The ketogenic diet is not easy to maintain, as it requires strict adherence to an unusual and limited range of foods. A typical ketogenic diet is usually made up of between 3 and 4 grams of fat for every one gram of protein and carbohydrate (a 3 or 4:1 ratio). This means that foods high in fat, such as butter, cream, and oils (canola or olive), make up the majority of a person's diet. Foods high in carbohydrates are limited. This includes breads, grains, and cereals. The ketogenic diet also includes a partial restriction of fluids.
Because of the possibility for vitamin deficiencies, vitamin and mineral supplements are recommended, including vitamin D, calcium, iron, and
folic acid.
There are several different variations of the ketogenic diet. Usually, the diet is started in the hospital under close supervision. For the first 24 hours, no food is given. The diet is then started by slowly increasing the calories.
Depending on which variation is recommended and how well
seizures are controlled, the diet may be continued for two years. At that point, the healthcare provider may recommend slowly weaning the person off of the ketogenic diet. Just like with
epilepsy medications, if the diet is suddenly stopped, seizures may become much worse.
People on the ketogenic diet continue to take their medications, although it may be possible to reduce the amount based on how he or she responds.
What Does Research Say About the Ketogenic Diet?
The ketogenic diet has not been widely studied. This may explain one reason why healthcare providers are hesitant to recommend this as a possible epilepsy treatment. However, several studies have shown the diet can help reduce or even eliminate seizures in people who were not controlled on
epilepsy medication.
One study of 150 children whose seizures were poorly controlled by epilepsy medication found that about one fourth of the children had a 90 percent or better decrease in seizures with the ketogenic diet, and another half of the group had a 50 percent or better decrease in their seizures.
Other studies have shown that some children can stop the ketogenic diet after several years and remain
seizure-free.
Researchers are not sure how ketosis prevents seizures. One study showed that a byproduct of ketosis called beta-hydroxybutyrate (BHB) inhibits seizures in animals. If BHB also works in humans, researchers may eventually be able to develop drugs that mimic the seizure-inhibiting effects of the ketogenic diet.
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