The ketogenic Diet Can Help Young Epileptics


By Melissa Tennen

Many children with moderate to severe epilepsy may be able to reduce the number of seizures by following what’s called the ketogenic diet. However, the plan temporarily raises cholesterol in these children, reports a Johns Hopkins Children’s Hospital (JHCH) study in the Journal of the American Medical Association. To tell you more about the diet is John M. Freeman, M.D., professor of neurology and neurosurgery at JHCH.

What is the diet?

John M. Freeman: The ketogenic diet is a high-fat, low-carbohydrate diet that has been shown to reduce or eliminate difficult-to-control seizures in children with epilepsy. The diet mimics the effects of fasting with about 90 percent of the calories derived from fat. The calories have to be carefully monitored and calculated.

This is a very restricted, medically monitored diet.

How does it work?

Freeman: The diet changes the way the brain gets energy from food. Instead of getting energy from glucose, the diet forces the body to burn fat. Burning fat produces chemicals called ketones – the same chemicals that are created during starvation. These ketones enter the brain.

I want to stress that this is a very restricted, medically monitored diet. It cannot and should not be done without a medical doctor’s supervision.

Do we know how this diet works in the brains of people with epilepsy?

Freeman: No, but we also don’t know the mechanisms behind epilepsy nor how most anticonvulsant medications work.

What does the diet entail

Freeman: The diet has three to four times as many calories from fat as it does from carbohydrates and protein combined. Some extra fat comes from cream or butter. Calories are strictly limited, and parents must not allow the child to eat anything, such as French fries, potato chips and pasta, that isn’t on the diet.

How did it come about?

Freeman: The ketogenic diet was developed in the 1920s as a way to help people with epilepsy. But as new drugs came on the market, people forgot about it.

Then in 1994 we had a 3-year-old boy named Charlie Abrahams come to us. He had been through surgery and medications but nothing helped. We had a registered dietitian here who had been using the diet for years when we decided to try it. I had also used it when I was a resident physician.

How is Charlie doing now?

Freeman: He’s doing well. His seizures disappeared almost immediately. It’s been nine years since he first came to see us. He’s been on and off the diet throughout the years. But he is currently off it and seizure-free.

How successful is the diet?

Freeman: In our study, most children who had 400 seizures or more a month, their seizures were dramatically reduced. One year after starting the diet about one-fourth of these children had no seizures or only very rarely seizures. Many did not need medication.

Is this a permanent change?

Freeman: We have found its effects can last at least for years after stopping the diet. Children can go back on the diet if seizures recur.

This diet is not a cure for epilepsy.

Why don’t adults try this?

Freeman: It has only been studied in children, not in adults. But it is probably equally effective in adults.

Do all medical institutions do this? And do doctors know about this?

Freeman: Everybody doesn’t do the diet because not everybody has a dietitian on staff with specific training. But doctors are learning about this.

How do you keep children on the diet?

Freeman: Naturally, children would rather eat French fries, but they stick with the diet because it works. Will they stick to it? If they have only failed one medication, probably not. But if they failed two medications, they probably will. Children do not like to have seizures and they do not like medications.

And if they have only one seizure a year, it’s doubtful they will remain on the diet. The seizure disorder must be sufficiently severe that the child and the family will see the benefit and stick to it.

How long should they be on it?

Freeman: We believe children should be on this diet for only one to two years. Children following the diet aren’t on it long enough to cause long-term health conditions. Once children go off the diet, their cholesterol levels go back to normal levels.

Do all children have elevated cholesterol readings? What are typical cholesterol readings in children on this diet?

Freeman: Elevated cholesterol occurs in most patients and it causes a mean level of 223. The significance of this is unknown.

Are there certain medical conditions that might prevent a child from being able to go on this diet?

Freeman: We have done this with many different types of patients with many different causes for their seizures. We would be very cautious about doing the diet in children who may have a metabolic condition. First we would want to know what the condition was, and then we could better decide.

Are there side effects?

Freeman: Nothing in life is without side effects. The risk for developing kidney stones may be higher. But this can be treated. There are no other important side effects that we are aware of.

How does this affect children’s development?

Freeman: They grow well, and they don’t get fat. That’s because we carefully control the number of calories while on the diet. Cholesterol levels do go down after treatment. Children aren’t getting any less or any more calories than they need. The diet doesn’t affect blood pressure.

What are the side effects of drugs?

Freeman: Children may be more likely to have certain side effects from anticonvulsant drugs, such as behavior or cognitive changes. Other medications can affect the liver or blood counts.

What is the age range that this diet can be tried on?

Freeman: Typically, we try it in children 3 to 6 years old, but we have done it in children as young as a month old. And we have done it in adolescents with success.

How many kids have tried this so far?

Freeman: We have helped 500 children. Other centers also have successfully treated many children.

How does this compare to the Atkins diet?

Freeman: This isn’t the same as the Atkins diet. It is not meant for weight loss.

Remember, this diet should only be done under the supervision of a medical doctor. Do not try this on your own.

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