Ketogenic diet: Can it control seizures in children?

What can you tell me about the ketogenic diet as an alternative treatment for epilepsy in children? Does it replace medication? How effective is it in managing epilepsy?

- Sheryl / California

Answer

The ketogenic diet is a high-fat, very low-carbohydrate diet that may be recommended for children who don't respond well to other epilepsy treatments, including anti-seizure medications. The ketogenic diet is a rigid diet that requires strict planning — including food weighing — and close monitoring. Some families find that it's worth the effort, however. In fact, according to the Epilepsy Foundation, the ketogenic diet helps two out of three children who try it — and may prevent seizures completely in one out of three. Most children who follow a ketogenic diet continue to take their anti-seizure medications, although eventually some may be able to take lower doses.

The goal of the ketogenic diet is to get a child's body to produce ketones, chemicals that cause the body to burn fat instead of sugar (glucose) for energy. Treatment may begin with a 24-hour fast. During this time, the child's body uses up its store of glucose — which comes primarily from carbohydrates. Once the child's glucose stores are gone, his or her body must burn fat for energy. The ketogenic diet encourages this fat-burning process by providing about 80 percent of calories from fat. Only about 20 percent of calories come from carbohydrates and protein.

For example, the daily diet for a child who needs 2,000 calories may include:

• 9 tablespoons (133 milliliters) butter or oil
• 6 ounces (177 milliliters) heavy whipping cream
• 3 ounces (85 grams) meat
• 3 ounces (85 grams) vegetables

Grains, fruits and other dairy products are not common — or extremely limited — in the ketogenic diet.

Researchers aren't sure why the ketogenic diet can help prevent seizures — or why it works for some children and not for others. One theory is that higher ketone levels help control seizures. However, more research is needed to reach a conclusion.

If you wonder whether the ketogenic diet may be helpful for your child, consult his or her doctor and a registered dietitian. Your child's health care team can help you create an appropriate meal plan for your child.

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