Epilepsy Treatment: Ketogenic Diet vs Drugs

Some hospitals start the diet out by putting children on a 36 hour fast, and reducing calories and liquids to increase ketosis, others don't. Recent papers have suggested that fasting and caloric restriction are not necessary.

In addition, the medical teams choose to try drugs before the diet, which I find puzzling, given that the drugs are highly toxic, don't work well, and are less effective than the ketogenic diet. The following studies highlight just how effective the ketogenic diet is as an epilepsy treatment:

Diet Over Drugs For Epilepsy Treatment

• In this study, A total of 150 children were entered into a study of the ketogenic diet's efficacy and tolerability. The results were remarkable. Of the original 150 patient cohort, 20 of the children (13%) became seizure-free and an additional 21 (14%) had a 90% to 99% decrease in their seizures. In addition, twenty-nine of the children became free of medications, and 28 were on only 1 medication.

• And in this study, 14 children with intractable epilepsy and RC complex defects who were treated with the classic ketogenic diet involving a 4:1 lipid to nonlipid ratio (% by weight), but without an initial fast and fluid restriction. The results again were amazing. Of the 14 patients, half became became seizure-free after commencing the diet. One patient with a greater than 90% seizure reduction, and 2 patients had seizure reductions between 50% and 90%. That's a 50% cure rate, and a seizure reduction rate of 71%.

• The ketogenic diet can be given to babies as an epilepsy treatment as well. In this study, during a 4-year period, 23 children with infantile spasms, aged 5 months to 2 years, were started on the ketogenic diet. At 3 months, 38% of the children were greater than 90% improved. At nine months, 53% had greater than 90% improvement, and at 12 months, 46% were more than 90% improved, and the rest were 50% improved. Fifty-seven percent had their medications reduced or discontinued by 12 months and fifty-seven percent had improvement in development, which was correlated with seizure control.

These studies show that a ketogenic diet can alleviate or cure seizures in more than half of the children who go on it. This is an amazing curative effect, and even better, the treatment itself is not harmful to the patient.

Just recently, this NYT article discusses a new study on ketogenic diet and epilepsy which shows the diet's positive effect on seizures as well.

And in March of 2012, PubMed Health published this article from the Cochrane Database of Systematic Reviews which reported that several large studies on the effects of a ketogenic diet on epilepsy has been completed. The Cochrane team wrote

"These studies suggest that in children, the ketogenic diet results in short to medium term benefits in seizure control, the effects of which are comparable to modern antiepileptic drugs."

In contrast, epilepsy drugs frequently fail to provide real help, and worse, the drugs cause further harm to the children through toxic side effects.

Given the non toxic effectiveness of the ketogenic epilepsy diet, and the harm that drugs can do, why do physicians and hospitals try drugs first as an epilepsy treatment? Why don't they try the ketogenic diet first to treat epilepsy?

Ketogenic Diet Efficacy: It's all in the Fat Quality

In several studies I've read, it was noted that some kids given a ketogenic diet as an epilepsy treatment end up quitting the diet because it is unpalatable. As a person who voluntarily eats a ketogenic diet, this is astonishing to me. I wondered "what are they feeding these kids?"

I figured it out when I took a look at a product called Ketocal, and tracked down the manufacturing process for the MTC oils being used in epilepsy treatment.

These products are based on refined vegetable oils and processed coconut oils. The refining process removes the natural antioxidants and makes the oils highly susceptible to oxidation. This is a terrible choice, given the research that indicates mitochondrial oxidation and free radical problems may be involved in the epileptic disease process.

Plus, these processed fats do taste awful, and they are highly inflammatory and toxic to the body as well.

• Why can't kids just eat real foods? What's wrong with egg yolks, butter and cream on an epilepsy treatment plan? What's wrong with Brie cheese, and bacon, and pork sausages? What's wrong with just using organic, virgin coconut oil instead of refined MTC oil?

Here's Why Real Food is Better

The mechanism by which ketosis calms seizures is still being studied, but there are several ways in which ketones provide protection for brain cells. Several studies have shown that a brain under metabolic stress can use ketone bodies as an alternative energy source, and this ability protects neurons from damage and premature death. Ketone bodies also have a strong anti-inflammatory effect which is also neuroprotective. They literally strengthen and protect brain cells.

I've also read several studies which indicate epilepsy is in part caused by mitochondrial dysfunction, and in an overabundance of ROS (reactive oxygen species), harmful free radicals within cellular mitochondria.

Ketone bodies help the mitochondria regenerate themselves, and may helps the brain handle excitatory molecules such as glutamate more efficiently. As one study put it:

"Cerebral metabolism of ketone bodies (β-hydroxybutyrate, acetone, and acetoacetate) alters mitochondrial metabolism, which improves the metabolic efficiency, increases the free energy of ATP hydrolysis, and decreases the production of free radicals."

If free radical damage is involved in epileptic seizures, it's an even stronger reason to use saturated fats instead of polyunsaturated vegetable oils (PUFAs). Vegetable oils are highly processed pseudo-foods, and they are extremely reactive. They are easily oxidized in the presence of heat and light, and once oxidized, they start to damage the surrounding tissues.

Many studies have demonstrated that vegetable oil consumption increases free radical formation and damage with the result of increasing inflammation in body tissues.

In contrast, real, whole saturated fats like butter and heavy cream are stable and delicious, and don't cause this type of oxidative damage. They are perfect for use in an epilepsy treatment plan.

One important point I want to make: This paper talks about the long term complications of a ketogenic diet, and sadly mentions the deaths of several children who had been put on the diet. The paper doesn't elucidate the actual food the children were eating, but I suspect that the dietary options given included industrial processed oils and fructose in the form of "shakes". This combination of pseudo-food can cause real harm, and it's unfortunate that the quality of the food given reflects on the safety of the diet itself.

Modified Atkins: Real Food Works!

The key differences in the implementation of the "modified Atkins" epilepsy treatment include no fluid or calorie restriction, an encouragement of fat intake without restrictions on proteins, and parents and patients don't have to weigh and measure the foods as they would on a standard ketogenic medical diet. They only have to track carbohydrate counts.

Even better, the modified Atkins diet is started outside of the hospital, without a fast, as well. Lastly, foods can be eaten more freely in restaurants and outside the home, and families can do it as well. The diet is called a "modified" Atkins diet as it allows for less carbohydrates than traditional Atkins (10-20g/day) and more strongly encourages fat intake.

This more closely follows what the average person does when putting themselves on an Atkins diet, and indeed the Modified Atkins has been shown to help adults with epilepsy as well.

Dawn Phenomenon and Fasting Insulin

Here a few more issues I wanted to discuss:

In some of the case studies I read, the child develops nausea when first starting on the diet which is alleviated by giving orange juice. Also, some kids may have isolated seizures in the early morning. This makes me wonder if these issues aren't related to reactive hypoglycemia and fasting insulin levels.

Here's why: it's well known in low carb/diabetes circles that two things happen almost immediately when a person who has been eating a high carb diet starts on a low carb diet:

1. The lower carb intake causes blood sugars to drop, but there is a several week delay in the return of insulin levels to baseline. During that several weeks, there will be times when the insulin levels are too high for ketosis to kick in fully, but meanwhile blood sugar is dropping. This initiates reactive hypoglycemia episodes, which makes the person feel shaky and nauseous until some carb (orange juice!) is given. The key here is that the blood sugar readings may look normal when measured, but the body perceives a blood sugar emergency relative to former blood sugar levels. I wonder if these kids are having hypoglycemic reactions to the reduction in carbohydrate intake while still having high fasting insulin? I checked with a few clinics, and some measure fasting insulin levels before they place children on the diet, some don't. But at least one was aware of what caused the issue, so the literature must be behind on reporting this.
2. Diabetics often suffer from a condition known as "Dawn Phenomenon" in which circulating blood sugars are higher in the morning hours. Richard Bernstein, MD writes that research suggests that the liver deactivates more circulating insulin during the early morning hours than at other times of the day. I wonder if this higher blood sugar reading in the morning is what is causing the isolated seizures for some children?

Resources for Further Reading

If you prefer to listen rather than read, Jimmy Moore spoke to one of the researchers about this study on his podcast.

This intriguing study published in 2012 shows that increasing vitamin D levels with supplementation lowers seizure rates. The authors of the study wrote the following:

"We found that seizure numbers significantly decreased upon vitamin D3 supplementation. Median seizure reduction was 40%. We conclude that the normalization of serum vitamin 25(OH)D level has an anticonvulsant effect."

Associated Medical Centers and Organizations

The Charlie Foundation has been formed to act as an advocate for ketogenic diets for children with epilepsy, and they actively support the diets as a first choice epilepsy treatment. Matthew's Friends is a similar site in the United Kingdom.

Another more personal and highly recommended site is Arlene Martell's Epilepsy Moms blog.

In addition, John Hopkins Ketogenic Diet Center has been instrumental in teaching other hospitals about the diet and in advocating for the ketogenic diet as an epilepsy treatment as well.

This Epilepsy Therapies website also has some helpful information on using dietary therapies in epilepsy treatment.

You can find other physicians and hospitals which provide epilepsy treatment via the ketogenic diet listed on the Keto World Wide website.

And here's a great post from a parent in which she talks about her experiences in using a less rigid ketogenic diet as an epilepsy treatment with great success. She is also tracking the diet effects for her child on this blog.

Finally, this resource has listings for hospitals and clinics which offer ketogenic diet support.

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