This week is Epilepsy Awareness Week which is not only incredibly important in itself but it’s also very linked to a current dietary trend. I thought this would be a great week to help clear up some of the myths and promote the role of the ketogenic diet as a means of epilepsy management. Recently the diet has been taken out of context for many individuals longing for weight loss.
Before we identify how this diet has been used to help manage symptoms of epilepsy it’s important to define epilepsy. “Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness or convulsions, associated with abnormal electrical activity in the brain.” (Oxford Dictionary). Some of the key symptoms of epilepsy include: loss of consciousness or awareness, uncontrollable shaking of the arms and legs, repeated seizures and temporary confusion.
The treatments for epilepsy are largely medicinal although the ketogenic diet has been tried and tested many a times in relation to its symptom management for which it has shown to be relatively successful.
You may be familiar with the ketogenic diet which in recent years has grabbed media attention for it’s controversial role in weight management strategies although this diet was first introduced as a treatment for epilepsy. In 1921 a scientist named Woodyatt identified that a very low carbohydrate (10-15g.d) and high fat diet may replicate the benefits found of fasting on epilepsy. In 1972 a study on over 1,000 epileptic patients showed the diet exerted a 50% complete control of seizures and 27% improved control of seizures. However, not long after anti-epileptic drugs were developed and consequently the use of the diet quickly dimished. Over more recent years modern science techniques have proven the diet to be significantly effective.
(Here comes the science; feel free to skip it if you wish) The mechanisms of action are not fully understood as of yet. However, there are a variety of suggestions. The ketogenic diet has been suggested to have anticonvulsant effects (e.g. stopping a discrete seizure) and anti-epileptic effects (e.g. preventing unprovoked seizures).
However, research has shown changes in two key neurotransmitters: the diet has been found to reduce the release of Glutamate (the primary exitatory neurotransmitter) and increase the release of GABA (the primary inhibitor neurotransmitter). The latter has been speculated to play a role in seizure protection.
Another suggested mechanism of action is that the ketone bodies which are produced in response to a very low carbohydrate, high fat diet may play a role in promoting anticonvulsant effects.
Additionally, there may be protective effects against free radical damage which has also been suggested to play a role in the success of the ketogenic diet for epileptics.
There are numerous proposed mechanisms of action and due to this being such a vast and complex topic far more research is required.
There has been plenty of research to suggest the success of the ketogenic diet in the management of epilepsy. However, anyone embarking on this new diet should be aware of the potential adverse affects such as acidosis (a condition which causes fluids in the body to contain excessive acid), hypoglycemia (very low blood sugar), gastrointestinal distress (due to the very low fibre intake), dehydration and lethargy. Additionally, children on the diet for a prolonged period of time may experience slow growth, lower bone density and increased risk of kidney stones.
As a result this dietary protocol should not be undertaken without supervision from a health care professional.
This article wouldn’t be complete without touching on fact that the ketogenic diet has also been marked as another fad diet for weight loss. Over a short period of time a very low carbohydrate diet has been shown to induce more weight loss than a low fat diet. However, overall most research shows no significant difference in weight loss after the 2 year follow up between a low fat and low carbohydrate diet. Any extreme diets can be difficult to adhere to. You should also be aware that a low carbohydrate diet may also pose risks to gut health due to limited intake of fibre and risks of nutrient deficiencies due to such limited food choices.
Dietary changes should be conducted under the supervision of a health care professional to prevent risks in nutrient deficiencies.
Wheless, J. W. (2008). History of the ketogenic diet. Epilepsia, 49(s8), 3-5.
Freeman, J. M., Kossoff, E. H., & Hartman, A. L. (2007). The ketogenic diet: one decade later. Pediatrics, 119(3), 535-543.
Nordmann, A. J., Nordmann, A., Briel, M., Keller, U., Yancy, W. S., Brehm, B. J., & Bucher, H. C. (2006). Effects of low-carbohydrate vs low-fat diets on weight loss and cardiovascular risk factors: a meta-analysis of randomized controlled trials. Archives of internal medicine, 166(3), 285-293.
Bazzano, L. A., Hu, T., Reynolds, K., Yao, L., Bunol, C., Liu, Y., … & He, J. (2014). Effects of low-carbohydrate and low-fat diets: a randomized trial. Annals of internal medicine, 161(5), 309-318.
Johnston, B. C., Kanters, S., Bandayrel, K., Wu, P., Naji, F., Siemieniuk, R. A., … & Jansen, J. P. (2014). Comparison of weight loss among named diet programs in overweight and obese adults: a meta-analysis. Jama, 312(9), 923-933.