The Ketogenic Diet May Help Stop Seizures
This dietary treatment based on ancient medicine is making a comeback.
Posted Mar 26, 2019
The ketogenic diet is arguably one of the most controversial diets today. Celebrities and pop stars are increasingly raving about this diet, with counter viewpoints being expressed by people like Jillian Michaels. Some healthcare professionals and organizations are warning of dire consequences from this diet. The American Heart Association expresses a concern from a heart health viewpoint. At the same time, other medical clinics are opening with very credible doctors who are using the diet to treat serious medical conditions such as diabetes, as just one example. So the diet is the subject of intense debate in some circles. However, the medical ketogenic diet is not new and it is not a fad. In fact, it has been used for about 100 years to treat epilepsy. In people with treatment-resistant epilepsy. the medical version of the ketogenic diet can stop or greatly reduce seizures This is true even when numerous medications and surgery have failed to control their seizures.
Most people don’t know that fasting can stop seizures, but in fact, it can. That story begins over 2,000 years ago.
Hippocrates and biblical references to fasting to control epileptic seizures
The use of fasting as a therapy for epilepsy was documented in 460 BC when Hippocrates wrote about the role of fasting in stopping seizures. There are also biblical references to the use of fasting and prayer to treat a boy having a seizure. (Matthew 17:21 and Mark 9:29). The challenge is that while seizures are controlled during a fast, people eventually need to eat. Unfortunately, once the person starts eating a typical diet again the seizures usually come right back.
Ketogenic diet developed in 1920’s to mimic the effect of fasting
Modern medicine eventually caught on. Dr. Rawle Geyelin reported his experience treating epilepsy with fasting at the 1921 convention of the American Medical Association. That same year, RT Woodyatt observed that the ketones generated by fasting could also be generated by a low-carb, high-fat diet. Dr. Russell Wilder from the Mayo Clinic coined the term ketogenic diet. Wilder suggested that a ketogenic diet could yield benefits as effective as fasting while allowing both children and adults to continue to grow and thrive. Early results were impressive.
Prescribing pills easier than prescribing a diet
In the 1940s, new anticonvulsants were discovered and became very popular. Pills are easy for a physician to prescribe, and for a patient to take. Changing what and how the patient eats takes a lot more time, effort and education. The ketogenic diet lost out to pharmaceuticals and was all but forgotten.
Treatment-resistant epilepsy revives ketogenic diets
The ketogenic diet was “rediscovered” in the 1970s at Johns Hopkins. Modern anticonvulsants, surgeries, vagal nerve stimulators, and other epilepsy treatments fail to work for about 30% of patients. These people continue to seize regularly. In an effort to help these patients, doctors and dieticians at Johns Hopkins went back to the ketogenic diet. They used it primarily in epileptic children.
Today - Compelling evidence that keto diet helps children with treatment-resistant epilepsy
A Cochrane review (Martin et al, 2016) of children and adolescents with “treatment refractory” epilepsy included 7 randomized, controlled trials in 427 children and adolescents with treatment-resistant seizures. Treatments tried included numerous medications and sometimes other interventions, including surgery. Yet, the children continued to have seizures. This review found that after starting the ketogenic diet:
- At 3 months, seizure freedom rates were as high as 55%.
- At 3 months, up to 85% had 50% or greater reduction in seizures.
- The Modified Atkins diet (often a 1:1 or 2:1 ratio) is not as effective as a 4:1 ratio diet.
In one series (Freeman et al, 2009), of all of the children who started the diet, after 1 year, 55% remained on diet. (They obviously found it beneficial.) Another 45% discontinued it (likely because it was too difficult to do, or it didn’t work). The compelling evidence is that it works for a majority of children with treatment-resistant epilepsy.
Less compelling evidence for treatment-resistant adults
But what about adults with treatment-resistant epilepsy? The evidence is much less compelling. Why? Likely because doing any diet is difficult for most people, and the medical version of the ketogenic diet is even more difficult, at least early on. Historically, most adults were not able to stick to it, even if their seizures stopped! This really speaks to the need for education and understanding of this dietary intervention.
Current keto education and support make the diet easier for people to do. The recent keto weight-loss movement has spurred innovation. For example, today’s ketogenic cooks understand how to make this diet palatable and sustainable. Gone are the days of spoonsful of supplemental oil. Fortunately, these interesting recipes have spilled over to improve the diet of patients doing keto for medical benefits. The medical ketogenic diets use anywhere from 2:1 to 4:1 ratio. The ratios are grams of fat: grams of combined protein and carbohydrate. In contrast, weight loss versions of the diet are much less rigid. Keep in mind, for epilepsy, the popular weight-loss versions of the diet often don’t work to control seizures.
Connections between epilepsy and psychiatric illnesses
There are well-documented overlaps between epilepsy and mental illnesses including depression, anxiety, schizophrenia, and bipolar disorder. Such psychiatric illnesses are often treated with the same anticonvulsant medications used to treat epilepsy. This includes things like Depakote, Lamictal, Tegretol, Neurontin, Topamax, Valium, and Klonopin. In fact, psychiatry and neurology share many of the same medications to treat brain disorders, whether they are called “neurological” or “mental” disorders. In many ways, that’s not surprising. They all affect the brain! Given the established effects of the ketogenic diet for seizures, it’s not far-fetched to think it might also work for some people with psychiatric illness.
In fact, the ketogenic diet is known to have profound effects on the brain - ones that very likely may help people with “mental” disorders. Stay tuned for some upcoming blog posts with much more on this cutting edge topic – Keto for psychiatry!
Ketogenic diet as a medical intervention
The ketogenic diet has a long history as a medical intervention. It can be powerful. It’s not just your average “diet.” If you have epilepsy or any other medical condition and are considering using the ketogenic diet as a treatment, I strongly recommend that you consult with a healthcare professional before trying this diet. Why? Because epilepsy, mental illnesses, and many medical disorders are serious - and sometimes dangerous - and you should have accurate information, and help, and medical supervision to implement treatments in a safe and effective way.