Feature Article: Treating epilepsy through diets
Epilepsy Diets: Treating epilepsy through diets: If you have not heard of this before, it may seem surprising, but there are actually several diets that can be used to treat seizures and, in some cases, they can be astoundingly effective.
Dietary treatments for epilepsy involve the use of specific diet plans that are utilized to help manage and reduce seizures in individuals with epilepsy. These are non-pharmacological approaches and might be considered when medications fail to adequately control seizures or when individuals experience significant side effects from medications. In certain metabolic conditions, such as GLUT 1 transporter deficiency epilepsy, dietary therapy is the first line treatment of choice.
Several types of diets have shown efficacy in reducing seizures in certain individuals with epilepsy.
The classic dietary therapy is the Medical Ketogenic Diet (KD), a high-fat, low-carbohydrate, and adequate protein diet. It aims to induce a state of ketosis in the body; ketones derived from fat metabolism become the primary energy source instead of glucose. The KD typically consists of a specific ratio of fat to combined carbohydrates and protein, often calculated by a dietitian. The exact ratio and specific foods may vary depending on the individual's age, health status, and dietary preferences.
KD has been shown to be effective in reducing seizures in some individuals with epilepsy, particularly children with difficult-to-control seizures. It should also be noted that there are pre-made ketogenic formulae available for infants and patients with tube feedings.
Another diet that can be used for epilepsy is called the Modified Atkins Diet (MAD): MAD is a less restrictive variation of the ketogenic diet. It emphasizes high-fat foods but allows for more flexibility in terms of protein and carbohydrate intake. It restricts daily carbohydrate consumption to a certain amount (usually 10-20 grams per day) but does not require strict macronutrient ratios. It is often more palatable and easier to follow than the ketogenic diet.
MAD has demonstrated effectiveness in seizure reduction for some individuals, especially adolescents and adults with epilepsy.
A third dietary treatment is called the Low Glycemic Index Treatment (LGIT) which focuses on consuming carbohydrates with a low glycemic index; these cause a slower and more gradual rise in blood sugar levels. This approach aims to stabilize blood sugar levels and prevent rapid fluctuations that may trigger seizures. Carbohydrates are restricted, but patients can have 50-60 grams per day. The LGIT is less restrictive in terms of overall carbohydrate intake compared to the ketogenic or MAD but still emphasizes healthier, low-glycemic index food choices.
Although all three have shown some effectiveness in reducing seizures in specific subgroups of patients, it should be understood that dietary therapies are not for everyone. Before initiating any dietary therapy for epilepsy, a thorough evaluation by a healthcare professional, including a neurologist and dietitian, is necessary to determine the suitability and appropriateness of the specific diet for the individual. The healthcare team will assess the individual's seizure type, medical history, nutritional needs, and potential contraindications such as certain metabolic conditions. Implementing dietary therapy for epilepsy requires careful monitoring and ongoing support from healthcare professionals. The diet is often deficient in certain minerals and vitamins and hence supplements may be needed under the supervision of the medical team. There are potentials risk due to the diet including constipation, kidney stones and metabolic acidosis. This is one of the reasons that it is important to keep hydrated to prevent constipation and kidney stones. Regular bloodwork and at times, ultrasound or bone scan may be needed for patients on long term ketogenic diet.
Regular follow-up visits with the healthcare team, including neurologists and dietitians, are necessary to evaluate the effectiveness of the diet, monitor nutritional status, and make any necessary adjustments. The healthcare team will provide guidance on meal planning, supplementation (if necessary), and managing any challenges or concerns that may arise during the dietary intervention. By working closely with healthcare professionals, individuals can determine the most suitable dietary therapy and receive the necessary support to maximize seizure control and improve their quality of life.
If you would like to explore these diet options further, make sure to bring it up at your (or your child’s) next appointment with the neurologist. And to learn even more about these treatment options, check out some of these foundations:
https://charliefoundation.org/
http://ketohope.org/
Rajeshwari Mahalingam, MD and Nicole Stawicki, MS RDN CNSC
