When we think of epilepsy and how it’s treated, we might jump straight to medication. But medicine does little to control seizures in some children. That’s when doctors turn to diet.
Research has shown that these three diets can reduce or prevent seizures in many children:
• Classic ketogenic diet (KD)
• Modified Atkins diet (MAD)
• Low glycemic index treatment (LGIT)
I will discuss each of these diets mainly in terms of children with epilepsy, but also touch on their broader potential to help treat other conditions.
At the Swedish Pediatric and Adult Neuroscience Clinic, we primarily use the ketogenic diet and the modified Atkins Diet to treat people with epilepsy. We also use them to treat people with cancerous brain tumors, and there’s promising clinical trials and research that show these diets also may help people with Parkinson’s disease, autism, ALS, traumatic brain injury, Alzheimer’s, mitochondrial disorders, and Type 1 and Type 2 diabetes.
Some warningsPreliminary research shows that the ketogenic and modified Atkins diets could affect fetal growth, so they aren’t recommended during pregnancy. And low-carb diets in general aren’t recommended for teens who don’t have specific health issues. If you have concerns about your child’s diet but he or she is generally healthy, the best course is to talk to your child’s pediatrician for guidance.
Similar but differentThe ketogenic diet, modified Atkins diet and low glycemic index treatment diet vary, but all have two things in common:
• They are high in fat.
• They limit carbohydrates.
The ketogenic dietYour body makes ketones when carbohydrates aren’t available to convert into energy and your body instead burns fat for fuel. Scientists know ketones have a neuro-protective effect that helps reduce seizures, but they still don’t fully understand why.
This diet is very, very low in carbohydrates and very, very high in fat. Think lots of heavy cream, butter and vegetable oils, and very few carbs. And absolutely no sweets.
The ketogenic diet also is complicated and tightly controlled:
• All foods are weighed on a gram scale.
• The diet has very specific calorie restrictions, tailored to each individual.
• Each meal is calculated to have a specific ratio, or proportion, of fat to carbohydrate and protein.
I can’t stress enough how important it is for parents to seek medical expertise before they put a child on this diet. Your child would need to be monitored for side effects, including constipation and kidney stones. At the beginning of the diet there’s also the potential for severe hypoglycemia, or low blood sugar, in infants and young children.
Scientists are studying whether the ketogenic diet can help people with other neurologic disorders and autism. Initial research on whether the diet can help people with glioblastoma and other brain cancers indicates that as these cancers get less sugar, their growth slows or stops. You can find clinical trials involving the ketogenic diet here.
The modified Atkins DietRobert Atkins, M.D., developed the Atkins Diet after he discovered that when people eat fat and fewer carbohydrates at the same time, they are more likely to use up their fat stores instead of storing more fat. He began promoting the idea that eating fat is helpful after people on his diet who had diabetes and heart disease saw their conditions improve.
The modified Atkins Diet has fewer carbs than the traditional Atkins Diet. A treatment plan typically includes 10 grams of total “net carbohydrates” a day for children, and 15 grams per day for teens and adults. Net carbohydrates represent carbs that directly affect your blood sugar levels. They are high in sugar and starch, but low in fiber.
As with the ketogenic diet, the modified Atkins Diet includes a lot of fat -- for some 150 to 200 grams a day. That compares with the normal 65 grams of fat for very active children 4 to 8 years old who consume 2,000 calories per day.
The modified Atkins Diet is different from the ketogenic diet in these key ways:
• There are no restrictions on calories.
• Food isn’t weighed, but it’s measured.
• There are no restrictions on proteins.
The low glycemic index treatmentElizabeth Thiele, M.D., and Heidi Pfeifer, RD, at Massachusetts General Hospital in Boston created the low glycemic index treatment diet for people who can’t incorporate the strict ketogenic or modified Atkins diets into their lives. They found that kids have an easier time sticking to the LGIT diet and that the reduction in epileptic seizures is near that of the other diets.
Glycemic levels refer to the amount of glucose, a sugar in carbohydrates, in the blood.
The higher the glycemic level, the more glucose available for the body to convert to energy instead of fat. This means people on this diet focus on low-glycemic foods such as fruits, vegetables and whole grains.
Some key points about LGIT:
• While the diet is high in fat, the amount of calories from fat is less than with the ketogenic and modified Atkins diets.
• People can eat more carbohydrates, but 10 percent of calories should come from low-glycemic foods.
• There typically are no restrictions on calories.
• People are encouraged to eat their carbs with fat and protein to lessen the impact of the body’s glycemic response.
Time and commitment requiredThis diet’s greater flexibility makes it a good option for teens, given their busy schedules.
But all three of these diets require quite a commitment in time and changes in lifestyle. I’m sincerely impressed by the devotion of the parents and kids who stick with these diets.
As providers, we are continually looking for innovative options and recipes to make it easier and more realistic for kids to follow a tough diet. For many of these children, medication doesn’t work. That means their epilepsy can worsen if they abandon a diet because it becomes unappealing and psychologically stressful.
Changing a lifeBut these diets do seem to have a great impact on the lives of kids with epilepsy, and I really enjoy working with them and their families. It’s a great feeling and time well spent when you’ve helped prevent another medical problem and a child with epilepsy can live a bit more freely.
If you have questions about epilepsy treatments, talk to your primary care doctor or your child’s pediatrician.
At Swedish, you can find a neurologist for adults here, and a pediatric epilepsy specialist here. Call 206 215-1440 to schedule an appointment.