What epilepsy diet is suggested?

The ketogenic diet should be used only under a doctor's supervision, usually with the help of a dietitian. In most cases, the diet is started while the child is in the hospital. During the first 2 or 3 days, the child is not allowed to eat anything and is permitted to drink only a certain amount of water or other fluids. The child's blood sugar level falls during this period of starvation. If the fall in blood sugar is too great, the child may become pale, sweaty, tremorous, irritable, confused, and unresponsive, or even have seizures, and will need some sugar or other carbohydrate supplementation. The blood sugar level can be safely monitored in the hospital. After several days of starvation, the ketones in the blood and urine rise, and the diet is gradually introduced. The urinary ketones can be easily measured at home by the parents, using an indicator strip. The presence of urinary ketones indicates that the diet has achieved its metabolic goal of ketosis.

The diet consists primarily of foods high in fat, with the remaining 25% to 35% of the calories made up of protein foods. Examples of high-fat foods include mayonnaise, butter, and cream. The child is allowed only small portions of cheese, meat, fish, or poultry each day. Fruit is allowed in modest amounts. There is an alternative source of fat, known as MCT, which is an oil. The use of the MCT allows a slightly greater expansion of nonfat foods in the diet. However, some authorities find that MCT is not as beneficial in controlling seizures as other fat sources such as butter and cream.

If a child is taking high dosages of several antiepileptic drugs, tapering of one drug is often started during the period of starvation. Barbiturates are often discontinued first because they are the most sedative of the antiepileptic drugs; furthermore, their blood levels can rise when the diet is started even though the dosage is unchanged. If adequate ketosis is maintained, and seizure control improves, a further reduction in medications is often possible. In some cases, all medications can be tapered and stopped.

The ketogenic diet was first introduced in the 1920s but fell out of use after the introduction of antiepileptic drugs. It is currently being revived for treating children with severe seizures that do not respond to medications.

It is a very difficult diet to keep. The children are allowed to eat almost nothing but fat (butter, heavy cream) with very little meat and a limited range of low-sugar vegetables such as lettuce, celery, and cucumbers. The most dangerous potential risk of the ketogenic diet is low blood sugar during the period of starvation. Other potential problems include a deficiency of the B vitamins, vitamin C, and calcium. It is often wise to supplement these nutrients (making sure the supplement does not contain sugar). Many parents worry about the potential effects of large amounts of dietary fat. We know that high-fat diets in adults can accelerate atherosclerosis, which contributes to heart attacks, stroke, and other disorders of blood vessels. However, there is no evidence that the ketogenic diet accelerates atherosclerosis in children or adolescents. Unfortunately, we cannot be sure that the diet has no long-term effects on the blood vessels. Weight gain is not usually a problem on this diet.

The diet often causes nausea and diarrhea. It can cause poor development from lack of nutrition and kidney stones from a build-up of uric acid in the system. Use of the diet must be supervised by a doctor. The diet seems most effective in children under eight years old but it is occasionally helpful for adults. It has been shown to help 25% to 50% of children who have uncontrollable seizures.

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