Ketogenic Diet and Epilepsy
The ketogenic diet is a powerful, evidence-based therapy that can help reduce seizures in both children and adults living with epilepsy. While it’s not a cure, this specialized high-fat, low-carbohydrate diet has offered life-changing results for many people, especially those who have not responded to standard medications.
This page provides a comprehensive overview of the different types of ketogenic therapies, how they work, who they may benefit, and what to expect when starting. Whether you’re exploring options for your child or considering dietary therapy as an adult, you’ll find the guidance, resources, and support you need to make informed decisions.
What is The Ketogenic Diet?
The ketogenic diet shifts the body’s main energy source from glucose (carbohydrates) to ketones, which are produced when fat is broken down by the liver. This state is called ketosis. While the exact mechanism is not fully understood, ketones are thought to stabilize brain activity and reduce seizure frequency by improving mitochondrial function and altering neurotransmitters such as GABA.
Who Can Benefit?
The ketogenic diet is primarily recommended for individuals with drug-resistant epilepsy, including:
- Children with epilepsy syndromes such as Dravet Syndrome, Doose Syndrome, Lennox-Gastaut Syndrome, Tuberous Sclerosis Complex, and Glucose Transporter Type 1 Deficiency (GLUT1).
- Adults with focal seizures, generalized seizures, or those who have not responded well to multiple antiseizure medications.
Types of Ketogenic Therapies
There are several ketogenic diet therapies designed to meet different medical needs, age groups, and lifestyles. Each one should be started and monitored under the guidance of a neurologist and a registered dietitian.
| Diet Type | Primary Use | Fat Ratio (Fat : Protein + Carbs) | Carb Limit | Key Features | Best For |
|---|---|---|---|---|---|
| Classic Ketogenic Diet | Children (especially under 10) | 4:1 or 3:1 | ~10g/day (depends on ratio) | – Most structured – Meals precisely weighed – High fat content (~90%) – Usually started in hospital – Requires detailed tracking | – Children with drug-resistant epilepsy – Patients needing intensive medical oversight |
| Modified Ketogenic Diet for Adults | Adults with busy lifestyles | 2:1 or 1:1 | Varies (moderately restricted) | – Looser version of classic KD – Less food weighing – Greater flexibility – Tailored to adult metabolism and work-life | – Adults with seizure disorders – Those unable to maintain strict classic KD |
| Modified Atkins Diet (MAD) | Adults, teens, older children | Approx. 1:1 | 10–20g/day | – Easy to follow at home – No calorie counting – No food weighing – Promotes ketosis with fewer restrictions | – Individuals seeking flexibility – Transition from classic KD – Adults wanting independence |
| Low Glycemic Index Treatment (LGIT) | Teens and adults | No set ratio | 40–60g/day (GI < 50) | – Focuses on stabilizing blood sugar – Lower ketosis than other diets – Less risk of side effects – Easy for school/work routines | – Mild to moderate seizure control – Individuals needing a softer approach |
| Medium Chain Triglyceride (MCT) Diet | Children or adults requiring more flexibility | Lower ratio due to MCT efficiency | Higher than classic KD (varies) | – Uses MCT oil to boost ketones – Allows more carbs and protein – Can cause stomach upset if not introduced gradually – May be combined with traditional fats | – Children sensitive to fat intake – Individuals needing palatable meal options – Those with poor tolerance to classic KD |
Children vs. Adults: Key Differences in Ketogenic Therapy
While the ketogenic diet can benefit both children and adults with epilepsy, the approach, support needs, and challenges can differ based on age. This table outlines key differences to help families and individuals understand what to expect.
| Aspect | Children | Adults |
|---|---|---|
| Main Goals | Seizure control, support development, reduce medication | Seizure control, reduce medication, improve energy and quality of life |
| Diet Type | Classic KD, MCT, sometimes MAD under supervision | Modified KD, MAD, or LGIT based on lifestyle and tolerance |
| Support Needed | Parental meal preparation, school staff training, frequent check-ins | Self-managed with dietitian support, adaptable for work and social settings |
| Medical Oversight | Pediatric neurologist, epilepsy nurse, registered dietitian | Adult neurologist, dietitian, less frequent clinic visits |
| Monitoring Needs | Growth, nutrient levels, bone health, ketones, side effects | Lipids, kidney function, energy levels, adherence, side effects |
| Challenges | Growth suppression, picky eating, school compliance, strict measurements | Long-term adherence, social dining, travel, food preparation effort |
Starting the Ketogenic Diet
A successful ketogenic diet plan involves multiple steps and regular medical oversight:
- Referral and Assessment: Consult with a neurologist and registered dietitian to determine eligibility.
- Baseline Testing: Blood work, weight/height, bone health, and lipid profile are often recorded.
- Diet Initiation: May begin gradually at home or in hospital, depending on seizure severity and age.
- Monitoring and Adjustments: Ketone levels, seizure logs, and side effects are monitored regularly.
- Supplements: Patients typically require vitamin and mineral supplementation (e.g., calcium, vitamin D, selenium, multivitamins).
- Ongoing Follow-Up: Regular check-ins help track success, manage challenges, and determine if/when weaning is possible.
Benefits and Limitations
Benefits
- Proven reduction in seizure frequency for many patients
- Possible complete seizure freedom in select cases
- Reduced reliance on antiseizure medications
- Improved alertness, mood, and energy reported by some patients
Limitations and Risks
- Can be difficult to maintain without structured support
- Possible side effects: constipation, acidosis, growth delays (in children), high cholesterol
- Nutritional deficiencies without proper supplementation
- Not appropriate for everyone (e.g., those with fatty acid oxidation disorders)
Frequently Asked Questions
Is the ketogenic diet a cure for epilepsy?
No, it is a therapy that may help control seizures, especially in cases that do not respond to medication.
How long does someone stay on the diet?
Some individuals follow the diet for 2–3 years, then gradually wean. Others may continue longer if it remains effective.
Is this a weight-loss diet?
No. While it is high in fat, it is not designed for weight loss. It is a medical therapy tailored to seizure control.
Watch & Learn: Recommended Videos
Starting the Ketogenic Diet for Epilepsy (C.S. Mott Children’s Hospital)
A helpful overview of what families can expect when beginning the diet for a child.
Diet Therapy for Adults and Children with Epilepsy (University of Colorado)
Explains dietary options, benefits, and considerations for all ages.
Percy’s Story: Epileptic Seizure Freedom Through Ketogenic Diet
A powerful real-life story of seizure freedom achieved through diet.
More information
Recommended reading: The Ketogenic Diet, by John and Jennifer Freeman and Millicent Kelly, 3rd edition, ISBN 1-888799-39-0, available to borrow from the Family Resource Library at BC Children’s Hospital.
For more information about the Ketogenic diet program at BC Children’s Hospital, visit the The Neurological Care Centre’s website or contact the number listed below.
Phone: 604-875-2121
Fax: 604-875-2285
Genetic Counselling – As defined by the ational Society of Genetic Counselors (NSGC), genetic counseling is the process of helping people understand and adapt to the medical, psychological and family effects of how genes are related to disease.