrial reasons to avoid it.
Fats for Fuel
The ketogenic diet switches your body from burning carbohydrates for fuel to burning fats for fuel. Carbohydrates are quick shots of energy. Adjusting your diet so that there are more available fats than carbohydrates switches your body to prefer burning fat for energy. This will improve the mitochondrial function of your body.
The body has a natural ability to utilize both fat and glucose for fuel. However, many people lack the ability to burn fat. This is a direct result of consuming a diet that is high in carbohydrates for an extended period.
As a result, many people struggle with weight issues and poor health. Some people may not be overweight, but have excess visceral body fat, which can be dangerous as well. Implementing a ketogenic diet can help to reduce the excess body fat. Implementing a pattern of intermittent fasting, or a feast and then famine cycle can help to reestablish the metabolic flexibility that is required to burn fat as a fuel. Avoiding late night eating and excessive snacking can help as well.
Animal-based omega 3 fats have been shown to reduce autoimmune responses. Some people have hypothesized that epilepsy is an autoimmune condition and the inflammation in the body triggers the seizure response. Omega 3s improve glucose metabolism and lower the inflammatory markers, which can improve seizure control.
How to Implement a Ketogenic Diet
Implementing the ketogenic diet does not have to be difficult at all! The first step is to identify which foods are high in carbohydrates and to eliminate those. These tend to be packaged and processed foods. You will dramatically reduce or eliminate all grain and any food that is high in sugar.
The next step is going to be to learn how to count the carbohydrates in your foods. You’ll want to reduce your carbohydrate count to about 20-50 grams of carbohydrates per day. This means that you will focus on eating leafy green vegetables, and meats. It is that simple. You can get more complicated by starting to measure out the amounts, but if you simply start by focusing only on eating leafy greens and meats, you should cut your calories to around 20 grams per day.
As a general rule, you will want to restrict protein to approximately 1 gram per kilogram of lean body mass. To make sure you’re actually meeting your nutritional requirements and maintaining the ideal nutrient ratios, a nutrient tracker can be an invaluable tool. However, as I mentioned earlier, it is not necessary.
Start the Ketogenic Diet
While no one likes the idea of limiting rich and decadent foods, there are plenty of foods on the ketogenic diet that are satiating and enjoyable. The ketogenic diet does not necessarily have to be implemented by your doctor. You have the freedom to take the initiative and cut your carbohydrate intake on your own. You have the freedom to check out a macronutrient calculator and figure out how many grams of carbohydrate to take in for your size. You have the freedom to make the diet as simple or as complicated as you want. You have the freedom to aim for zero carbohydrates and eat mostly meats and animal products.
There are many ketogenic diet cookbooks that you can start to use for your everyday meals. These will help you adjust to eating a lower carbohydrate diet. You have the freedom to start by simply changing one meal a day to fit the ketogenic parameters. When that becomes natural, change the next meal and keep thinking about lowering your fruit and high vegetable carbohydrate intake.
Disclaimer: I am not a doctor. Speak to your doctor for personalized advice.