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Ketogenic Diet for Epilepsy

What Is a Ketogenic Diet?

If medicine doesn't control seizures in epilepsy, sometimes doctors prescribe a ketogenic (or keto) diet. A ketogenic (kee-toe-JEN-ik) diet is a strict diet that can reduce, and sometimes stop, seizures. A ketogenic diet is high in fat, low in carbohydrates, and includes just enough protein for a child to grow.

It's called "ketogenic" because it makes ketones in the body. Ketones (KEE-tones) are made when the body uses fat for energy instead of carbohydrates.

The keto diet is prescribed by a doctor in coordination with a dietitian. Kids on the diet need to be followed closely by their keto team, who will make sure that kids follow the diet, get the nutrients they need, and monitor their seizures. Close monitoring is required when someone starts the diet, so patients are admitted to the hospital for keto diet initiation.

Who Needs a Ketogenic Diet?

Children whose seizures are not well-controlled by medicines (called intractable epilepsy) or who have severe epilepsy syndromes (such as infantile spasms or Lennox-Gastaut syndrome) might benefit from a keto diet.

How Does a Keto Diet Work?

Although the keto diet for epilepsy has been around since 1920, doctors aren't exactly sure how the higher ketone levels work. Some seizure types seem to respond better than others to the keto diet.

Babies on the keto diet get medical formula. Children who get their nutrition through a tube placed in the stomach also can use medical formula. Toddlers and older children can follow the keto diet by eating foods made from special recipes.

How Long Do Kids Need a Keto Diet?

You should know if a keto diet works for your child within a few months. If it does, your doctor may recommend weaning your child off the diet after 2 years of seizure control. The weaning process is done over several months to avoid triggering seizures.

Some people stay on a keto diet for years.

Are There Any Risks?

The keto diet is a safe treatment for epilepsy in children. There are some possible side effects with long-term use, though, including:

Are Other Versions of the Keto Diet Less Restrictive?

Yes. The keto diet can be hard for some kids and teens to follow due to the restrictions and the need for higher protein intake to grow. The Modified Atkins Diet is a less-restrictive alternative that still allows the patient to make ketones to help control seizures. If the keto diet seems too restrictive for your child, talk to your doctor and dietitian to see if this diet is a possibility.

How Can Parents Help?

The ketogenic diet isn't a quick, easy fix. It can be very hard to stay on such a strict diet. To help your child:

  • Keep foods they can't eat out of sight and not in easy reach.
  • Get support from your doctor and dietitian.
  • Be sure the whole family and other caregivers understand the diet and help your child follow it.
  • Talk with your child’s teacher and school staff so your child can follow the diet while at school.

Following the ketogenic diet requires regular follow-up with your doctor and dietitian. Be sure to go to all visits.

For many families, the hard work pays off with better seizure control and less medicine use.

Reviewed by: Lily Tran, MD
Date reviewed: August 2022