Dr. Anthony Gustin is a board-certified sports chiropractor, functional medicine practitioner, entrepreneur, podcast host, and founder of Perfect Keto.
In recent years, the ketogenic diet and using ketosis for losing weight, improving overall health and boosting mental clarity spiked major interest. However, many ketogenic diet followers are surprised to find out the diet was originally designed for a specific population of people: those with epilepsy. In this article, we’ll cover some of the history of ketosis for epilepsy, how it’s used for treatment, and possible reasons ketosis has been successful in this area.
History of Ketosis for Epilepsy
The ketogenic diet was first developed in the 1920s as a therapy diet for those with epilepsy. Epilepsy is a chronic neurological disorder that causes unpredictable seizures among other health problems. Epilepsy affects people of all ages, and the types of seizures vary widely per person.
Fasting, which leads to ketosis in the body, has been used as a treatment for epilepsy since as far back as 500 BC [*], and the ketogenic diet was created as an alternative. Those following it could still achieve the benefits of ketosis for epilepsy without abstaining from food.
Causes of Epilepsy
Around 2.3 million American adults and almost half a million children have epilepsy. About 150,000 new epilepsy cases are diagnosed each year in the United States.
Most epilepsy diagnoses don’t have a true identifiable cause. However, there are several additional conditions that can lead to epilepsy, including infection, head trauma, strokes, and brain tumors.
What’s important when it comes to ketosis and epilepsy is the mechanisms by which the ketogenic diet helps alleviate seizures is those with this chronic disorder. Let’s take a look at some ideas about why it’s been successful in some epilepsy patients.
How it Works
A ketogenic diet is a high-fat, moderate-protein, and very-low-carb diet. This balance of macronutrients causes the body to move from using glucose for fuel to using fat, which leads to the formation of ketones as fat is broken down.
It’s not completely understood just why the ketogenic diet works, even though the diet has been prescribed for a long time, mostly for children not responding to seizure medications. Here’s what we do know:
The most common theory for why the ketogenic diet (and therefore ketosis) improves the control of epileptic seizures is the high presence of ketones in the body. The ketones bodies that are made cause a change in metabolism, which is what might cause an anticonvulsant effect in those with epilepsy [*].
Some animal studies show that ketones may even have control over the progression of epilepsy [*].
Other theories propose that long-term ketosis might limit the creation of reactive oxygen species, increase synthesis of GABA (a neurotransmitter in the brain and reduces excitability of the cells), and boost the production of energy in the brain’s tissue [*]
Ketosis for Seizure Types
The ketogenic diet is often recommended for children with seizures that haven’t responded positively to seizure medications. There are two main categories of seizures that happen in those with epilepsy:
- Generalized seizures (also called local): produced by electrical impulses through the whole brain
- Partial seizures (also called focal): produced by electrical impulses in a small part of the brain
Reduction in Seizures through Ketosis
According to Epilepsy.com, more than half of children who follow the ketogenic diet see a 50% or more reduction in the amount of seizures they have. Around 10-15% of children in ketosis will even stop having seizures completely.
This is especially true for kids who have Lennox-Gastaut syndrome, a form of epilepsy where the patient has several different types of seizures. Although ketosis has been shown as most helpful in those with generalized seizures, the ketogenic diet has also benefitted children with partial seizures.
Small studies have shown the ketogenic diet to be helpful for the following epilepsy-related conditions:
- Rett syndrome: rare, genetic disorder of the grey matter of the brain that forms after birth. Up to 80% of Rett syndrome patients experience seizures.
- Infantile spasms: epileptic disorder seen in people of all ages, including infants, usually occurring between 3-12 months after birth. Patients experience three categories of epileptic seizures, often simultaneously.
- Dravet syndrome: rare genetic epileptic brain dysfunction that starts within the first year of birth.
- Tuberous sclerosis complex: genetic disorder where tumors formed on the eyes, brain, kidney, lungs, and skin. Tumors on the brain can lead to several problems, including seizures.
- GLUT1 deficiency syndrome: disorder that usually includes frequent seizures starting within the first months after birth.
- Doose syndrome: myoclonic-atonic seizures (a type of generalized seizure) that occur between seven months and six years old.
In addition, more alertness and improvements in endurance, activity levels, and attention [*] are experienced in epilepsy patients following the ketogenic diet.
Studies on ketosis for adults with epilepsy show it as effective, although in a hospital setting, ketosis seems to be more commonly prescribed for children. This seems mostly due to the fact that the diet was originally seen as too restrictive for adults and that many seizure disorders begin in early childhood.
Treatment Process: Ketogenic Diet for Epilepsy
When a child is to go on a ketogenic diet for their epilepsy symptoms, it typically begins with a fast followed by the start of the diet in the hospital. This allows the medical staff to ensure there is no increase in seizures when starting the diet, educate family members on the diet, and to make sure all medications being used are free of carbohydrates.
A ketogenic diet formula may also be used for infants and children being fed through a gastrostomy-tube.
Although fasting is not necessary for getting into ketosis, it does speed up the process and is often used for this reason.
Although patients still take seizure medications while following the ketogenic diet, some patients have been able to take smaller doses after implementing the diet. However, this can be risky in children since it’s so easy to get kicked out of ketosis, even with one meal. It might even be difficult for parents to constantly monitor everything their children are eating throughout the day.
Although we don’t know the exact mechanisms by which ketosis is helpful for those with epilepsy, we do know that it’s been beneficial in reducing or eliminating seizures, especially in children, as it was first intended almost a decade ago. It also gives us a powerful look at the overall potential of ketosis for improving a range of conditions.