Let’s be honest: the words “therapeutic dietary intervention” sounds about as exciting as watching paint dry. But if you or a loved one has seizures that won’t quit, then the ketogenic diet might just be the superhero cape your neuron’s didn’t know they needed. And yes, it involves fat!
Why Would Anyone Eat So Much Fat?
The ketogenic diet (KD) isn’t just about fitting into skinny jeans. Nope. It was invented back in the 1920s as a treatment for epilepsy, before we had a pharmacy aisle longer than the Great Wall of China. Its use declined with the rise of anti-epileptic drugs but has re-emerged in the 1990s for drug resistant epilepsy. The diet is high-fat, very low-carb, and moderate in protein. The idea? Starve your brain of sugar (glucose) so it switches to burning ketones (made from fat).
For some mysterious but wonderful reason, this switch can calm down overexcited neurons and reduce seizures. Think of it as swapping Red Bull for chamomile tea… but on a cellular level.
The ketogenic diet also changes the type of gut bacteria, which then influences the metabolites that cross the gut-brain axis, ultimately promoting a more balanced neurotransmitter environment in the hippocampus and providing protection against seizures. Talk about a “super bug”… but in a good way.
Does It Actually Work?
Short answer: Yes.
Longer answer: Yes, but it depends.
- 30–60% of patients get at least a 50% reduction in seizures.
- 10–20% may become seizure-free. (That’s the brain equivalent of hitting the jackpot).
- Certain syndromes like GLUT1 deficiency, Dravet syndrome, and Lennox-Gastaut love this diet like kids love candy.
How the Magic Happens (Without Wizardry)
Scientists still don’t know every detail, but here’s the highlight reel:
- Ketones as brain snacks – Your neurons munch on fat-fueled ketones instead of sugar.
- Calmer chemistry – More GABA (the chill neurotransmitter), less glutamate (the hyper one).
- Mighty mitochondria – Cells get better at making energy and handling stress.
- Ion channel karaoke – Ketones tinker with electrical channels so your neurons don’t start raving at 3 a.m.
- Less inflammation, cooler genes – Ketones even dabble in epigenetics. Basically, they tell your DNA, “Hey, chill.”
Who should avoid the Keto Diet?
If you have any of the following conditions, best to give this a skip:
- Type 1 diabetes
- Liver failure
- Kidney disease
- Pregnancy
- Breastfeeding
- Irregular heartbeats
- Stroke
- Heart attack or heart failure
- Cancer
- Respiratory infections or failure
- Elderly
- Mental disorders
- Increased levels of uric acid
- Abnormal cholesterol levels
What Can You Actually Eat?
Good news: You’re not stuck gnawing on kale stems. Here’s what a ketogenic plate looks like:
- Yes, please!
- Fatty fish, eggs, cheese, butter, cream, avocados, nuts, oils, low-carb veggies.
- Not today, buddy.
- Bread, pasta, rice, potatoes, most fruit, sugar (a tragedy for cake lovers).
Types of Ketogenic Diets for Epilepsy
1. Classic Ketogenic Diet (CKD)
- Ratio:
- Typically 4:1 (fat : protein+carbohydrate by weight).
- This means ~80-90% of calories from fat, ~6–8% from protein, and ~2–4% from carbohydrates.
- What it includes:
- Very strict food weighing and measuring.
- High-fat foods (butter, cream, oils, fatty meats, avocado).
- Protein allowed in moderation.
- Carbohydrates kept extremely low, mostly non-starchy vegetables.
- Effectiveness:
- Strong evidence: about 30–60% achieve ≥50% seizure reduction.
- 10–20% can become seizure-free.
- Particularly effective in GLUT1 deficiency, pyruvate dehydrogenase deficiency, Dravet, Doose, and Lennox-Gastaut syndromes.
2. Modified Ketogenic Diet (Sometimes called Modified Classic KD)
- Ratio:
- More flexible than the strict CKD. Ratios may range from 3:1 to 1:1
- Fat usually provides ~70–80% of calories.
- What it includes:
- Still high-fat but not every gram of food is weighed.
- Wider variety of foods allowed.
- Effectiveness:
- Similar seizure reduction rates as CKD for some patients, though slightly less robust in research.
- Easier to maintain, so adherence is often higher.
3. Medium-Chain Triglyceride (MCT) Diet
- Ratio:
- Fat: ~60% from MCT oil (are a type of fat that is generally made by processing coconut and palm oils – they are not found in traditional foods) which produces more ketones per calorie than long-chain fats. Ratio of 1.9:1 ie 1.9g of fat for every 1 gram of protein and carbohydrate
- What it includes:
- Uses MCT oil to provide fat calories.
- Allows more protein and carbohydrate compared to CKD.
- Effectiveness:
- Comparable seizure reduction to CKD in studies.
- May improve food variety and quality of life since carbs and protein are less restricted.
- Downside: MCT oil can cause GI side effects (nausea, diarrhoea).
4. Modified Atkins Diet (MAD)
- Ratio:
- Roughly 65% fat, 25% protein, 10% carbs.
- No strict ratios, but carbs are usually limited to 10–20 g/day (net carbs).
- What it includes:
- Foods are not weighed precisely.
- Focus on fatty foods, moderate protein, very low carbs.
- Much more flexible and easier to start than CKD.
- Effectiveness:
- ~40–50% achieve ≥50% seizure reduction, and ~10% may become seizure-free.
- More effective in children than adults, but beneficial for both.
- Often chosen as a first-line dietary option because it’s practical.
5. Low Glycemic Index Treatment (LGIT)
- Ratio:
- Fat: ~60% of calories, Protein: ~20–30%, Carbohydrates: ~10%.
- Carbohydrate intake: ~40–60 g/day, but restricted to low glycemic index foods (GI < 50).
- What it includes:
- More liberal carb allowance than other keto diets.
- Focus on low-GI carbs (berries, non-starchy vegetables, some whole grains, legumes in small amounts).
- High-fat foods still encouraged.
- Effectiveness:
- Evidence suggests ~50% of patients achieve ≥50% seizure reduction.
- Less effective than strict KD but much easier to maintain, especially long-term.
A Day in the Life of Keto
Breakfast: Eggs scrambled in butter with cheese and spinach.
Lunch: Chicken salad with mayo, avocado, and olive oil dressing.
Snack: Cream cheese + coconut oil
Dinner: Salmon with cauliflower mash and buttered broccoli.
See? Way tastier than it sounds.
Final Thoughts
The ketogenic diet is not just another internet fad. For some people with drug-resistant epilepsy, it’s life-changing. It is important however to always work with a medical team when doing such a diet.
So, if someone tells you they’re on keto, don’t just assume they’re trying to look good in skinny jeans. They might be fighting seizures—with buttered broccoli as their sidekick.