Ketogenic diet for Epilepsy

Introduction

There are many conditions in Western industrialised societies today that were unheard of, or at least very rare, just a century ago. The same conditions are still unheard of in primitive peoples who do not have the 'benefits' of our knowledge. There is a very good reason for this: They eat what Nature intended; we don't. The diseases caused by our incorrect and unnatural diets are those featured on these pages.

Dietary causes:

Epilepsy today is generally controlled with antiepileptic medications. Occasionally surgery and nutritional strategies are also used. Despite these, up to 30% of epilepsy seizures are not adequately controlled. Yet for decades a carefully calculated ketogenic diet, very high in fat, low in protein, and almost carbohydrate free, has proven to be very effective in the treatment of difficult-to-control seizures in children. This ketogenic diet for epilepsy was only discontinued for the control of seizures as new medications were developed. Nevertheless, Johns Hopkins Medical Center in the USA has continued to use it in epilepsy with great success.[1]

The Johns Hopkins Ketogenic Diet for epilepsy was first formulated in the early 1920's It is a carefully calculated diet, in which some 90% of calories come from fat. The other 10% is almost all from protein as it is almost carbohydrate-free. It is very effective when used for the treatment of difficult-to-control seizures in children. For more than three-quarters of a century, it has been very effective. However, many centers stopped using the diet to control seizures as new medications were developed.

Of recent times a ketogenic diet very high in fats has been advocated for epilepsy again in other centres. Again about 90% of the calories in the diet come from fats. It is not clear what mechanism of action accounts for reports of decreased epileptic seizure activity during ketosis. Drs. Lefevre and Aronson of Northwestern University Medical School, Chicago, reviewed the literature to determine if there was any evidence that a ketogenic diet could be useful in paediatric patients with intractable epilepsy.[2] They analysed eleven published studies and one unpublished study. The results of this review are shown below:

The range of patients who:

• Became completely seizure free 7 — 33%
• Had more than 90% reduction 22 — 56%
• Had more than 50% reduction 29 — 100%

Although there were some adverse effects such as gastrointestinal symptoms in up to half of the epileptic children, these only lasted for a short time and were probably caused because the diet was so different from what the children were used to.

These studies of the ketogenic diet in epilepsy were not placebo-controlled and the evidence gleaned was not of the highest quality. Nevertheless, it is not likely that the results were merely caused by the placebo effect or by the spontaneous remission that sometimes occurs in childhood epilepsy.

It's not just for children

A small study of eleven epileptic adults: nine women and two men, conducted at Jefferson Medical College, Philadelphia, and published the previous year had showed that this diet works for adult epileptics as well.[3] After eight months of follow-up, three patients had a 90% decrease in epilepsy seizures, three patients had between 50% and 89% decrease in seizure frequency, and one patient had less than 50% seizure decrease. The other four patients discontinued the diet. The authors say 'The ketogenic diet shows promise in both adult generalized and partial epilepsy' but recommend further study.

But what will further study achieve? This ketogenic diet regime has been used successfully in epilepsy for over 80 years and it conforms almost exactly to the diet advocated here for the prevention and alleviation of many other conditions. With millennia of epidemiological evidence and a wealth of clinical study to back it, I see no reason to suppose it has any inherent dangers.

Johns Hopkins scientists have produced a text and a computer disc which enables families to calculate the diet more easily. (see http://www.neuro.jhmi.edu/epilepsy/keto.html)

Epilepsy and schizophrenia

Several studies, have found that patients with epilepsy tend to have a higher prevalence of schizophrenia-like psychosis compared with the general population. The authors of a population-based Danish study of 2.27 million people report that 'There is a strong association between epilepsy and schizophrenia or schizophrenia-like psychosis. The two conditionsmay share common genetic or environmental causes.'[4] It may be significant that this study showed that the type of epilepsy didn't seem to affect the likelihood of schizophrenia. The risk increased with increasing number of admissions to hospital for epilepsy treatment and particularly with increasing age at the first admission for epilepsy. As most hospitals treat epilepsy with drugs and a 'healthy' diet, could they be the reason for the increased risk?

References

[1]. http://www.neuro.jhmi.edu/epilepsy/keto.html . Accessed February 2002.

[2]. Lefevre F, Aronson N. Ketogenic diet for the treatment of refractory epilepsy in children: a systematic review of efficacy. Pediatrics 2000; 105: e46.

[3]. Sirven J, Whedon B, Caplan D, et al. The ketogenic diet for intractable epilepsy in adults: preliminary results. Epilepsia 1999; 40: 1721-6.

[4]. Qin P, et al. Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study. BMJ 2005;331:23.