Eat To Beat Seizures: The High-fat Ketogenic Diet Can Help Stop Seizures In Hard-to-treat Epilepsy. Doctors And Dietitians Explain How It Works And How It Is Implemented.
Issue Table of Contents Carr, Coeli Download Article PDF Outline Back to top Luella Klein had her first seizure at 13 months and was prescribed antiseizure medication. But by the time she was two and a half, the drugs had stopped working and she had developed new symptoms, including a severely imbalanced gait. During a visit to the Columbia University Medical Center in New York City, Luella underwent a spinal tap to measure glucose levels in her cerebral spinal fluid. Based on the results, she was diagnosed with glucose transporter type 1 deficiency syndrome (Glut1 DS), a genetic metabolic disorder that occurs when glucose, a sugar in the blood, doesn't reach the brain in levels high enough to be used for fuel. That lack of fuel disrupts brain growth and function and can cause a variety of symptoms, including seizures, movement disorders, speech problems, and developmental delays. Luella's doctors recommended that she be put on the ketogenic diet, a high-fat, low-carbohydrate regimen that is standard care for Glut1 DS because it provides an alternate source of fuel—fat—for the glucose-starved brain. FATS FOR FUEL [ Click here to enlarge ] Normally, the body converts the carbohydrates in food into glucose, which then becomes fuel for all parts of the body, including the brain. On the ketogenic diet, which restricts carbs and loads up the fat, a different mechanism kicks in: The liver converts fat into fatty acids and ketone bodies, chemicals that “can cross the blood-brain barrier and be used as fuel and may even be anticonvulsant,” explains Eric H. Kossoff, MD, a professor of neurology and pediatrics and medical director of the Ketogenic Diet Center at Johns Hopkins Hospital in Baltimore, MD, and a member of the American Academy of Neurology (AAN). When the body Continue reading >>
Ketogenic Diet
This article is about a dietary therapy for epilepsy. For information on ketogenic diets as a lifestyle choice or for weight loss, see Low-carbohydrate diet and No-carbohydrate diet. The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet forces the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fueling brain-function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] Almost half of children, and young people, with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists even after discontinuing the diet.[2] There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regimen, such as a modified Atkins diet, is similarly effective.[1] The most common adverse effect is constipation, affecting about 30% of patients—this was due to fluid restriction, which was once a feature of the diet, but this led to increased risk of kidney stones, and is no longer considered beneficial.[2][3] The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was develope Continue reading >>
How Can A High-fat Diet Treat Epilepsy? Dr. Besser Reports
Imagine treating childhood epilepsy with bacon, heavy cream and hot dogs. This may sound like an unlikely approach, but the extremely high-fat and low-carb ketogenic diet has been shockingly effective in treating kids with drug-resistant epilepsy. ABC News' senior health and medical editor Dr. Richard Besser sat down with the director of pediatric epilepsy at Massachusetts General Hospital, Dr. Elizabeth Thiele, to discuss this unusual approach to fighting epilepsy. For more information on the ketogenic diet and pediatric epilepsy, watch 'World News With Diane Sawyer' Thursday at 6:30 p.m. ET on ABC Dr. Richard Besser: So what is the ketogenic diet? Dr.Elizabeth Thiele: The ketogenic diet is a high-fat, low carbohydrate diet, and it was developed in the 1920s after people noticed that when epileptics fasted, for various reasons, seizures would be markedly reduced. Besser: So the ketogenic diet mimics what you'd see in someone who's fasting? Thiele: Right. When this was noticed, this observation was made in the 1920s, people started thinking, "Gee, what happens when someone fasts?" And when a person fasts, your body starts breaking down your fat stores. Obviously, fasting is not great for a treatment for epilepsy or other conditions because it doesn't provide adequate nutrition, so the thought was, "Gee, how could we mimic starvation and trick our bodies into thinking we're starving by using fats as the main energy source?" Besser: So this treatment is solely based on diet? Thiele: This treatment is solely based on diet. Besser: No medicines, nothing else? Thiele: We do supplement vitamins, because with the high-fat, kids can become deficient in some vitamins -- so while on the diet, all children are supplemented with vitamins and also calcium. Besser: So on this diet, s Continue reading >>
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How Does The Ketogenic Diet Work?
A ketogenic diet can help seizure control for some people with drug-resistant epilepsy, but how does it work? Researchers in China have found clues that could potentially help the development of a new epilepsy therapy. Their findings are published in the journal Experimental and Therapeutic Medicine. Background A ketogenic diet is high in fat, low in carbohydrate and ‘moderate’ in protein. Its anti-seizure properties have been widely reported, but the mechanisms for these are still not clear. This type of diet requires a lot of time and commitment, and understanding how it works could lead to the development of a more simple drug treatment to replace it. Earlier research suggests that a compound called beta hydroxybutarate (BHB), which is made in the liver during fat metabolism, has anti-convulsant properties. Some of these studies involved giving additional BHB to experimental epilepsy models, but the doses of BHB used varied between them. Scientists in China have recently looked more closely at the effects of BHB on seizure activity and how different doses of BHB affect this. The details The right epilepsy model For the study the team needed to ensure they had an effective epilepsy model to work with, and they did this by inducing seizures in a group of rodents via a widely-used method. They analysed the resulting behaviour of the animals (using standard criteria) and found that all developed seizures. The effects of BHB treatment In a separate group, the scientists investigated the effects of external BHB administration on both blood BHB and blood glucose (which can also affect seizure activity) levels. They measured the ‘baseline’ levels of BHB and glucose in the animals’ blood and then administered one of three doses of BHB (2mmol/Kg, 4 mmol/Kg or 8mmol/K Continue reading >>
The Ketogenic And Related Diets
The ketogenic diet The ketogenic diet (also called ketogenic therapy) is a specialist medical diet. It’s a treatment option for children with epilepsy whose seizures can’t be reduced or stopped with epilepsy medicine. It’s recommended in the National Institute for Health and Care Excellence (NICE) guideline for the management of epilepsy which is difficult to control. The ketogenic diet is much higher in fats and lower in carbohydrates than a typical diet. If you think your child might benefit from the ketogenic diet, you will need to discuss this with an epilepsy specialist. This isn’t a treatment option for adults on the NHS yet. This is because there is currently no reliable evidence to support its use. This can make transition to adult services difficult for teenagers on the ketogenic diet. How does the ketogenic diet work? We don’t completely understand how the ketogenic diet works but there is some evidence that the brain needs energy from glucose (a sugar) to create a seizure. The ketogenic diet makes the body think that it’s in a state of starvation or fast. In this situation, our bodies use fat instead of carbohydrates (complex sugars or starches) as the main energy source. So the ketogenic diet gives a much higher amount of fat than is found in a normal diet, enough protein for growth and a very small amount of carbohydrate. This makes the body’s ketones. The brain uses these for energy instead of glucose. It also reduces the amount of glucose available for the brain. Why do you need medical supervision to go on this diet? The ketogenic diet is not a ‘natural’ treatment for epilepsy as it’s not a natural diet. It should only be managed by a team of a paediatrician and a paediatric dietician who are experts in the diet. This is because the b Continue reading >>
What Is A Ketogenic Diet?
If medicine doesn't control seizures in epilepsy, sometimes doctors prescribe a ketogenic (or keto) diet. A ketogenic diet is a strict high-fat, low-carbohydrate diet that can reduce, and sometimes stop, seizures. It's called "ketogenic" because it makes ketones in the body. Ketones are made when the body uses fat for energy. By replacing carbs with fat in the diet, the body burns more fat and makes more ketones. The ketogenic diet is prescribed by a doctor. Kids on the diet need to be followed closely by a dietitian to make sure they follow the diet and get the nutrients they need. The diet starts with fasting during an overnight hospital stay. Who Needs a Ketogenic Diet? Children with seizures that are not well-controlled by medicines (called intractable epilepsy) and severe epilepsy syndromes (such as infantile spasms or Lennox-Gastaut syndrome) might benefit from a ketogenic diet. Studies show that the ketogenic diet also may help treat other conditions, such as diabetes, obesity, and even cancer. How Does a Ketogenic Diet Work? Although the ketogenic diet for epilepsy has been around since 1920, doctors aren't exactly sure how the higher ketone levels works. Some seizure types seem to respond better than others to the ketogenic diet. In babies, the keto diet is given in formula. Young children may be fed by a tube that is place in the stomach by a surgeon. This helps the child stay on the diet. How Long Do Kids Need a Ketogenic Diet? You should know if a ketogenic diet works for your child within a few months. If it does, your doctor may recommend weaning your child off the diet after 2 years of seizure control. The weaning process is done over several months to avoid triggering seizures. Some people stay on a ketogenic diet for years. Are There Any Risks? The keto Continue reading >>
Ketogenic Diet
What the Diet Does Normally, our bodies run on energy from glucose, which we get from food. We can’t store large amounts of glucose, however. We only have about a 24-hour supply. When a child has no food for 24 hours — which is the way the diet begins, usually in a hospital — he or she uses up all the stored glucose. With no more glucose to provide energy, the child’s body begins to burn stored fat. The ketogenic diet keeps this process going. It forces the child’s body to burn fat round the clock by keeping calories low and making fat products the primary food that the child is getting. In fact, the diet gets most (80 percent) of its calories from fat. The rest comes from carbohydrates and protein. Each meal has about four times as much fat as protein or carbohydrate. The amounts of food and liquid at each meal have to be carefully worked out and weighed for each person. Doctors don’t know precisely why a diet that mimics starvation by burning fat for energy should prevent seizures, although this is being studied. Nor do they know why the same diet works for some children and not for others. Trying to put a child on the diet without medical guidance puts a child at risk of serious consequences. Every step of the ketogenic diet process must be managed by an experienced treatment team, usually based at a specialized medical center. Chances of Success Often, a period of fine-tuning is needed before it’s clear whether or not a child is going to respond to the ketogenic diet. Doctors often ask parents to try the diet for at least one month, and even as long as two or three, if it’s not working at first. A child on the diet usually continues taking anti-seizure medicine, but may be able to take less of it later on. If a child does very well, the doctor may sl Continue reading >>
Treatment Of Epilepsy With A Ketogenic Diet
This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated. Contribute Thoughts | Search Serendip for Other Papers | Serendip Home Page From Biblical times to the present, epilepsy has been a disease shrouded in mysticism and fear. Seizures have been called everything from "fits" to "turns" to the modern politically correct "epileptic episodes," and blamed for centuries on insanity and bodily occupation by spirits. Seizures, which are now known to be a neurophysiological phenomenon, are the defining characteristic of epilepsy. (1) Although they are still considered dangerous and undesirable, science has made much advancement in the treatment of epilepsy and other seizure disorders, which will be discussed in greater detail later in this paper. Epilepsy is a disorder affecting approximately one in every two hundred people. (2) Epileptic seizures begin when one or more unstable neurons fire in an uncontrollable manner. This occurs when the neuronal membrane is made particularly sodium permeable in an area that is not supposed to have increased sodium permeability. As the neurons fire, the signal spreads until it encompasses part or all of the brain. Seizures vary from partial, which involve only part of the brain and may not cause unconsciousness, to generalized, which involve the entire brain, and an almost certain loss of consciousness. The initial neuronal instability may be due to many factors including inherent genetic instability of proteins in ion pumps or channels, metabolic abnorm Continue reading >>
Treating Childhood Epilepsy: The Origins Of The Ketogenic Diet
Many people use the ketogenic diet today to manage symptoms of diabetes, lower triglycerides, and lose body weight. However, the high fat, adequate-protein, low-carbohydrate ketogenic diet was not first used for any of these purposes. Instead, doctors created it to help treat epilepsy in children. Below we give a brief overview of epilepsy, specifically pediatric epilepsy, and the origins of using keto to treat it. Then, we investigate the hard evidence from high-quality research showing its effectiveness. We hope that children and adolescents who utilize the ketogenic diet to treat epilepsy can use Ruled.me to live a healthy, fulfilling lifestyle. A Brief Primer on Epilepsy Epilepsy is a disorder of the nervous system in which someone experiences recurrent, unpredictable seizures. It is a result of abnormal activity in the human brain. Epileptic seizures can include physical symptoms such as muscle spasms, convulsions, and unconsciousness, as well as mental symptoms such as strange behavior, unusual emotions, and a warped perception of the outer world. Epilepsy is not a one-size fits all disorder. Some people experience severe, disabling seizures while others experience ones that are much less life threatening and more infrequent. Additionally, while epilepsy is a disorder of the brain and nervous system, its underlying causes can vary greatly. It can result from changes in channels between brain cells, unevenness between chemicals in the brain called neurotransmitters, a disruption of brain wiring, or any combination of these or other causes. Someone is formally diagnosed with epilepsy when she or he has had two or more seizures without a clear cause in a period over 24 hours. [1] If someone has a single seizure due to something such as a head injury, alcohol withdraw Continue reading >>
Ketogenic Diet
What is the ketogenic diet? The "classic" ketogenic diet is a special high-fat, low-carbohydrate diet that helps to control seizures in some people with epilepsy. It is prescribed by a physician and carefully monitored by a dietitian. It is usually used in children with seizures that do not respond to medications. It is stricter than the modified Atkins diet, requiring careful measurements of calories, fluids, and proteins. Foods are weighed and measured. The name ketogenic means that it produces ketones in the body. (keto = ketone; genic = producing) Ketones are formed when the body uses fat for its source of energy. Usually the body uses carbohydrates (such as sugar, bread, pasta) for its fuel. Because the ketogenic diet is very low in carbohydrates, fats become the primary fuel instead. The body can work very well on ketones (and fats). Ketones are not dangerous. They can be detected in the urine, blood, and breath. Ketones are one of the more likely mechanisms of action of the diet, with higher ketone levels often leading to improved seizure control. However, there are many other theories for why the diet will work. Who will it help? Doctors usually recommend the ketogenic diet for children whose seizures have not responded to several different seizure medicines. The classic diet is usually not recommended for adults, mostly because the restricted food choices make it hard to follow. However, the modified Atkins diet does work well. This also should be done with a good team of adult neurologists and dietitians. The ketogenic diet has been shown in many studies to be particularly helpful for some epilepsy conditions. These include infantile spasms, Rett syndrome, tuberous sclerosis complex, Dravet syndrome, Doose syndrome, and GLUT-1 deficiency. Using a formula-only Continue reading >>
Unraveling The Secrets Of The Epilepsy Diet
For decades, neurologists have known that a diet high in fat and extremely low in carbohydrates can reduce epileptic seizures that resist drug therapy. But how the diet worked, and why, was a mystery — so much so that in 2010, The New York Times Magazine called it “Epilepsy’s Big, Fat Miracle.” Now, researchers at Dana-Farber Cancer Institute (DFCI) and Harvard Medical School (HMS) have proposed an answer, linking resistance to seizures to a protein that modifies cellular metabolism in the brain. The research, to be published in the May 24 issue of the journal Neuron, may lead to the development of new treatments for epilepsy. The research was led jointly by Nika Danial, HMS assistant professor of cell biology at Dana-Farber Cancer Institute, and Gary Yellen, professor of neurobiology at Harvard Medical School. The first author was Alfredo Giménez-Cassina, a research fellow in Danial’s lab. Epilepsy is a neurological disorder characterized by an electrical storm in the brain that can manifest as convulsions, loss of motor control, or loss of consciousness. Some epilepsy cases can be improved by a diet that drastically reduces sugar intake. Such a diet causes neurons to switch from their customary fuel of sugar to fat byproducts called ketone bodies. The diet, which mimics the effects of starvation, was described more than 80 years ago and received renewed interest in the 1990s. Recent studies corroborate that it works, but shed little light on how. Yellen was introduced to the ketogenic diet by his wife, Elizabeth Thiele, professor of neurology at HMS and director of the Pediatric Epilepsy Program at MassGeneral Hospital for Children, who was not involved in the study. “The connection between metabolism and epilepsy has been such a puzzle,” said Yellen. Continue reading >>
Epilepsy And Ketogenic Diet
Did you know that we can “thank” epilepsy for the emergence of the ketogenic diet? While a majority of you is probably practicing the diet for weight loss or general health improvement, epileptic patients use it to significantly ease their everyday life, making it as seizure-free as possible. Epilepsy As the most common neurological disorder, epilepsy affects approximately 1% of the population.[1] It primarily appears in the form of repeated seizures that generate in the brain. Basically, a seizure happens when the brain’s normal electrical activity is briefly disturbed, which causes the nerve cells to fire off in an unusual pattern. Epileptic seizures are diverse and complex, ranging from convulsions (motor seizures) to subtle changes in thought, mood, or behavior.[1] While the frequency and severity of seizures can often be reduced by antiepileptic medications, such treatment appears to be insufficient for 25 – 30% of patients. Moreover, approximately 10% of patients do not respond to any antiepileptic drug at all.[2] This is where the ketogenic diet comes in. The aid called ketogenic diet The ketogenic diet has been mostly used as a treatment for drug-resistant childhood epilepsy, but it is showing promise to have an impact on adults with epilepsy, as well.[3] A variety of studies have shown that half the children on the diet will have 50% improvement in seizures, and about one-third of dieting children will show more than 90% improvement. Some, around 10 – 15%, will even go seizure-free on a continuous ketogenic diet.[2] Still, as with most treatments, the diet will not be successful for everyone. One of the reasons sometimes being that some patients fail to fine-tune their diet, and/or stop with the regime completely, before even coming to see possible im Continue reading >>
How A Diet Change Can Free People From Epilepsy
Can you cure your epilepsy without medication? Yes, this seems possible for many. At least you can keep the disease in remission long term with a change in lifestyle – without the need for strong drugs or their side effects. Here’s Michel Lundell’s story: The Email Here is my story on how I went from living on Red Bull and Snickers to having butter in my coffee, bacon for lunch and how I manage epilepsy with a ketogenic diet instead of medicine. The story begins when the IT market hit the bottom. In order to make a living I started Sweden’s first kitesurfing center with certified instructors. My days as a certified kitesurfing instructor began when most other people were asleep and ended at sunset. There was a lot of running in yard-deep water, dragging students and kites. Luckily the kitesurfing center was sponsored by Red Bull and Snickers…! At the beginning of season two that started off in the same spirit – with Red Bull and Snickers – my wife and I took a trip to an island off the west coast of Sweden, where I spent a lot of time as a child. After we had our evening coffee, I guided my wife around the island. Suddenly… a coast guard ship? A sting in my head from a needle, which was held by a doctor… I was in a room at the hospital? How did I get here? Why did the doctor keep asking me about my name and birth date? … Then two years of tests and MRIs followed. At one point I was told that I had a brain tumor, which was quite a blow and I spent six months in agony. On the positive side, this was an eye opener, which really made us think about what’s important in life. After some more tests and a number of MRIs an expert team concluded that I didn’t have a tumor. However, they did not know what caused the incident. “Nothing is growing in there Continue reading >>
New Study Validates Ketogenic Diet For Epilepsy Treatment In Adults
Epilepsy can be caused by a variety of different conditions including head trauma, infection, brain tumor, and stroke, but by and large most cases of epilepsy have no readily identifiable cause. Epilepsy affects some 2.3 million adults in America and close to half a million children. Further, about one in 26 people will be diagnosed with epilepsy at some point in their lives. It’s been estimated that there are approximately 150,000 new cases of epilepsy diagnosed in the United States each year and overall about $15.5 billion in medical costs as well as lost earnings and production are attributed to this disease. The mainstay of treatment for epilepsy is pharmaceutical intervention. As I recently noted, more and more we are seeing surgical procedures being performed for those individuals who have not had a significant improvement with drugs. I indicated that at least some individuals are gluten sensitive and may benefit from a gluten-free diet which potentially could keep them from undergoing potentially life-threatening surgery as a treatment for their epilepsy. But it is also important to understand that there’s another extremely effective dietary intervention that has proven itself quite useful in the treatment of epilepsy. In 1920 a New York physician, Dr. Galen, reported at the American Medical Association convention that he had had significant success in treating epilepsy by initiating a program of fasting. At that time the only pharmaceutical interventions that were available included phenobarbital and bromides. Interestingly, the patient he treated was actually a young cousin who had aggressive seizures. On the second day of fasting the child’s epilepsy abated and did not return over the next two years of follow-up. Further studies appearing in 1923, 1926, Continue reading >>
Ketogenic Diet
Dr. Thio is an Assistant Professor of Neurology at Washington University School of Medicine and an epileptologist in the Pediatric Epilepsy Center at St. Louis Children’s Hospital. Introduction The ketogenic diet is only one of several methods available for treating epilepsy. Other treatment options include antiepileptic drugs, epilepsy surgery, and the vagal nerve stimulator. If your child’s epilepsy is treated, most neurologists will try using an antiepileptic drug first. Generally, the ketogenic diet will not be the first choice, though exceptions exist. The ketogenic diet is a high fat, low carbohydrate, and low protein diet designed to increase the body’s dependence on fat rather than glucose for energy. It mimics the fasting state, and can treat disorders of the brain. The two disorders most commonly treated with the ketogenic diet are epilepsy and certain inborn errors of metabolism involving glucose utilization. This paper will briefly review the history, physiology, efficacy, mechanism of action, indications, contraindications, deficiencies, adverse effects, and some of the practical aspects of initiating and maintaining the ketogenic diet as related to epilepsy. History The ketogenic diet has its origin in the observation that fasting reduces seizures. This observation is old since Hippocrates used fasting to treat seizures, and the Bible mentions fasting as a treatment for seizures. In 1921, Wilder proposed a high fat, low carbohydrate diet as a means of mimicking fasting, which is not practical for extended periods. After phenobarbital and phenytoin became available, interest in the diet declined. However, interest has increased recently because 20-30% of epileptic children have seizures that are resistant to antiepileptic drugs. The introduction of se Continue reading >>
