The keto brain, coming soon to a disorder near you!

There was a commenter on this page that mentioned the lack of articles on epilepsy and keto on this site. This is a good point! The ketogenic diet has been used for many many years for epilepsy- it is extremely well documented and known. Why have I avoided talking about it?

For one, I would say I perceived a lack of interest in the topic. More people are interested in using this diet for dieting purposes. I would say more people have extra weight to lose than a seizure disorder.

Secondly, I’ve always held a little extra room in my heart for endocrinology, which obesity studies tend to focus heavily on (no pun intended).

This is ironic because I am on the diet myself for my crippling rare migraine syndrome. I was tired of medications and was looking for alternatives. There are some migraine alternative treatments that sound rather horrifying- cauterizing blood vessels and Botox shots to the neck- so I started to think outside of the box. Migraines are in the same class of disorders as epilepsy, and I had often had some success with anticonvulsants. Alternative epilepsy treatments? Yep. Now here I am, migraine free, medication free.

So let’s talk keto and the brain!

Let’s start with the history: In 1911 in France the first patients were treated with diet for their epilepsy. And by diet I mean fasting and low calorie vegetarian diets. When starved, patients had a lot fewer seizures. They also were hungry and adherence to a diet that involved not eating became extremely difficult. So in 1921 Dr. Wilder came up with an alternative: the ketogenic diet. The classic ketogenic diet is a 4:1 ratio of fats:protein and carbs. This diet fell to the skirts of medicine once anticonvulsants hit the market in 1938, but has seen a resurgence of use to treat intractable epilepsy- epilepsy that doesn’t respond to medications, and for people who are interested in being medication free.

There are 4 different forms used to treat epilepsy- the classic, MCT, MAD, and low glycemic index diets. The MCT (medium chain triglyercide) incorporates large amounts of MCT oil- which is most readily turned to ketones by the body. The MAD (modified Atkins diet) is the most common one used for weight loss: 5% carb, 65% fat, 30% protein. The low glycemic index diet maintains similar ratios with only slightly more carbs but focuses on carbs that are low on the glycemic index. All types of these diets seem to have similar efficacy (possibly still slightly better on the classic), despite differing amounts of ketosis produced. The degree of ketosis seems not to be terribly important.

Awesome! Well then, how does it work? What makes ketosis magic?

“The exact mechanism of action of the diet is still unknown
though there are a number of theories and ongoing research.”

Maybe another article has the answer?

“The mechanism(s) through which the KD exerts its anticonvulsant effects remains elusive. Although there is an abundance of data regarding the physiologic effects a KD exerts on humans and rodents, how these effects contribute to seizure protection is unclear. The diet has both anticonvulsant (ie, stopping a discrete seizure) properties and antiepileptic (ie, stopping the propensity to develop recurrent unprovoked seizures, or epilepsy) effects.”

Nope. It appears to be a mystery. There’s a whole host of potential suitors, though, and article after article advocating for a particular reason. Here’s a small list:

  • antioxidant effects and lowering free radials
  • protection against cell death
  • anti-inflammatory effects
  • GABA vs glutamate, where glutamate is the catnip toy to a bunch of cats and GABA is the morning sunlight and open cardboard boxes (excitatory vs inhibitory neurotransmitters, see this journal article if desiring a less feline version).

Well these things all seem highly nonspecific to epilepsy, actually. They sound like a good combination for a lot of issues (or just normal brains in general). What other brain disorders/diseases get benefit from keto?

Apparently it’s not just me: keto is good for migraines. I’m not in love with this article because it is the briefest of summaries, but there it is.

On autism:

“In this study, the application of a ketogenic diet was highly successful for the two patients with mild autistic behavior, whereas minor or moderate improvement was established in patients with severe autistic behavior.”

A study on ALS in mice showed significant slowing in motor deterioration and protected motor neurons.

Brain cancer may see some benefit from keto.

There are some rumblings about Parkinson’s and Alzheimer’s, the evidence is shaky at best right now.

ADHD mice and depressed mice seemed to do better, more studies needed for sure.

The one that hasn’t been done that I’m waiting on bated breath for is bipolar disorder. Bipolar disorder is the third sibling of epilepsy and migraines, and is treated with anticonvulants as well. So will someone pleeaaaase just do the study already!


8 Responses to “The keto brain, coming soon to a disorder near you!”

  1. Lauren Romeo, MD

    Thanks for the links, I have a patient with Transverse Myelitis and I have put her on a gluten free low carb diet…I would like to see if a ketogenic diet will also, help her.

  2. mjoneill

    Secondly, I’ve always held a little extra room in my heart for endocrinology, which obesity studies tend to focus heavily on (no pun intended).

    Did you really just write that? 😛

    • mjoneill

      Thanks Eugenia! I remember seeing that post as well on reddit! I’m so glad you followed up on it. It’s a sad story at the beginning, but it’s inspiring to read of her recovery and the role nutrition played in it.

      Your comments on the post are closed, but if you are in touch with her, I’d love to learn more about what supplements and protocol she followed to address her “adrenal fatigue”.

      At one point I was curious about the condition as well, but gave up reading when found some information claiming it wasn’t a “real condition”.

      Sadly this is the dilemma so many of us face with competing opinions about the efficacy and legitimacy of various conditions, ways of eating, treatments, etc… Learning to find our way is starting to look like a lifelong commitment.

  3. Darn. I thought the medical community aligning migraine with epilepsy was just a favor to Big Pharma. Oh well. I guess everything can’t be a conspiracy.

    Truly enjoy the site.

  4. I used to have chronic refractory migraines. I sought treatment with migraine specialists and tried every prophylactic–blood pressure meds, anti-seizure meds, tricyclic antidepressants. I tried Botox injections with little relief. I was getting IV DHE and related medications quarterly. It was not uncommon for me to have a migraine that lasted several weeks, with severe nausea and vomiting.

    After reading about Italian dietary study of High Fat Low Carb (HFLC) diets that were effective in reducing migraines, I tried it. Once I adjusted to ketosis, my migraines nearly resolved. I had a few small ones that responded to Zomig. I read about MTC oil and added 1 tablespoon to my coffee in the morning. Now my migraines have completely resolved as long as I stay below 50g carbohydrate and 80 grams protein. I have to eat 60-80% fat as a total portion of my daily intake and MTC oil to maintain this level of clinical migraine remission. The impact on my quality of life has been amazing and I am trying to spread the word.


Leave a Reply