By: Lance Fogan, M.D.
Lance Fogan, M.D. is Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA. His hard-hitting emotional family medical drama, “DINGS, is told from a mother’s point of view. “DINGS” is his first novel. Aside from acclamation on internet bookstore sites, U.S. Report of Books, and the Hollywood Book Review, DINGS has been advertised in a recent Publishers Weekly, New York Times Book Review and the Los Angeles Times Calendar section. DINGS teaches epilepsy and is now available in eBook, audiobook, and soft and hard cover editions.
Since the 1920’s it’s been observed that a very high fat with very low protein and low carbohydrate diets benefited children whose epilepsy initially failed to respond to anticonvulsant medications (ACM). Adult epilepsy patients have found that following such a ketogenic diet can help their seizures, too. However, these adults had to deal with very, very strict diets for the ketogenic diet to be effective. They would say, “What, no bread? No sugar?” But, when properly following the diet, they often said, “I haven’t had a seizure since I started the diet. I used to be debilitated by them.”
In the 1990’s interest in the ketogenic diet resurfaced after the promising newer ACMs did not prevent enough seizures. The exact mechanisms for this diet’s effectiveness are not known.
Ketones are chemicals created in the liver from fat and fatty acids and act as fuel for the brain that can pass through the blood-brain barrier (a microscopic-diffusion barrier, which impedes influx of most compounds from the blood into the brain. A 2015 analysis of 12 relevant studies found about half of adult patients who follow the classic ketogenic diet (where they eat four grams of fat for every gram of carbohydrates and/or protein) experience at least a 50 percent reduction in seizures. 1 Even if they were a little less strict in following the diet, the restricted diet was still beneficial in some reduction in their seizures.
Ketones are an alternative form of energy. Normally, the body’s primary fuel source is glucose coming from carbohydrates (fruit, vegetables and grains and sodas and sweets). The typical American adult derives half of their daily calories from carbohydrates. Fasting causes the liver to convert stored fat into ketones which supply energy to our cells. A state of KETOSIS in our body is created when the diet consists of AT LEAST 90% of calories derived from fat (generous ingestion of butter, mayonnaise, and heavy cream) and only 4% from carbohydrates and 6% from protein. An iteration of the modified Atkins diet also limits carbs but involves less fat with no restrictions of proteins. This diet can be more palatable and easier for adults to continue. Typically, about half of adult patients give up the diet within 6 months because of side effects that can include constipation and kidney stones. Many stopped the ketogenic diet if the onerous diet didn’t reduce their seizures as hoped.
One patient whose seizures were reduced following the modified Atkins diet said her favorite meal is hot chicken wings minus the barbecue sauce (too much carbohydrate sugar).
I invite you to learn more about ketogenic diets and epilepsy by consulting with your neurologist and especially with a nutritionist.
Fang Ye, Xiao-Jia Li, Wan-Lin Jiang, et.al.Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis Journal of Clinical Neurology 2015; 11(1): 26-31.