If your seizures are not controlled by anti-epilepsy medication, your doctor may have talked about following the keto diet for epilepsy. This is a special diet that has been used to treat epilepsy since the 1920s.

The keto diet may be effective for reducing or even stopping seizures among people with refractory epilepsy (when medicines don't adequately control seizures).

In this article, you’ll learn more about the keto diet and epilepsy. If you have any questions about the keto diet, speak with your doctor. 

What is the keto diet?

The keto diet is a diet which is high in fat and low in protein and carbohydrates. In a normal diet most energy comes from carbohydrates (things like bread, pasta and potatoes). Simplifying a little, these foods get turned into sugar and are used by the cells in the body. However, if a person’s body does not receive much carbohydrates, it can use fat for energy instead. This is a state called ketosis.

The aim of a keto diet is to encourage people’s bodies to reach ketosis. To do so, most of the food in their diets needs to consist of fatty foods like butter, cream, oils, avocado and cheese.

Looking for recipe inspiration? Ask your doctor or nutritionist if they can recommend keto cookbooks. The International League Against Epilepsy has a number of recipes on its website. There are also various cookbooks written by medical doctors, such as The Ketogenic Diet Cookbook. If you buy a cookbook, always double check with your doctor about its content. 

Why might the keto diet be beneficial for some people with epilepsy?

We still do not know exactly why the keto diet helps people with epilepsy and there are a number of different theories.

One possible explanation is that the electrical activity in your brain that causes seizures requires lots of energy. It is easy for your brain to quickly get energy from sugar. On the other hand, if your body is making energy from producing molecules called ketones, it gets transmitted slower (this is, of course, a very simplified explanation). This then means seizures cannot start as easily. 

Other theories focus more on mitochondrial function (the 'powerhouses' of cells), neurotransmitter changes (GABA, which has an inhibitory effect), inflammation, or changes in gut bacteria.

Get to know your condition: What is drug-resistant epilepsy?

The potential benefits of the keto diet for epilepsy

Several studies have found that the keto diet may reduce or even stop seizures in people with epilepsy. It can be more effective for some people than others. Some people can achieve seizure freedom, while others see a significant reduction in the number of seizures they have. But it’s not always so effective for everyone. And, for some, it may not be effective at all.

Does the keto diet help adults with epilepsy?

The keto diet has traditionally been used for treating children whose seizures are not controlled by medication. But, it can also be used by adults and there are studies which show it may be effective. However, adults often stop the keto diet because it can be unpalatable and difficult to follow.

Problems with the keto diet

Doctors may recommend the keto diet for seizures. But it does have some potential drawbacks:

• Many people find it unpleasant to eat such a high fat diet.
• It can cause other health issues such as constipation, kidney stones and high cholesterol levels in the blood .
• It may affect bone mineral density (which affects how strong bones are), but the evidence here is not conclusive.
• It is inflexible. People who are on the keto diet must follow it very strictly.  

Working with specialists on the keto diet for epilepsy

The keto diet is a specialist diet and you should only follow it with the help of your doctor and a nutritionist. It is not something that you should start doing at home on your own. If your doctor believes the keto diet might help you, you may:

• Visit a nutritionist who might do an assessment of your health and dietary needs
• They may then develop a personalized meal plan for you
• The diet is very strict and so all food must be weighed
• You are likely to have regular checkups and tests with your doctor and the nutritionist
• The keto diet is long term - people typically follow it for up to two years
• Be aware that it might take some time to see the benefits of following the diet

Keto diet and epilepsy - knowing your options

If your seizures are not controlled by medication it can be very frustrating. But there are additional treatments that may be options for bringing seizures under control - including the keto diet for epilepsy.

If seizure medication isn’t helping control your seizures, talk to your doctor about non-pharmacological epilepsy treatments at your next appointment.