International Epilepsy Day: Expert Speaks About Ketogenic Diet For Epilepsy

Every year, the second Monday in February is observed as International Epilepsy Day to promote awareness of epilepsy in more than 130 countries each year. The Day is a joint initiative by the International Bureau for Epilepsy (IBE) and the International League Against Epilepsy (ILAE).

People with epilepsy have seizures due to abnormal electrical activity in the brain. A seizure is a sudden and uncontrolled disturbance in the brain which can lead to changes in one’s behaviour, feelings, movements, and levels of consciousness. Each seizure may not only be life-threatening to the patient, but repeated seizures can also cause significant brain damage.

Expert Views On Ketogenic Diet For Epilepsy

Keto diet is a special diet-high fat and low carbohydrate tailor-made for children to control seizures. The name “ketogenic” indicates the consumption of high fat. The body uses the end products “Ketones” as the primary fuel source for the body, especially the brain. This is not a weight loss diet in children and should be followed under the supervision of a doctor and a dietitian in children who have epilepsy. It is usually implemented for children with seizures that do not respond to medications.

In India “cereals” are the staple food and majority of the calories and the energy is derived from carbohydrates. Most of the Indian diets are 65-70 per cent carbohydrates. The classic “ketogenic” diet prescribed by a Neuro physician and carefully monitored by a dietitian provides 3-4 g of fat for every gram of carbohydrate and protein. 90 per cent of the calories are derived from fat. The ratio of fat to carbohydrates & protein combined is a 4:1 or a 3:1 ratio formulated and customized for the child, keeping in mind his weight, growth, and food habits.

Foods are weighed and measured, and when the child is on a “high fat” diet, the ketones can be detected in urine, blood and even breadth. The higher the ketone level, the better the seizure control.

This is usually not recommended for adults with epilepsy, and this diet works well for children with “focal” seizures. It works optimally with “epilepsy” medications prescribed by the neurologist. Some children respond well, and the medicines are tapered. Some children function well in following this special diet and on concurrent medications. This diet needs the complete support of parents, family, and caregivers to successfully achieve the goal of seizure reduction in the child.

The major sources of fat are butter, coconut oil, ghee, cream, mayonnaise, cheese, egg yolks, meat, and other oils. The meals, beverages and snacks have to be specially prepared for the child as the family meals will not suit in this diet plan. The carbohydrates are severely restricted, and the child may refuse to eat some meals as the taste may be completely different. The common side effects are constipation as the fruits are restricted because of its fructose content, but the fibre can be encouraged through enough fluids like water and low carb vegetables and greens. Some children have nausea and diarrhoea in the initial stages and also fat in stools.

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There will be a two-week adaptation period required to transition to this “keto” plan fully. Achieving a state of ketosis has many benefits. When the brain uses fat as a primary source of fuel, there is seizure reduction in the majority of the children with focal seizures. It also reduces oxidative stress and inflammation in the body. Caregivers need to maintain a daily urine ketone level chart to be checked 3-4 times a day. This is to monitor the body is in ketosis.

Many parents will face many issues until the child gets used to the diet plan, and the child needs constant encouragement. Variety in cooking and use of herbs and spices will make the meal more palatable for the child. This diet has been proved in its efficacy in controlling seizures in children.

On A Final Note…

Although the mechanism of keto diet’s anti-epileptic activity is not completely understood, new evidence suggests that the production of ketone bodies may diminish the hyperexcitability of neurons and improve seizure control.

Along with accurate medical treatment, it is very crucial to make conscious lifestyle changes including that in diet, sleep, self-care, stress-reduction, etc. While the patient along with the doctor figures out what works best for them, the person must not hesitate in reaching out for emotional support.

With inputs from Ms Sreemathy Venkatraman, Chief Clinical Dietitian, BRAINS Hospital, Bangalore

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