Keto Diet: It's Not All About Weight Loss!

keto diet for children with seizures

Ketogenic Diet, popularly known as Keto Diet and Atkins diet, has regained recent popularity due to its effects on weight loss. One can see various types of advertisements on search engines with a plethora of weight loss regimes ranging from 7 day to 30 day menus guiding people on ways to lose weight.

But that’s what I am NOT going to talk about! Instead, Ketogenic diet is a powerful tool I use in my pediatric neurology practice to help children with epilepsy. Many parents may wonder how it is different from the Keto diet used for weight loss, while both have the same basic principles i.e. low carbohydrates and high fat, there are many differences. Keto Diet for management of epilepsy has been around for a long time, but has regained popularity in the late 90’s. In this blog I will focus on usual questions parents ask me with regards to the Keto diet and management of epilepsy.

Does every child with Seizures or Epilepsy needs Keto Diet?

First and foremost, Ketogenic diet is NOT meant for every child who has epilepsy. It is usually meant for the group of children who have severe, intractable epilepsy which cannot be managed despite using multiple anti-epilepsy medications. So if your child has had few seizures which are controlled by one or two anti-epileptic medication, he/she does not need Keto diet management.

Keto diet for epilepsy, unlike the one for weight loss, is designed and monitored by a Consultant Pediatric Neurologist and a trained Ketogenic dietitian. The diet is initiated in the clinic or hospital and is stringently monitored on a regular basis to look out for side effects, to ensure nutritional needs are being met, and to assess the diet’s effect on seizure control.

What is Ketogenic diet for epilepsy and how does it differ from the one used for weight loss?

The Ketogenic diet (also called Ketogenic therapy) is a specialized medical diet and used as a treatment option for children with epilepsy whose seizures cannot be reduced or stopped with epilepsy medication.

One of the main differences between the Keto diet for epilepsy and the one for weight loss is the way the diets are designed. No two children using the keto diet will have the exact same ratio The classical medical ketogenic diet is designed according to the ketogenic ratio, i.e. the ratio of the amount of fat to the amount of combined carbohydrates and protein. The measurements are carried out by a specialist pediatric dietician who is integral part of Keto diet programme. The ratio of Fat: Protein/Carbs varies depending on the type of diet e.g. 4:1, 3:1 ratio etc. In my experience, every child is different and needs a tailored approach to their Keto diet after a thorough medical history and clinical examination.

On the other hand, Keto diet for weight loss can be standardized for adults to limit certain amount of Carbs and calories to certain more than one individual.

How does the Keto diet work?

The exact mechanism of action is not completely understood, but the basic principle is that the hyper excitable brain which has excess of abnormal electrical discharges causing epilepsy needs glucose to cause seizure. The Keto diet “starves” the brain of glucose by producing a state of starvation in the body. This forces the brain to use ketone bodies (fat) as a source of fuel instead of glucose thereby decreasing the chances of child having seizures.

There have been numerous studies which clearly show that about half of children will have a good response to the Keto diet and some may even become seizure free. Children may also become more alert and active. However, just like other anti-epilepsy medications there are times when Keto diet does not work. I usually give a 6 weeks trial of diet for children with severe epilepsy and if there is no response, they are weaned off the diet.

How is the Keto diet initiated?

Keto diet for epilepsy in children is a “medical treatment” therefore it is initiated under close medical supervision of Consultant Pediatric Neurologist and Dietician. The doctor will take preliminary blood tests prior to starting the diet to ensure there are no contraindications. When children are relatively young, they may have to be admitted in the hospital for a few days to keep a strict vigil to look for any side effects that may occur and ensure that the child tolerates the diet. The parents and caregivers are also trained for “do’s and don’ts” whilst the child is on the diet.

The parents have to be careful that even a small bite of sugar can “break the diet” and result in breakthrough seizures. The parents are usually in constant touch with the dietician to ensure that the child puts on appropriate weight and gets all the necessary vitamins and minerals needed for normal growth.

How long is the Keto diet for?

In most cases, if the child’s epilepsy is controlled by Keto diet, it is given for 2 years following which the diet is gradually weaned off. Rarely, the diet is continued for life in some specific disorders, where Keto diet is the “treatment of choice”.

About Author

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Dr Aman PS Sohal

MBBS FRCPCH CCT (Pediatric Neurology) U.K , Fellowship in Pediatric Neurophysiology, Adjunct Clinical Associate Professor MBRU Dubai . U.K Board certified Consultant Pediatric Neurologist with over 11 years of experience in Pediatrics which includes more than six years of experience as a Consultant in Pediatric Neurology.