Can Keto Diet help Reduce Epilepsy Seizures?

Fasting and Epilepsy

In the early 1900s, it was discovered that fasting reduced the occurrence of seizures. This is believed to be the result of a metabolic shift that happens in the body during the fasting period.

As such, when people fast, carbohydrates reserves become depleted in the body. Hence, the liver can’t produce glucose from carbs anymore.

Subsequently, since glucose is the primary source of energy for the body and brain, the body will be forced to look for an alternative source of energy in order to survive. 

This will force the body to move into a metabolic shift in which the liver starts metabolizing fat and producing ketones instead of burning carbohydrates and producing glucose. 

These ketones become the alternative source of energy for the brain. It has been noticed that when ketones are being used as a source of energy by the brain, seizures occurrence and frequency became reduced. 

There are several suggestions to explain how ketones can impact seizures. The current scenarios are mainly based on the possible role of ketones in improving the brain’s functions and enhancing the brain’s energy compared to glucose. Additionally, ketones are believed to reduce the hyperexcitability of the neurons compared to glucose. 

However, these propositions require further study before being able to confirm what happens exactly when ketones are processed, and understand how this can affect the brain behavior.

Why Keto Diet helps reduce Epilepsy Seizures

The keto diet can help reduce epilepsy because it can mimic the effects of fasting. It has been used for epilepsy treatment since the 1920’s, and this diet has shown very good results so far. The treatment is suitable for children and adults as well. 

The exact mechanism of the keto diet and how it helps exactly in treating and controlling epilepsy is still unknown. However, according to reviews of several studies, there can be several explanations that include:

- Ketone metabolism in the brain enhances the brain's ability to produce the neurotransmitter GABA (gamma-aminobutyric acid) which has a calming effect on the brain. 

- Polyunsaturated fatty acids available in the keto diet may reduce the hyperexcitability of the brain cells. Other components of the diet might also have inhibitory effects on some brain receptors that can trigger epilepsy.

- The anti-inflammatory and anti-oxidant impact of the diet appears to alter the way how some genes involved in epilepsy behave.

- Certain fatty acids foods present in the diet have anticonvulsant effects that boost the effects of valproic acid, which is a common anti-seizure medication.

Numerous studies have been done on the keto diet. These have shown high rates of seizure control among children and adults who followed this diet. 

For instance, a follow-up study by Neal et al. evaluated the efficacy of the keto diet in epileptic children. The results showed a reduction in frequency of seizures by 75%, while a similar study for adults showed a 52% reduction in the frequency of seizures.

How Keto Diet works for Epilepsy

When carbohydrates are consumed by an individual, they are metabolized in the body and converted into glucose. Glucose being the main source of energy and nutrition used to feed the body and the brain cells.

However, the keto diet is a regimen that requires consuming 70 to 80 percent of fat, 10 to 20 percent of protein, and around 5 percent of carbohydrates only (less than 50 grams per day). Hence, by following this diet that is very low in carbohydrate, the body gets depleted from its carbohydrate reserves in few days, and the liver is not able to produce enough glucose anymore.  

Subsequently, this will deprive the body from its main source of energy: glucose.

Faced by this situation, the body is forced to start looking for an alternative source of energy to survive. With the absence of carbohydrates, fat is the only substitute available. Accordingly, the body starts burning fat for energy instead of carbs.

This metabolic shift produced in the body is known by the name of “ketosis”, in which the liver starts producing ketones from fat instead of glucose from carbohydrates because carbs are not available anymore.

These ketones are now used as an alternative source of energy by the brain. Accordingly, it is believed that these ketone bodies contribute to the anticonvulsant and antiepileptic effects which help in controlling epilepsy and reducing the number and frequency of seizures. 

By putting the body into a state of “ketosis”, the keto diet was found to mimic the effect of fasting in which the body starts using ketones for energy instead of glucose. However, since the keto diet restricts carbohydrates consumption at all time, it acts as if the body is being put into a continuous state of fasting. Accordingly, following the keto diet to treat epilepsy would result in far more better results than just fasting for short periods of time.

It is important to understand that there is not only one single ketogenic diet to follow, rather the diet is defined as a ratio of carbohydrates, protein and fat that should be followed. 

Accordingly, the ketogenic diet focuses on consuming high fat foods such as healthy oils, meats, fish, high fat-dairy, some nuts and non-starchy vegetables. By the same token, the person should avoid high sugar, high carbohydrate foods, and most fruits and low-fat products.

Keto Diet Guidelines for Epilepsy

The ketogenic diet used for epilepsy is structured as a ratio of fat grams to protein plus carbohydrate grams. The standard value is 4 to 1 ratio; however, this may differ on a case by case basis.

It’s important to always consult with a medical team that includes a neurologist, dietitian and general practitioner to receive the proper guidance and supervision before following a keto diet for epilepsy.

There are no specific requirements for the duration of the diet and the length varies by case.

There’s not enough data related to the long-term effects of the diet to conclude if it can be adapted as a lifelong eating plan or to be applied only for specific durations. Regular checkup should be scheduled with the medical team in order to follow up on the efficacy of the diet. In general, it is followed for up to 2 years, and if seizures are reduced or disappear the person can gradually go off the diet.

Keto Diet for Epilepsy: Foods List

The various food types incorporated in the keto diet are high in good fat and very low in carbohydrates. Maintaining the proper proportions is critical to maintain the state of ketosis. Proportions should be done as per the macro calculation provided in the diet structure section.

Below is a list of the various food types for Keto diet: 

- Healthy fats: incorporate healthy high fat foods daily such as some oils (coconut, olive), avocadoes, nuts (macadamia, walnuts, almonds, pecans), and seeds (sunflower, pumpkin, sesame, flax). 

- Meat: it is suggested to consume grass-fed beef instead of grain-fed, and free-range poultry because they contain higher amounts of omega-3. Pork, bacon and organ meats can be consumed in moderation.

However, it is important to avoid eating too much meat in order to maintain the protein restrictions. It is also important to note that processed meats like sausages and cold cuts contain added carbohydrates. You should avoid them. 

- Dairy: some dairy products are allowed such as butter, high fat cheese, and high fat yogurt, because of their low lactose content. Low fat dairy products should not be consumed as they tend to be higher in carbohydrates.

- Fish: it is suggested to consume fatty fish like salmon, wild-caught fish being the best option. Avoid breaded fish because it contains carbohydrates. 

- Non-starchy vegetables: non-starchy vegetables (low carb) include leafy greens (kale, Swiss chard, spinach, lettuce), cauliflower, broccoli, Brussels sprouts, asparagus, bell peppers, onions, garlic, mushrooms, cucumber and celery. Mostly, all vegetables that grow above the ground are lower in carbohydrates, and hence can be consumed.

- Fruits: fruits that are low in net carbs such as berries are allowed. 

- Nuts: nuts can be consumed in moderation as a snack. Avoid cashews and peanuts since they are high in carbohydrates.

- Dark chocolate: 90% dark chocolate and cocoa powder are allowed. Only higher than 70% dark chocolate can be consumed. For example, one ounce (28 grams) of unsweetened chocolate (100% cocoa) has 3 grams of net carbs.

- Drinks: water is the best choice in order to stay hydrated since it has no carbohydrates. Unsweetened coffee and tea can also be consumed. It is critical not to add any sugar. For example, 1 teaspoon of sugar is equivalent to 4 grams of carbohydrates. Hence, this will make it so difficult to remain within the recommended carbohydrates amount if you add any sugar.

Keto Diet for Epilepsy: Recommendations to Follow

- Always check food labels: some hidden carbs may be present in spices, vegetables, and drinks. Always read food labels carefully before you buy any product.

- Always stay hydrated: make sure you always drink enough water to stay hydrated. Carbohydrates retain water in the body, so a low-carb diet can lead to dehydration and constipation.

- Consume enough salt, electrolytes, and magnesium: minerals can be lost along with water while following a keto diet. It is important to consume enough salt and take electrolytes or magnesium if necessary.

- Restrict your calories consumption: always restrict your diet within the allowed daily calories requirements. Do not exceed the recommended calories, otherwise this will result in weight gain.

Keto Diet for Epilepsy: What you should Avoid

- Limit grains and starches: avoid wheat-based products like rice, pasta and cereals since they are high carbohydrate sources.

- Limit sugary foods: avoid soda, beverages and juices with added sugars, smoothies, cake, and candies.

- Limit fruits: avoid fruits that are not considered low net carbs and all fruit juices because they are high carbohydrate sources.

- Limit beans and legumes: avoid eating beans, lentils and peanuts because they have high carbohydrate content.

- Limit root vegetables: avoid potatoes, sweet potatoes, carrots and parsnips because they are high in carbohydrates.

- Limit high lactose dairy: while dairy can be high in fat, most are also high in lactose sugar. Be aware of the amounts of carbohydrates present in the dairy products consumed. Avoid highly processed dairy such as ice cream because they are higher in sugar content. 

- Avoid low fat or diet products: pay attention to low fat products because they are usually high in carbohydrates.

- Limit unhealthy fats: while a high fat diet is recommended, avoid consuming too much bad fat found in processed vegetable oils and mayonnaise.

- Limit alcohol: avoid full carbohydrates wine, beers, and cocktails with added sugars.

- Avoid processed food: processed foods should be avoided even if they are low in carbohydrates. They are composed of bad fats and increase the risk of several diseases.

- Be aware of sweeteners and sugar: sugar is naturally present in fruits and dairy, and hence these should be consumed in limited amounts. Watch out for sweeteners as well, and go instead for keto-friendly sweeteners or Stevia.  

- Avoid eating farmed fish: While eating fish is great for keto but you should avoid eating farmed fish because of the fewer benefits they might have and the chemical additives they might contain. Check out this video about farmed fish.

Additional Keto Diet benefits

The ketogenic diet includes many benefits besides its potential ability to treat epilepsy. For instance, the diet is known for its ability to reduce weight, control blood sugar, increase mental performance, increase energy, reduce blood pressure, and reduce cholesterol. The diet can also help in Alzheimer’s disease, type 2 diabetes, and solving acne problems.

Below is a list of the keto diet various benefits:

- Weight loss: the diet is quite effective for reducing weight as it increases the amount of fat burned in the body which contributes to weight loss. Plus, the diet triggers satiety much quicker. Hence, fewer calories are consumed, resulting in additional weight loss.

- Improve physical performance: the body has large amounts of fat stores that are not used effectively. However, when the body starts burning fat efficiently for energy instead of carbs, it can benefit from large fat fuel reserves available. 
Hence, a long-lasting energy burning process. Accordingly, this diet can sustain improved energy and physical performance

- Type 2 diabetes: the diet is beneficial for diabetes because it reduces carbohydrate intake and control levels of glucose in the blood.

- Heart disease: the diet can protect against heart diseases by reducing the risks factors associated with heart diseases such as overweight, triglycerides, hypertension, and blood sugar levels. The diet can also increase the good cholesterol (HDL) in the body and lower the bad cholesterol level (LDL). This would balance the cholesterol ratio in the body and help further in reducing the risks of heart disease. 

- Triglycerides: the diet reduces drastically the triglyceride levels found in the blood. High levels of triglycerides are associated with heart disease.

- Cholesterol: the diet increases the level of good cholesterol called HDL and reduces bad cholesterol. High levels of HDL cholesterol lower the risk of heart diseases, because it helps in balancing the cholesterol ratio. 

- Blood pressure: the diet may also decrease blood pressure levels. Hypertension is associated with many diseases such as heart disease and kidney failure.

- Alzheimer’s disease: the diet can reduce symptoms and slow down the progression of the disease. This is mainly due to the ketones that can be used as an alternative source of energy and nutrition for the brain.

Other conditions: following a keto diet has also shown to have beneficial effects for other conditions such as cancer, Parkinson’s disease, acne, and polycystic ovary syndrome (PCOS). However, more research and findings are needed in order to support these statements further.

Keto Diet for Epilepsy: precautions

Before you start your keto diet, it is important to take some precautions in case you are taking some medication or if you have any medical condition. Always consult with a health expert especially if you have any of the following conditions or you are taking any medication.

- Blood-pressure: a combination of blood pressure medication and a low carb diet is risky because there’s a possibility of decreased blood pressure from the diet. Low blood pressure may occur within the first days and sometimes might take months to happen. If low blow pressure occurs, it is important to contact a doctor.

- Diabetes: the keto diet will reduce blood sugar levels due to the reduced carbohydrate intake. If you are taking any diabetes medication such as insulin to reduce blood sugar levels as well, it is important to discuss this with your doctor before starting the diet to avoid any possible complications. 

- Pregnancy / breast feeding: it is not advised to restrict any food groups if you are pregnant or breast feeding. A balanced diet is highly required for developing babies. Since the keto diet eliminates completely some food groups, this can be risky for them. Always make sure to discuss this with a specialized nutritionist before starting any diet to make sure you avoid any sort of nutrient deficiencies. 

- Nutritional deficiencies: it is important to watch out for any possible nutritional deficiencies since the keto diet does not include all food groups. Other reasons that may lead to deficiencies are fewer calories that are consumed because they are subtracted from the TEE in order to promote weight loss or because less food is consumed due to increased satiety. Always make sure to follow up with a nutrition expert before starting this diet.

Keto Diet for Epilepsy: side effects 

The ketogenic diet is mainly safe, however there are some side effects that need to be taken into consideration:

- Keto flu: the keto flu is a series of symptoms such as fatigue, headache, nausea and cramps that are experienced by some people following the keto diet. These symptoms are quite common especially at the beginning of the diet.

However, this problem will be resolved in few days by the time the body starts adapting to lower carbohydrate intake and starts burning fat properly. To avoid these symptoms, it is recommended to reduce carbohydrates gradually out of the diet so that the body gets used to this gradually.

- Cramps:  leg cramps are common with the keto diet. It’s an indication of mineral deficiency, mainly magnesium. This is because carbohydrates retain water in the body. Hence, less carbs mean less water retention, resulting in fewer electrolytes as well. It is important to stay hydrated and consume enough salt as this helps retain magnesium in the body. 

- Constipation:  the main cause behind constipation is dehydration, due to less water retention from the reduced carbohydrates intake. It is important to drink enough water while making sure the vegetables consumed contain some fiber.

- Heart palpitations:  during the transition period, the heart may beat faster and harder. This is quite common especially because of dehydration and lack of salt. Accordingly, you should always make sure to have enough water and salt. This should usually solve this problem. However, if this situation continues, you should immediately seek medical assistance. 

- Fatigue: at the initial stages of ketosis while the body is shifting to using fat for energy instead of carbohydrates, people would feel tired. Their physical performance might be affected as well. However, this should be resolved once the body adapts to the new process and starts burning fat properly to produce the required energy.

- Ketoacidosis: this happens when the buildup of ketones results in higher levels of acids in the blood (byproduct of burning ketones). Ketoacidosis can affect the livers, kidneys, and the brain.

Ketoacidosis can occur for people following a low carbohydrates diet, though it is very rare. However, this can be a more common problem for people that suffer from diabetes. Accordingly, if you have diabetes, it is important to contact your doctor before starting the keto diet.

- Hypoglycemia: this is when glucose levels become very low in the blood. Accordingly, people might experience blurred vision, headaches, and confusion. This might become dangerous if left untreated as it can cause seizures. In some cases, it can even be fatal. Hypoglycemia happens mainly because our bodies are not used to run on ketones from fat instead of glucose from carbohydrates, this might lead in some cases to hypoglycemia.