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.
“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.
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!
- A ketogenic diet as a potential novel therapeutic intervention in amyotrophic lateral sclerosis, Zhao, Lange et al. BMC Neuroscience 2006, 7:29. doi:10.1186/1471-2202-7-29.
- Application of a Ketogenic Diet in Children With Autistic Behavior: Pilot Study, Evangeliou, Vlachonikolis et al. Journal of Child Neurology, 2003 18: 113. DOI: 10.1177/08830738030180020501.
- Ketogenic Diet, Dhamija, Eckert et al. Canadian Journal of Neurological Science, 2013; 40: 158-167.
- Neuroprotective and disease-modifying effects of the ketogenic diet, Gasior, Rogawski et al. Behavioral Pharmacology. 2006 September; 17(5-6): 431–439.
- Short term improvement of migraine headaches during ketogenic diet: a prospective observational study in a dietician clinical setting, Lorenzo, Coppola et al. The Journal of Headache and Pain. 2013 1(Suppl 1):P219. doi:10.1186/1129-2377-1-S1-P219.
- The antidepressant properties of the ketogenic diet, Murphy, Likhodii et al. Bioligcal Psychiatry. 2004 Dec 15;56(12):981-3. Abstract.
- The calorically restricted ketogenic diet, an effective alternative therapy for malignant brain cancer, Zhou, Mukherjee et al. Nutrition and Metabolism, 2007, 4:5 doi:10.1186/1743-7075-4-5.
- The ketogenic diet: metabolic influences on brain excitability and epilepsy, Lutas and Yellen. Trends in Neurosciences, Volume 36, Issue 1, 32-40, 10 December 2012.
- The Ketogenic Diet: One Decade Later, Freeman, Kossof et al. Pediatrics, Vol. 119 No. 3 March 1, 2007. pp 535-543. (doi: 10.1542/peds.2006-2447).
- The ketogenic diet causes a reversible decrease in activity level in Long–Evans rats, Murphy and Burnham. Experimental Neurology 201 (2006) 84–89.