What to Know About the Medical Keto Diet for Epilepsy

Once you’ve seen it, you can’t unsee it.

Over the last 10 years, grocery store shelves have been flooded with prepared goods and packaged ingredients marketed as “keto friendly.” Around the 1990’s, the ketogenic or “keto” diet started to gain traction in pop culture as a tool for weight loss and led to a massive influx of products targeting people seeking this lifestyle. It may feel like a new fad or craze—but in reality, the original keto diet actually has deep roots in the field of neurology as a longstanding treatment for epilepsy.

It remains one of the most effective treatments for medication-resistant epilepsy—and the only treatment for children with a specific genetic disorder.

So, how similar is medical keto to the fad diet? According to Katie Klier, RD, CSP, CDCES, Clinical Dietitian in the Comprehensive Epilepsy Center at Children’s Hospital Los Angeles, not very similar at all.

Clinical dietitians in the center treat up to 150 children with ketogenic diet therapy at any given time. Klier explains that the key differences lie mainly in each diet’s purpose, precision, and the level of supervision required for adherence.

“I like to describe it as ‘pop keto’ versus ‘brain keto,’” she says. “While there are some similarities, there are a lot of nuances to brain keto that you don’t find in pop keto.”

The ketogenic diet gets its name from the state of energy use the body is in, called ketosis.

Glucose, a simple sugar that’s broken down when we eat carbohydrates, is the body’s primary fuel source for daily brain function. Research suggests that the average adult needs around 130 grams of carbohydrates per day to support adequate brain function. But when the body can’t source carbohydrates to break down into glucose, it can utilize alternative fuel sources—primarily fat.

When a person consumes a diet that is extremely low in carbohydrates, moderate in protein, and high in fat, that fat is broken down to ketones, which can serve as an alternative fuel. This is ketosis.

In the medical ketogenic diet, ketosis helps to stabilize erratic electrical disturbances in the brain, called seizures. People with recurring seizures and no clear trigger are categorized as having epilepsy. Ketogenic diet therapy is an effective, evidence-based treatment for a wide variety of seizures, including infantile spasms.

For some children, diet therapy is prescribed to stop or reduce seizures in conjunction with medicine, and even wean patients off a seizure medication that’s causing uncomfortable side effects. For others, diet therapy is the only treatment that works for their type of epilepsy.

A small number of children are born with a deficiency in a critical protein called GLUT1. This protein transports glucose from the blood to the brain. Without a functioning glucose transporter protein, the brain becomes starved, causing seizures. Medications don’t help people with GLUT1 deficiency because the brain is still not receiving enough nutrients to function properly.

This was the case with toddler Lucia, whose parents brought her to CHLA for treatment once genetic testing revealed GLUT1 deficiency. Klier explains that the medical ketogenic diet provides the tool Lucia and other children need to bypass the defective glucose transporter protein and create alternative fuel, in the form of ketones, for their bodies.

“For patients with GLUT1 and other types of epilepsies, this diet can be like a light switch going on in their brain,” says Klier.

Purpose: 
The purpose of the medical ketogenic diet is to use food as therapy when other medical interventions have failed. Typically, a child is prescribed a medical ketogenic diet as a second or third-line treatment to control their epilepsy. The results can be life changing.

Precision: 
When a child goes on the medical keto diet, they do so as an inpatient alongside a clinical dietitian and a physician. The medical team monitors the patient closely for about a week, noting their response and personalizing their unique nutritional ratio. Patients on the medical ketogenic diet can experience low blood sugar, vomiting, nausea, and weight loss while their body adjusts to the alternative fuel.

Supervision:
Once the child has adjusted to diet therapy, they need to be monitored daily to ensure their body maintains a therapeutic level of ketosis. This can be measured by a urine or blood test, usually taken right after they wake up.

In terms of purpose, precision, and supervision, the only similarities pop keto shares with medical keto are in the name.

This is because ketosis is extremely difficult to maintain. The ratio of macronutrients—carbs, protein, and fats—must be tailored to the person’s unique biology and needs to stay the same every day for a person to achieve ketosis while ensuring adequate nutrition to promote growth and energy.

Given the positive effects of the ketogenic diet on the brain health of children with epilepsy, some parents might be asking, “Should my kid try the keto diet?”

Before drastically changing their child’s diet, experts urge parents to discuss their options with a medical professional. Even briefly trying keto can have detrimental consequences—the child could be deprived of critical brain fuel if they’re consuming extremely small amounts of carbohydrates and an inadequate amount of fat to bring their body into ketosis.

“I want to make sure that anyone who does medical ketogenic diet therapy does this alongside a qualified medical team,” adds Klier. “We're looking at blood work, monitoring for side effects, and ensuring your child is safe and getting the fuel they need.”

The label “keto-friendly” is not regulated by the governing bodies that oversee our food sources. This means that any manufacturer can use the term without a standardized definition. While this may be fine for someone following the fad keto diet, most of these foods can contain ingredients that aren’t suitable for children on a strict medical ketogenic diet.

“With epilepsy, nutrition plays an important role in giving your brain and gut the energy it needs,” says Klier. “We know that what we eat and what’s in our gut impacts our brain.”

Whether or not the ketogenic diet is right for you, CHLA’s clinical dietitians encourage everyone to focus on eating a wide variety of foods, including fruits and vegetables, omega 3 fatty acids from fish, and a balanced source of foods to source the vitamins, minerals, fats, carbohydrates, and proteins your brain and body need to function.

(Newswise/VK)