By: Ann L.
Over 300,000 American children under the age of 14 are living with epilepsy. Some children can have hundreds of seizures per day, which can severely limit their ability to participate in social activities. Seizure control is important for helping kids achieve otherwise normal lives.
In the 1920s, it was noted that children who fasted for up to three weeks were seemingly cured of their epilepsy. Dr. Wilder at the Mayo Clinic was the first to describe a diet designed to mimic this starvation state that was high in fat and low in carbohydrates. However, due to the development of anticonvulsants in the 1930s, the diet fell out of favor and was deemed unnecessary. Since the mid-1990s, there has been renewed public and scientific interest in the ketogenic diet to treat epilepsy that is not responsive to drugs.
What is the ketogenic diet?
The classic ketogenic diet provides 90% of calories from fat, a minimum of 1 g/kg protein, and minimal carbohydrates. The ratio of fats to protein and carbohydrates is 4:1. Heavy cream, butter, and oil are some of the foods that can become staples of children on a ketogenic diet. The diet does require vitamin and mineral supplementation.
When should a ketogenic diet be used?
According to a 2008 consensus report from an international expert panel, the ketogenic diet “should be offered to a child after two anticonvulsants are used unsuccessfully” (1). The diet must be started under close medical supervision in consultation with a physician and a dietician.
Is it an effective treatment?
In 2008, the first randomized controlled trial of the ketogenic diet demonstrated that 38% of children on the ketogenic diet had a >50% reduction in seizures compared with only 6% in the control group (2). Observational studies have also reported similar rates of seizure control achieved by use of the ketogenic diet. For children who achieve seizure freedom, 80% will remain seizure free after discontinuation of the diet.
Are there any long-term health consequences?
While the duration of time spent on the ketogenic diet varies widely between individuals, most children stay on the diet between 1-2 years. Some of the major concerns with the ketogenic diet include impaired growth, kidney stones, and dyslipidemia. Patients must follow up regularly with their physicians to monitor growth and blood chemistries.
Further Reading:
1. Freeman JM, Kossoff EH. Ketosis and the ketogenic diet, 2010: advances in treating epilepsy and other disorders. Adv Pediatr. 2010;57(1):315-29.
2. Neal EG et al. The ketogenic diet for the treatment of childhood epilepsy: a randomised controlled trial. Lancet Neurol. 2008 Jun;7(6):500-6. Epub 2008 May 2.
3. The Charlie Foundation. https://www.charliefoundation.org/
