What Is the Ketogenic Diet for Epilepsy?

Medically Reviewed by Christopher Melinosky, MD on August 02, 2021

Could the solution to your child's epilepsy be a diet loaded with butter, cream, oils, and mayo? It might sound weird -- and maybe not so appetizing -- but the ketogenic diet is real. And in many kids, it works.

But the super high-fat, super low-carb ketogenic diet is not for everyone. It's strict and complicated. And it's not really "healthy" in the normal sense. If you're considering it, you need to think through how it affects your child's life -- and the impact on the whole family.

Who Should Think About Trying the Ketogenic Diet?

The ketogenic diet has been curbing seizures since it was first developed in the 1920s. About half of kids who follow it have a big drop in how many they get. As many as 1 in 7 stop having seizures completely.

The diet helps with many types of epilepsy, but works especially well with Lennox-Gastaut syndrome, myoclonic astatic epilepsy (Doose syndrome), and others. Some pediatric epilepsy syndromes respond very well to the ketogenic diet and most adult epilepsies do not.

Because the ketogenic diet is so demanding, doctors usually only recommend it if a child has already tried two or three medications and they haven't worked.

When the diet works, kids can often lower their medication doses or stop taking them. What's more, most kids who stay on the ketogenic diet for at least 2 years have a good chance of becoming seizure free -- even after they go back to eating normally.

What Foods Can Your Child Eat?

Your child's diet will have a lot of fat. To put it in perspective, in a healthy diet for kids, about 25% to 40% of calories come from fat. In the ketogenic diet, about 80% to 90% of calories come from fat.

So your child's meals are loaded with fats while portions of protein and especially carbs are small. In the typical ketogenic diet, kids get three to four times as much fat at each meal compared to carbs and protein combined.

What does that mean in practice? Most high-carb foods -- like bread, pasta, sweets, and more -- are off the menu. Your doctor will usually start with this first...but there are also modifications. If it works, you can usually step down to more of a modified atkins and slow introduce carbs. This usually involves carb counting and monitoring ratio of carbs to fats.

How Does It Work?

Even though it's been around for about a hundred years, we still don't know. Many experts believed it had to do with a process called ketosis. That's where the diet's name comes from. Ketosis happens when your body runs out of carbohydrates to burn for energy and burns fat instead.

But now many experts aren't sure if ketosis has anything to do with why the diet works. It may be related to some other effect we don't understand.

What to Expect

The ketogenic diet is not something you try out casually. It's a big commitment, and starting it on your own is risky. You and your child need to work closely with a team of experts.

Prepare for a few days in the hospital. Doctors often want to keep an eye on kids when they start the diet to make sure they're doing OK.

Work closely with a dietitian. The ketogenic diet is tailored to each child. So a dietitian will give you detailed info on exactly what your child can eat and how much. Since the ketogenic diet is low in important nutrients, your child will probably need supplements of calcium, vitamin D, iron, folic acid, and others.

Watch out for carbs in everything. Tiny amounts of carbs show up in unexpected places, like toothpaste.

See the doctor often. Your child will need regular checkups every 1 to 3 months at first. The doctor will chart their growth and weight, test their blood and urine, keep an eye on cholesterol and decide whether to tweak the diet or medication dose.

Stick with the diet for a few months at least. If it works, you should notice fewer seizures by then -- or even sooner. If the diet doesn't help, your child will gradually return to a normal eating plan. If they stop the ketogenic diet suddenly, it could trigger seizures.

What Are the Side Effects?

Right after your child starts the diet, they may feel tired. Other side effects include:

If your child has side effects, tell their doctor. You may be able to treat them with changes to their diet or medication.

If the side effects are too much for your child, ask the doctor about other epilepsy diets, like the modified Atkins diet and the low glycemic index treatment diet. They can be a little easier to handle.

Is the Ketogenic Diet Right for Your Child?

You have to decide if your family is ready for the ketogenic diet. You'll need to change the food you have in your home and the meals you eat. That can be tricky if you have other kids in the family.

All caregivers for your child -- from babysitters to teachers -- have to understand the diet and be on board, too. Even a little cheating on the food plan could trigger a seizure.

If you think you're up for it, talk to your child's doctor. Going "keto" is never easy -- but for many kids, it can be a big success.

WebMD Medical Reference



Epilepsy Foundation: "Ketogenic Diet."

UpToDate: "The ketogenic diet and other dietary therapies for the treatment of epilepsy."

The Charlie Foundation for Ketogenic Therapies: "Classic Ketogenic and Modified Ketogenic."

Boston Children's Hospital: "Epilepsy Center: Ketogenic Diet."

Epilepsy Foundation (Greater Chicago): "Ketogenic Diet."

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