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Q
Ketogenic Diet to Control Epilepsy?

My grandchild has infantile seizures and has recently been put on the ketogenic diet. Do you know anything about this diet?  

A
Answer (Published 6/28/2010)

Epileptic seizures are caused by sudden increases of electrical activity in specific areas of the brain, which disrupt normal brain function. Individuals with epilepsy are often born with the disorder, but some develop it later in life (sometimes after a head injury). The seizures themselves can range in severity from the barely noticeable (with only momentary lapses of awareness) to the dramatic (grand mal seizures with violent muscle contractions and loss of consciousness).

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I do recommend the ketogenic diet for severe seizures in young people, but I reviewed your question with Sandy Newmark, M.D., a California-based pediatrician who is on the faculty of the Arizona Center for Integrative Medicine. Dr. Newmark agrees that this diet can be very helpful in the case of seizures that are difficult to control with the drugs usually prescribed, but he noted that it is a very difficult diet to maintain and requires close medical supervision.

The diet is very high in fat and very low in carbohydrates, a regime that keeps the child’s body in a constant state of "ketosis," in which it is forced to burn fats only. Under the right circumstances this diet can make a tremendous difference in seizure frequency and intensity and is certainly worth trying.

Although we know that the brain and other tissues in the body prefer to use ketones over glucose for fuel, we don’t know why inducing a ketotic state decreases the number of seizures. The diet seems to work best for children ages one to 10 and for those whose epilepsy isn't well controlled by drugs. It doesn't appear to help adults and adolescents. However, according to the Epilepsy Foundation, when carefully monitored by a medical team familiar with its use, the diet helps two out of three children and may prevent seizures completely in one out of three.

Because the diet is so strict, it requires a strong family commitment. On a ketogenic diet, a child gets 80 percent of his or her calories from fat. The amounts of food and liquid at each meal have to be carefully individualized, which requires a lot of weighing and measuring.

Typically, a physician will suggest a trial of two or three months to see if the diet helps. If so, it can be continued for about two years and then the child can be slowly weaned off to see if the seizures remain under control. The Epilepsy Foundation reports that after going off the ketogenic diet some children may remain seizure free without further treatment; others may need medication.

Andrew Weil, M.D.

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