Epilepsy, Children, and the Ketogenic Diet

Some parents of children with epilepsy are skeptical of the ketogenic diet when they first hear about it. A diet that can control epilepsy and stop seizures without any medication? It almost sounds like a scam.

But the ketogenic diet is real and legitimate. It works very well in many people. The catch is that it's extremely demanding and difficult to follow. In fact, it is so difficult to follow that most doctors recommend it only for people who haven't been able to control their seizures with medicine.

What Is the Ketogenic Diet for Epilepsy?

The ketogenic diet is an extremely high-fat diet that requires a child to eat four times as many fat calories as calories from protein or carbohydrates. A meal might include a small portion of chicken, a little bit of fruit, and a lot of fat, typically butter or cream. Frankly, it's a difficult diet to swallow.

Your child may start the diet in the hospital, so nurses and doctors can observe the first few days. Your child will probably need to go without any food for 36 to 48 hours before beginning the diet. After that, food is gradually increased over a few days. This diet does not provide all the vitamins a body needs, so your child will probably have to take sugar-free vitamin supplements.

Why Does the Ketogenic Diet Work?

No one knows why the ketogenic diet -- which was developed in the 1920's -- works so well. But we do know something about how it affects the body.

By reducing the number of carbohydrates a person eats, the body is forced to burn fat for energy, a process called ketosis. This ketosis is the same process that kicks in when someone is fasting -- on purpose or because of starvation. Fasting has been a traditional seizure treatment for centuries.

How ketosis helps with epilepsy isn't known, but it does. Researchers at Johns Hopkins University studied 150 children with epilepsy in one important study. After a year on the ketogenic diet, half of children had 50% fewer seizures. One fourth of the children reduced their seizures by 90%. After a few years on the diet, many of these children no longer needed medications at all.

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The Drawbacks of the Ketogenic Diet

There are many difficulties following the ketogenic diet:

  • Weighing food precisely is important.
  • Even little lapses -- like sneaking the crumbs of a cookie or swallowing a nasal decongestant -- can result in a seizure.

"You even have to measure the carbohydrates that are in your toothpaste," says William R. Turk, MD, Chief of the Neurology Division at the Nemours Children's Clinic in Jacksonville, Florida.

As you might imagine, it's a challenge for most parents to keep their children on this diet. Children may accept foods from other kids at school, or over at a friend's house. Older children may already have strong opinions about what they want to eat. The ketogenic diet works best in young children who haven't yet developed strong tastes in food.

Children on the ketogenic diet also often feel very hungry, at least at first. You need to monitor all of the food in the house, including food in the dog's bowl.

You may also be concerned about the effects of eating all that butter and cream. After all, isn't fat supposed to be bad for you? A recent study confirmed that children on the ketogenic diet do have significantly higher levels of cholesterol than most kids. But damage from a high-fat diet generally comes only after many years. Children usually follow the ketogenic diet for just a few years.

Starting the Ketogenic Diet

This high-fat/low-carb diet may sound like any number of protein diets you've read about. In fact, some popular protein diets also claim to cause the process of ketosis. But the ketogenic diet is not like a typical protein diet and you can't do it on your own.

"It's very important that a family have a doctor and a dietician working with them on this diet," says Solomon L. Moshe, MD, director of Clinical Neurophysiology and Child Neurology at the Albert Einstein College of Medicine in New York. "Otherwise, it won't work and it isn't even safe."

A dietitian can also help you adapt the strict rules of the diet to real menus, so you can come up with meals your child may enjoy.

If you're considering the ketogenic diet, don't assume your child will fight the strict rules. Talk it over together. Your child probably wants the seizures to stop, too, and may cooperate willingly.

WebMD Medical Reference Reviewed by Roy Benaroch, MD on July 28, 2016

Sources

SOURCES:
Solomon L. Moshe, MD. Professor of Neurology, Neuroscience and Pediatrics, Director of Clinical Neurophysiology and Child Neurology at Albert Einstein College of Medicine, Bronx, New York; past president of the American Epilepsy Society. William R. Turk, MD. Division Chief, Department of Pediatrics, Division of Neurology, The Nemours Children's Clinic, Jacksonville, Florida.
Freeman, J. et al. Seizures and Epilepsy in Childhood: A Guide. 2nd ed. 2002.
National Information Center for Children and Youth with Disabilities web site.
Nemours Foundation web site.
Epilepsy Foundation web site.
American Epilepsy Society web site.
National Institute of Neurological Disorders and Stroke web site.
Epilepsy Foundation Entitled 2 Respect web site.
Medscape Epilepsy Resource Center web site.
WebMD Medical News: "Some Kids on Epilepsy Diet Still Seizure-Free."
WebMD Medical News: "Ketogenic Diet Raises Cholesterol in Kids."
Freeman, J. "What every pediatrician should know about the ketogenic diet." Contemporary Pediatrics June, 2003: vol 20; 113-127.

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