Ketogenic diet for epilepsy
Overview
As a nutrition support pharmacist, you will hear more about the use of ketogenic diet in special situations like intractable epilepsy. Many people started talking about the keto diet for epilepsy, especially since the TV movie, First Do No Harm in 1997. This is NOT quackery. It's a legitimate medical therapy...
Ketogenic diet for epilepsy management
Mechanism and history of ketogenic diet
The ketogenic diet "see table 1" has been around for about 70 years. It fell out of favor when phenytoin and newer antiepileptics came out. But some children aren't controlled with drugs and the diet can make a dramatic improvement for SOME of them.
- This diet is VERY HIGH in fat and VERY LOW in carbohydrates. It forces the body to burn fat instead of carbohydrates.
- This causes ketosis, which sometimes controls seizures.
- It's used mainly in children under 10 years. About a third of them become seizure-free and stop their seizure medications. Another third has fewer seizures and the rest don't improve or can't tolerate it.
| Table (1). Sample Menu for One Day on Ketogenic Diet | |
|---|---|
| MEALS | CONTENTS |
| Breakfast | Breakfast quiche with bacon beef |
| Lunch | Belgian salad with avocados, pineapple, and pecans |
| Dinner | Sausage, potato, sauerkraut |
| Creamy milkshake |
|
| Snacks | Cheesecake with blueberries |
| (Total: 1000 calories/ 3.8:1 ratio) | |
| This information form... Hartman AL, Vining EP. Clinical aspects of the ketogenic diet. Epilepsia. 2007 Jan;48(1):31-42. |
|
Strict supervision and adherence requirements
The diet is hard to follow and MUST BE MEDICALLY SUPERVISED. About 80% of calories come from fat. Carbohydrates must be STRICTLY controlled, including the sweeteners in liquid medications, vitamins, etc. For example, just the daily dose of Depakene (valproate sodium) syrup alone exceeds the carbohydrate limit!. Too many carbohydrates reverse ketosis and can result in seizures. Refer interested patients to a nutritionist and medical center that specializes in this. We can point you towards some excellent resources and information about the keto-diet "see note below".
- Guidelines: National Institute for Health and Care Excellence (NICE) guideline on diagnosis and management of epilepsies can be found at NICE 2012 Jan:CG137.
- Articles: Ketogenic diet and epilepsy can be found in Front Neurosci 2019;13:5full-text, ALSO review can be found in Curr Opin Clin Nutr Metab Care 2008 Mar;11(2):113.
- Patient education: Information from Epilepsy Foundation, ALSO handout from HARVARD university.
References
- Lee M. The use of ketogenic diet in special situations: expanding use in intractable epilepsy and other neurologic disorders. Korean J Pediatr. 2012 Sep;55(9):316-21.
- Epilepsy Foundation (2017). Ketogenic Diet. [online] Epilepsy Foundation. Available at: https://www.epilepsy.com/learn/treating-seizures-and-epilepsy/dietary-therapies/ketogenic-diet.
- Feldstein TJ. Carbohydrate and alcohol content of 200 oral liquid medications for use in patients receiving ketogenic diets. Pediatrics. 1996 Apr;97(4):506-11.