Your Brain On Fat: Nutrition Therapy For Epilepsy

This blog was co-written by Dr. Angus Wilfong, Medical Director, Comprehensive Epilepsy Program. There are several medical conditions for which nutrition therapy serves as an important part of the treatment plan. You may know someone with diabetes who follows a consistent carbohydrate diet, someone with high blood pressure who follows a low sodium diet, or perhaps you’ve known someone with food allergies or intolerances who must follow a specialized diet based on their allergies or intolerances. A less commonly known medical condition that may benefit from nutrition therapy are severe forms of epilepsy. For children with intractable epilepsy, or “drug-resistant epilepsy”, the ketogenic diet may be used to help improve seizure control and overall quality of life. The ketogenic diet is considered a medical treatment and must be administered under a guidance of an experienced medical team. At Texas Children’s Hospital, our ketogenic diet team consists of an epileptologist, a PhD epilepsy nurse practitioner, two registered ketogenic dietitians, nurses and a dedicated PharmD clinical pharmacist. The ketogenic diet is a high fat, low carbohydrate, adequate protein diet that may be given using foods or as a special, high fat formula. All foods are weighed on a gram scale for correct dosage. Roughly 80-90% of the ketogenic diet is fat, provided in the form of butter, oils, nuts, seeds, avocado, mayonnaise and heavy whipping cream. This leaves room for adequate protein - enough to help children continue to grow – and a small amount of carbohydrate, in the form of fruits and vegetables. The ketogenic diet excludes most starchy and sugary foods, such as breads, cereals, pasta, rice, juices, candy and desserts. Now, I know what you’re thinking… a high fat diet? How does THAT work? Does it work for every child with intractable epilepsy? Will children gain too much weight on this diet? Below, I will help address a few common questions and concerns about the ketogenic diet: How does the ketogenic diet work? This is one of the most common questions we receive. While studies have proven the effectiveness of dietary intervention, the exact mechanism for seizure reduction remains unknown. Is the ketogenic diet effective for every child with intractable epilepsy? About 1/3 of patients who try the ketogenic diet will have less than 50% reduction in seizures, 1/3 will have a greater than 50% reduction in seizures, and about 1/3 will have a >90% reduction. Do children gain too much weight while on the ketogenic diet? Each ketogenic diet is individualized based on the child’s energy needs. Children are provided with adequate calories to continue to grow without gaining weight excessively.  What are the potential side effects? While the ketogenic diet can be helpful in reducing seizures, there are also potential side effects that may occur. These include, but are not limited to: hypoglycemia (low blood sugar), metabolic acidosis (blood becomes too acidic), high cholesterol and gastrointestinal problems (vomiting, constipation). There is also a small risk of kidney stones. For these reasons, the ketogenic diet is always initiated in the hospital so children can be monitored for potential side effects. Is my child a candidate for the ketogenic diet? At Texas Children’s Hospital, potential candidates are referred by their neurologist to meet with the ketogenic diet team. At this appointment, we review the child’s medical and nutrition history, teach families about the ketogenic diet and discuss potential risks and benefits of the ketogenic diet. For more information about the ketogenic diet, visit the Texas Children’s Epilepsy Center or call 832-822-1099.