By: Natalie L. Boehm, MBA, RBLP-T
What is the Keto Diet?
According to the Academy of Nutrition and Dietetics, the keto diet is a high fat, moderate protein, low carbohydrate eating pattern which differs from the general, healthful eating recommendations. The keto diet is restrictive and for individuals battling epilepsy, a medical professional should help to plan and monitor any keto plan they follow. Many people have used the keto diet to reduce body fat percentage, but if not followed properly, they can get sick and experience what is known as the “keto flu”. Before starting any keto diet plan, it is best to consult with your physician before making the changes.
What is ketosis?
According to The Charlie Foundation, ketosis refers to a byproduct of the breakdown of fat into useable energy, known as ketones. Ketones are used by the body as a source of energy. Ketosis is defined as having blood ketone levels that are greater than 0.5 millimolar/L.
Are there variations of the Keto Diet?
According to The Charlie Foundation, there are five variations of the Ketogenic Diet that have been researched and proven to be effective treatments for conditions such as epilepsy, cancer, and Alzheimer’s disease. Listed below are the different types of plans:
1. Classic Keto
The classic keto diet is an individualized plan in which foods are weighed and the meals should be consumed in entirety for best results. It consists of ninety percent fat, six percent protein, and four percent carbs. Macronutrient ratio is 4:1.
2. Modified Keto
The modified keto diet is a plan that is good for people who are just starting out or are going to be using the keto plan long-term. It consists of eight-two percent fat, twelve percent protein, and six percent carbs. Macronutrient ratio is 3:1 to 1:1 range.
MCT is a structured diet that contains highly ketogenic medium chain triglycerides, which allows more carb and protein intake compared to the average keto diet. It consists of seventy-three percent fat, ten percent protein, and seventeen percent carbs. Macronutrient ratio is 1.9:1
4. Modified Atkins
The Modified Atkins diet limits the amount of carbohydrate, encourages fat intake, and does not limit protein. Carbohydrates are to be consumed when fat is consumed. It consists of sixty-five percent fat, thirty percent protein, and five percent carbs. Macronutrient ratio is 0.8:1.
5. Low Glycemic Index
An individual plan, but less structured diet, low glycemic uses exchange lists for planning meals and emphasizes complex carbohydrates. This diet plan is not intended to promote ketosis. Macronutrient ratio is 2:3.
6. Intermittent Fasting
A dietary intervention that shifts the body into ketosis by limiting the time frame when one eats throughout the day. This forces the body to access energy from body fat. There is no macronutrient ratio for intermittent fasting.
Keto Diet and Refractory Epilepsy
The keto diet has been used to reduce seizure activity, improve cognition, and quality of life for patients battling refractory epilepsy. In the article, Current Perspectives on the Role of the Ketogenic Diet in Epilepsy Management, the authors point out how long-term therapy use requires the cooperation of the patient, parents if it is a child battling epilepsy, and the heath care provider. Keto diet is used as a resource when despite trying two or more antiepileptic medications, physicians cannot get seizure activity controlled.
Multiple things need to be taken into consideration before starting a keto diet plan. For families with children battling epilepsy, such as age, type of epilepsy, metabolic illness (if diagnosed), financial and social issues, as well as the level of commitment from the parents. Weighing and monitoring the diet is very demanding and physicians must make sure that parents understand for the treatment to be carried out.
In the article stated above, the researchers state the recommendation that anti-epileptic drugs should be converted from liquid to tablet form when following the keto diet in order to restrict additional carbohydrate intake. Different anticonvulsants carry out different risks for the patient. Keto for children can be carried out long-term but the average timeline for following the plan is two years. If seizures worsen under the keto plan, then treatment is discontinued. Benefits of the keto plan in studies have been improvements cognition and behavior, many cases due to the decrease in anti-seizure medication.
Keto Diet and Dravet Syndrome
Dravet syndrome, also known as severe myoclonic epilepsy, is a rare form of epilepsy that starts within the first year of a child’s life. According to the Dravet Syndrome Foundation, dravet syndrome is a result of a mutation in the SCN1A gene. Individuals with dravet syndrome are at higher risk for SUDEP (sudden expected death due to epilepsy), as well as having behavioral and developmental delays.
In the article, Ketogenic Diet in Patients with Dravet Syndrome, fifty-two patients took part in a study and twenty were placed on the keto diet that followed the Hopkins protocol. Of the 20 participants, thirteen stayed on the protocol. Out of the thirteen patients, three children stayed on the diet for a year, four for two years, four for three and two for four years.
A year after starting their keto diet, ten of the children achieved greater than a seventy five percent decrease in seizure activity. Of the four children who were on the diet for two years, one became seizure free.
The results of this study showed of the keto diet improved the quality of life for these children. Even though some were not able to get their seizures fully controlled, many were able to reduce the amount of medication they were taking. It strengthens the argument that epilepsy needs to be approached with working towards achieving overall wellness. Medication is life saving for many; however it cannot be considered the only option.
Is the Keto Diet just for children or can adults benefit as well?
The keto diet was originally created for children. However, in 2010 John Hopkins opened the first ever clinic to offer the keto diet program to adults who are battling epilepsy.
John Hopkins offers the modified keto diet which is similar to the Adkins diet which has shown to reduce seizure activity within a few months. This is a program offered through their clinic for adults who despite trying different medications and combinations of meds are having limited success.
Listed below in our resources is the information from John Hopkins Medicine. There you can find the link that will lead you to their webpage with the information on how to qualify for the program and what to expect if you take part. I have been lucky enough that with the right combination of medication, my seizures are controlled. For many adults that I know, that is not the case. Always talk to your doctor before making any changes to your care plan and make sure you properly understand how to follow a keto diet plan.
The keto diet is a resource that is beneficial for those battling epilepsy where medication has not helped. There are different variations of the keto diet, some that must be followed under a doctor’s supervision. Individuals with refractory epilepsy and Dravet’s syndrome can benefit from following a keto plan. The keto diet was made for children, but through research the modified keto diet was created as a resource for adults with drug-resistant epilepsy. Remember to consult with your physician before starting or changing any care plan you are on.
Academy of Nutrition and Dietetics (2019). What is the Ketogenic Diet? Academy of Nutrition and Dietetics. Retrieved from: https://www.eatright.org/health/weight-loss/fad-diets/what-is-the-ketogenic-diet
Caraballo, R., Cersósimo, R., Sakr, D., Cresta, A., Escobal, N., & Fejerman, N. (2005). Ketogenic Diet in Patients with Dravet Syndrome. Epilepsia (Copenhagen), 46(9), 1539–1544. https://doi.org/10.1111/j.1528-1167.2005.05705.x
Goswami, J., & Sharma, S. (2019). Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management. Neuropsychiatric Disease and Treatment, 15, 3273–3285. https://doi.org/10.2147/NDT.S201862
Dravet Syndrome Foundation (2021). What is Dravet Syndrome? Dravet Syndrome Foundation. Retrieved from: https://www.dravetfoundation.org/what-is-dravet-syndrome/
John Hopkins Medicine (n.d.) Ketogenic Diet Therapy for Epilepsy. John Hopkins Medicine, Department of Neurology and Neurosurgery. Retrieved from: https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/epilepsy/diet-therapy.html
Mayo Clinic (2021). The truth behind the most popular diet trends of the moment. Mayo Clinic. Retrieved from: https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/the-truth-behind-the-most-popular-diet-trends-of-the-moment/art-20390062
The Charlie Foundation (2021). Keto Therapies. The Charlie Foundation for Ketogenic Therapies. Retrieved from: https://charliefoundation.org/diet-plans/
The Charlie Foundation (2021). Nutritional Ketosis. The Charlie Foundation for Ketogenic Therapies. Retrieved from: https://charliefoundation.org/learn-about-ketosis/