Natural approaches to epilepsy

Alternative Medicine Review, March, 2007 by Alan R. Gaby

To be effective, the diet must be followed strictly; if the patient discontinues it, seizures are likely to return within hours. Typically, treatment is initiated in the hospital, starting with a 36-hour water fast to induce ketosis; however, some investigators have found that it is not necessary to begin the diet with a fast.

The ketogenic diet is usually followed for about two years, after which the proportion of fat is reduced gradually over 6-9 months to that of a regular diet. After a patient has been on the diet for two years, seizures are less likely to recur on resumption of a normal diet. In some cases, the diet regimen is repeated if seizures recur.

There are some drawbacks to the ketogenic diet. Supplementation with multivitamins, calcium, and iron is necessary to prevent nutritional deficiencies. In addition, the ketogenic diet is unpalatable and is difficult for parents to administer.

Ketogenic Diet for Adults

While most ketogenic diet studies have been conducted in children, one trial investigated its effect in 11 adults (ages 19-45 years; median, 32.2 years) with refractory epilepsy. At eight months of follow-up, three patients had a 90-percent reduction in seizure frequency compared with baseline, three patients had a 50- to 89-percent decrease, and one patient had a less-than-50-percent decrease. All types of seizures responded to the diet. Common adverse effects included constipation, menstrual irregularities, and increases in triglyceride levels and cholesterol/HDL ratios. (33)

Ketogenic Diet with Medium-chain Triglycerides

The triglycerides of octanoic and decanoic acids (medium-chain triglycerides; MCTs) are more ketogenic than long-chain triglycerides present in dietary fats. Diets containing large proportions of MCTs (usually provided by supplementing with MCT oil) are also easier to prepare, more palatable, better tolerated, and require less carbohydrate and protein restriction than standard ketogenic diets.

The MCT ketogenic diet, which provides 50-70 percent of total energy in the form of MCTs, has been used as an alternative to the classic ketogenic diet. (34-36) In one study, adherence to this diet resulted in improvement or complete control of seizures in 44 percent of 50 children with drug-resistant epilepsy. (37) Children who have had a positive response to this diet may be able to taper off the diet after 3-4 years without experiencing a recurrence of seizures. While the MCT diet is frequently well tolerated, some patients abandon it because of gastrointestinal intolerance.

Ketogenic Diet: Adverse Effects

The ketogenic diet has caused a number of adverse effects, some serious. Initiation of the diet can result in vomiting, hypoglycemia, or dehydration. In one study, serious adverse events (severe hypoproteinemia, Fanconi's renal tubular acidosis, or marked abnormalities on liver function tests) occurred in five of 52 children on a ketogenic diet. (38) Other potential side effects include increased bruising or other minor bleeding (in association with a prolonged bleeding time), constipation, and diarrhea. (39,40)