The ketogenic diet, or ketogenic therapy, is a high-fat eating plan that may be considered to help manage epilepsy. It is usually considered when two anti-seizure medications don’t work well, a situation known as drug-resistant epilepsy. The ketogenic diet may also be used as a first-line treatment for people with certain rare conditions, such as GLUT1 or pyruvate dehydrogenase complex deficiency. These conditions interfere with the way the body turns sugar into energy, which is why the ketogenic diet may be helpful.

However, ketogenic diet therapies aren’t for everyone. Talking to your healthcare team beforehand can be very important, especially when you’re first starting out. A ketogenic diet can take some time to adjust to and may cause side effects for some people.

Members of MyEpilepsyTeam living with epilepsy have shared their questions and experiences with the ketogenic diet. One member asked, “Has anyone ever tried the ketogenic diet to help stop having seizures? I don’t want to keep taking more medication, and in the future, I want to have more children, but my doctor said I would need to stop taking the medication I am on now. I would like to try this as an alternative to meds.”

So is the ketogenic diet helpful for people with epilepsy? Here is the latest research, along with real-life stories from MyEpilepsyTeam members.

How To Follow a Ketogenic Diet

A ketogenic diet restricts carbohydrates — typically to 50 grams per day or less — with the goal of getting the body to shift from using glucose (sugar) to fat for energy. This produces ketone bodies, or ketones, and puts the body into a state called ketosis. Some people with epilepsy find that running on ketones instead of glucose provides better seizure control.

Medical supervision is essential, especially when you’re first starting out on a ketogenic diet.

The classic keto diet, prescribed for conditions like epilepsy, uses a 4:1 or 3:1 ratio of fat to protein plus carbs. This means about 90 percent of calories come from fat. There are now many different types of ketogenic diets that may allow for more protein and carbohydrates with medical supervision, including the:

• MCT diet — Uses MCT (medium-chain triglyceride) oil to make ketones more easily, so more carbs and protein are allowed
• Modified Atkins diet (MAD) — Has higher protein and slightly more carbs, often a 1:1 ratio of fat to protein grams
• Low-glycemic-index treatment (LGIT) — Allows more carbs, focusing on low-glycemic foods, or foods that have less impact on blood sugar

Sticking to a ketogenic diet can be complicated, especially at first. Meeting with a dietitian who specializes in ketogenic diets is essential to making sense of the numbers and translating the guidelines into a realistic meal plan.

The types of foods encouraged on a ketogenic diet include:

• Leafy greens (romaine, arugula)
• Broccoli
• Cauliflower
• Cucumber
• Olive oil
• Macadamia nuts
• Walnuts
• Salmon
• Chicken thigh
• Full-fat cheese

Lean meats and low-fat dairy products tend to be too high in protein to meet the ratio of fat to carbohydrates necessary for a classic ketogenic diet. You’ll need to limit all grain foods, beans, starchy vegetables (like potatoes), and high-sugar fruits (like bananas) to stay within a ketogenic range. Eliminating sugary beverages and desserts is an essential part of the keto diet.

What Researchers Say

About one-third of people with epilepsy eventually develop drug resistance, meaning their medications stop controlling their seizures. For these individuals, the ketogenic diet may be a suitable alternative with promising effects. The ketogenic diet works by exerting multiple effects on the brain that can be helpful for seizure prevention.

The ketogenic diet works by exerting multiple effects on the brain that can be helpful for seizure prevention.

Studies show that the ketogenic diet effectively reduces seizure frequency by at least half in 40 percent to 67 percent of pediatric epilepsy cases, and researchers saw 90 percent improvement in 27 percent of adolescents. Although all types of epilepsy, including intractable (refractory) epilepsy, may improve on a ketogenic diet, people with generalized epilepsy and some epilepsy syndromes seem to respond the best.

If you have trouble with a classic ketogenic diet, you might prefer variations, such as the modified Atkins diet and the low-glycemic-index treatment. These diets are less restrictive than the classic ketogenic diet because they let you eat more carbs and protein. Research has shown that both the MAD and LGIT diets can help reduce seizures, but how well they work depends on the person and the type of epilepsy. Vegetarian and plant-based ketogenic diets are also options and should be tailored carefully to include a variety of nutrient-dense fats and proteins. Always check with your doctor or neurologist before changing your diet to make sure it’s safe and will help you.

Medications and the Ketogenic Diet

Although many members of MyEpilepsyTeam look to the ketogenic diet as a replacement for seizure medication, others see it as a supplement to their current treatment plan. One member shared, “You definitely don’t want to make dramatic or sudden changes because then you’re just inviting seizures. Even the implementation or starting with the ketogenic diet is a process. … The main attribute of the keto diet is that it introduces more stability throughout the body.”

A ketogenic diet can interfere with certain medications.

However, a ketogenic diet can also interfere with certain medications. Although most medications are safe and effective on a ketogenic diet, this diet may interfere or interact with certain anti-seizure drugs. Speak to your doctor before starting the ketogenic diet if you are taking zonisamide (Zonegran) or topiramate (Topamax), especially if you are at risk for kidney stones. You may be recommended oral citrate, or potassium citrate, to lower your kidney stone risk. If you take SGLT2 inhibitor medications (used for type 2 diabetes or heart failure), make sure to consult your doctor. SGLT2 inhibitors have been shown to increase the risk of a dangerous condition when combined with the ketogenic diet.

Before starting the ketogenic diet, check with your doctor and discuss your dietary plans, especially if you’re considering a new medication. Don’t stop taking medication without your doctor’s advice.

Challenges and Contraindications

While the ketogenic diet may help some people, it’s important to keep your healthcare team updated on how you’re feeling and any changes you notice. You may need to adjust your medications after starting a keto diet. It’s also important to note that some conditions may make the ketogenic diet a poor choice.

Keto can also cause side effects in some people. Tell your healthcare team if you notice any of the following:

• Fatigue (tiredness that doesn’t improve with rest)
• Nutrient deficiencies
• Constipation
• Kidney stones
• Liver issues

On rare occasions, some individuals on low-carbohydrate diets develop a potentially dangerous condition called ketoacidosis. In ketoacidosis, ketones build up to dangerous levels in the blood, making the blood too acidic.

Nutrition Issues

The restrictive nature of ketogenic diets can make it challenging to get enough essential nutrients, leading some people to stop the diet early. Working with a healthcare professional can help you follow keto safely and effectively. Prioritize balanced and wholesome foods, which can help prevent constipation and nutrient deficiencies, like calcium and vitamin D, which are important for bone health. A vitamin and mineral supplement may also be beneficial, but consult a healthcare provider to determine if you need one and how to choose a reputable brand. To help lower kidney stone risk, follow your clinician’s advice about fluids and electrolytes.

Join the Conversation

On MyEpilepsyTeam, people share their experiences with epilepsy, get advice, and find support from others who understand.

Have you tried a ketogenic diet to help with epilepsy? How did it work for you? Let others know in the comments below.