The Ketogenic Diet & Epilepsy

The History of Ketogenic Diet and Epilepsy

The Ketogenic Diet goes back a lot further into history than you might initially think.

The modern application of the diet as a targeted treatment for epilepsy dates back to the 1920s. But the basis for the modern ketogenic diet was laid more than 2,500 years ago!

The Hippocratic Collection, a collection of about 60 classical writings on ancient medical science, contains references to the treatment of epilepsy based on fasting.

The Bible also refers to the use of fasting to prevent (epileptic) seizures and strokes.

With fasting, you depri0 your body of food, including carbohydrates.

This means that the body goes in search of other energy sources, including ketones. These ketones are produced by the liver from stored fats (triglycerides) and serve as an alternative fuel for the brain in the absence of glucose.

In all likelihood, they did not know about the existence of ketones in ancient times, but they did know from practical knowledge and experience that fasting was an effective way to combat certain symptoms and disorders.

Thus, the application of fasting in antiquity can be seen as the precursor of the modern ketogenic diet.

Long after fasting was first described as a medical approach to certain conditions, two crucial observations were made in the 1920s that accelerated the development of the ketogenic diet.

Important Finding #1

American physician Rollin Woodyatt researched the link between diet and diabetes. He noted in 1921 that the liver of healthy people produced three substances when they starved or when they followed a very low-carb and high-fat diet (4).

These substances are acetoacetate, acetone and β hydroxybutyrate. Stimulating the production of these substances forms the basis of the ketogenic diet.

Important Finding #2

At the same time as Woodyatt’s finding, another doctor, Russell Wilder, was looking for a way to use the therapeutic benefits of fasting through a longer-term diet in the treatment of epilepsy.

Wilder built on Woodyatt’s findings and then developed the ketogenic diet as a way to fight epilepsy in 1921.

How the Ketogenic Diet Works in Epilepsy

It is not yet entirely clear what the exact effect of the ketogenic diet is in epilepsy patients and why it can be so effective.

But the most common theory about why the ketogenic diet (and therefore ketosis) improves control of seizures concerns the large presence of ketones in the body.

In the article Ketones as Premium Fuel for the Brain, we discuss the benefits that ketones have for men. Let’s also list them here:

  • Ketones stimulate mitochondrial production

    When cells use ketones as fuel, they form new mitochondria. The mitochondria are the “power plants” of the cell. In the mitochondria, the energy from the diet is converted into a form that the cell (and therefore the body) can use for all functions (moving, growing, thinking etc.) (5).

So what happens is that your body gets an extra battalion of small power plants, which help to improve the energy production and health of the cells (6).

  • Ketones protect and repair the nervous system

    Ketones help to maintain the functioning of aging nerve cells, and they help repair damaged or malfunctioning nerve cells.

    There are many scientific studies showing that ketones can help significantly improve acute brain damage (7) (8).

  • Ketones act as an antioxidant.

    As mentioned, ketones are a more efficient energy source than glucose. One of the reasons is that ketones produce much less free radicals and reactive oxygen components when burned than glucose. Thus, by using ketones as fuel, the body can protect itself from the damage normally caused by reactive oxygen components and free radicals (9) (10).

  • Ketones stimulate the action of neurotrophin

    Neurotrophin (BDNF) is a substance that occurs in the brain and stimulates the production of new brain cells (11) (12) (13). It helps to create new communication paths between neurons (nerve cells) in the brain.

    It also strengthens existing connections between neurons. The renewed connections between your brain cells benefit memory and the ability to think abstractly and critically.

  • Ketones increase the activity of the neurotransmitter GABA

    GABA is a neurotransmitter. It’s a substance that transmits signals in the brain.

    One consequence of burning ketones is that in the brain there is a shift in the balance between two neurotransmitters called GABA and glutamate (14).

    GABA has a relaxing effect, while glutamate has a stimulating effect.

    A shift, in which GABA exhibits more activity, allows ketones to prevent excessive brain activity, and thus counteract the uncontrollable impulses associated with neurological disorders such as epilepsy, autism, and Parkinson’s disease.

    If we list the neurological benefits again, we can make the following list.

Ketones provide:

  1. More energy
  2. Repairs to nerve and brain cells
  3. Protection against free radicals
  4. New communication paths in the brain
  5. Fewer stimuli in the brain

Thus, the above effects of ketones can cause the brain to be in better shape and less susceptible to seizures due to fewer stimuli.

Epilepsy Treatment with the Ketogenic Diet

In the introduction to this article, we already indicated that the ketogenic diet is often used in children with seizures who have not responded positively to medication. There are two main categories when it comes to seizures in epilepsy patients:

generalized seizures: generated by electrical impulses throughout the brain region;
partial seizures (also called focal epilepsy): triggered by electrical impulses in a small part of the brain.

If a child has to follow a ketogenic diet due to epilepsy symptoms, a period of fasting is usually started, after which the diet is started in the hospital.

In this way, the medical staff can monitor whether or not the seizures increase at the start of the diet, inform family members about the diet and check that all medication used is carbohydrate-free.

A ketogenic diet formula can also be used for infants and children fed via a ‘gastrostomy tube’, also known as the ‘G-tube’.

A G-tube is a flexible tube that runs through a small hole from the abdominal wall to the stomach. A G-tube is held in place by a balloon filled with water on the inside of the stomach (15).

Research has shown that:

  • in about a third of users, attacks decrease by more than half;
  • reduce attacks by half in about a third;
  • about a third do not reduce seizures

Small studies have shown that the ketogenic diet may also improve the following epilepsy-related conditions:

  • Rett syndrome: a rare genetic abnormality of the gray matter in the brain that occurs after birth. Up to 80% of patients with this syndrome suffer from seizures.
  • Infantile spasms: an epileptic abnormality in people of all ages, including children, which usually occurs at the age of 3-12 months. Patients have three different types of seizures, often at the same time.
  • Dravet syndrome: a rare genetic epileptic brain abnormality that manifests itself within the first year of life.
  • Tuberous sclerosis complex: a genetic abnormality in which tumors form on the eyes, brain, kidneys, lungs and skin. Tumors on the brain can lead to various problems, including seizures.
  • GLUT1 deficiency syndrome: a condition that usually involves regular seizures that begin in the first months after birth.
  • Doose syndrome: myoclone-astatic seizures (a type of generalized seizures) that occur from a moment sometime between the seventh month and the sixth year.

Different therapeutic ketogenic dietary variations

Various ketogenic eating methods are used to combat epilepsy (17):

  • MCT diet
  • Classic Ketogenic Diet
  • Modified Atikins Diet

MCT diet

The MCT diet is based on a relatively high intake of MCTs. These fatty acids are easy to process by the body and thus also support the production of ketones.

The ratio of macronutrients is 71% fat, 19% carbohydrates and 10% protein.

In this form of the ketogenic diet, MCT oil in the form of a supplement drink is widely used.

Classic Ketogenic Diet

The classic ketogenic diet, when used for therapeutic purposes, has an extremely high content of fat: no less than 90%!

The remaining 10% comes from carbohydrates and proteins.

Often vitamins and minerals need to be supplemented by supplements.

Modified Atkins Diet

The modified Atkins Diet corresponds in terms of macronutrients to macros as recommended with a Standard Ketogenic Diet.

The distribution is 75% fat, 20% protein and 5% carbohydrates.

Finally

The ketogenic diet has a long tradition of combating seizures.

This tradition even goes back to antiquity in which the concept of fasting was already used to prevent seizures and disorders.

Experienced a ‘revival’ in the early 19th century when american doctors Rollin Woodyatt and Russell Wilder discovered that ketone production could be stimulated not only through fasting, but also through a low-carb and high-fat diet: the ketogenic diet.

The action of the ketogenic diet as a remedy for epilepsy is based on various properties of ketones in the body. Ketones provide:

  • More energy
  • Repairs to nerve and brain cells
  • Protection against free radicals
  • New communication paths in the brain
  • Fewer stimuli in the brain

In therapeutic treatments, different variants of the diet are used:

  • MCT diet
  • Classic Ketogenic Diet
  • Modified Atkins Diet

Of these variants, the Modified Atkins Diet comes closest to the Standard Ketogenic Diet.

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