Diet

Types of Dietary Therapy

Dietary therapies can help control various types of seizures in both children and adults when medicines alone don’t work. There are four major dietary therapies used today for epilepsy. They are all low in carbohydrates (like sugar, pasta, and bread) and high in fat (like butter, oils, bacon, and avocados).

Types of Diets to Treat Seizures

Ketogenic Diet (KD)
Medium-Chain Triglyceride (MCT) Diet
Modified Atkins Diet (MAD)
Low Glycemic Index Diet (LGID)

Ketogenic Diet

The Keto Diet is very high in fat and very low in protein and carbohydrates. It is designed to make the body burn fat instead of carbohydrates as the main source of energy. The body will go into ketosis as a sign that fat is being burned, and this can be detected in the urine of those on the diet. This diet is often restricted to a small number of calories each day and strict amounts of fat, proteins, and carbohydrates.

Medium Chain Triglyceride (MCT) Diet

The MCT Diet is often used to supplement the Keto Diet by adding a specific type of fat called MCT. MCTs are smaller than most fats and easier to digest. They get absorbed into the blood quickly and turn the oil into usable energy. This diet adds MCT oil to supplement the fats consumed during the Keto Diet.

Modified Atkins Diet (MAD)

This diet, like the Keto Diet, is very high in fat and very low in protein and carbohydrates. It is less restrictive than the Keto Diet and allows for more calories and a wider variety of foods. With the MAD, foods are not weighed and measured as in the Keto Diet, and the amounts of fats, proteins, and carbohydrates are less restricted.

Low Glycemic Index Diet (LGID)

The LGID is an alternative to the Keto Diet and limits the type of carbohydrates a person can eat. This diet focuses on eating carbohydrates with a Low Glycemic Index, a measurement of how a food raises blood sugar. Low Glycemic Index foods (e.g., whole grain breads and berries) do not raise blood sugar as dramatically as those with a High Glycemic Index (e.g., candy and chips).

Comparison of Diet Therapies for Epilepsy

Swipe sideways to compare all four diets. Questions stay visible as you scroll.

Comparison of Diet Therapies for Epilepsy
Questions	Classic and Modified Keto	MCT Oil	Low Glycemic Index Treatment	Modified Atkins
Is medical supervision required?	Yes	Yes	Yes	Yes
Is diet high in fat?	Yes	Yes	Yes	Yes
Is diet low in carbohydrate?	Yes	Yes	Yes	Yes
What is the ratio of fat to carbohydrate & protein?	4:1, 3:1, 2:1, 1:1	Approximately 1:1	Approximately 1:1	Approximately 2:1
How much carbohydrate is allowed on a 1000 calorie diet?	8gm carb on a 4:1; 16gm carb on a 3:1; 30gm carb on a 2:1; 40–60gm carb on a 1:1	40–50gm	40–60gm	10gm adolescents or 15gm adults for 1 month; 20gm afterwards
How are foods measured?	Weighed	Weighed or measured	Measured or estimated	Estimated
Are meal plans used?	Yes	Yes	Yes	Optional
Where is the diet started?	Hospital or Home	Hospital or Home	Home	Home
Are calories controlled?	Yes	Yes	Yes	No
Are vitamin and mineral supplements required?	Yes	Yes	Yes	Yes
Are liquids (fluids) restricted?	No	No	No	No
Is a pre-diet laboratory evaluation required?	Yes	Yes	Yes	Yes
Can there be side effects?	Yes	Yes	Yes	Yes
What is the overall difference in design of these diets?	Foods are weighed in grams; the ratio can be adjusted for stronger ketosis or for better tolerance.	Medium Chain Triglycerides (MCT) are highly ketogenic which allows more carbohydrate.	Low glycemic carbs in combination with fat results in steady glucose levels.	Loosely structured; fat is encouraged, protein is not limited but too much is discouraged.

Statistics on Treatments for Epilepsy

Epilepsy is a diagnosis that is made after someone has had a seizure along with specific symptoms. An anti-seizure drug is typically tried as a first line of treatment. Some people are candidates for epilepsy surgery if their epilepsy is found to stem from a localized area of the brain.

Statistics on the success of anti-seizure drug treatment haven’t changed in 60 years.¹

After trying the 1st drug, 47% become seizure-free; 53% continue having seizures.
After trying the 2nd drug, 13% become seizure-free; 40% continue having seizures.
After trying the 3rd drug, 1% become seizure-free; 39% continue having seizures.

This treatment failure is known as “medication resistant epilepsy”.

When Should Ketogenic Diet Therapy Be Considered?²

After trying a 2nd drug according to the International Ketogenic Diet Study Group’s published guidelines in 2018 and, sooner for some conditions (see chart below).

According to the 2016 Cochrane Review of evidence from 11 randomized controlled trials:³

Seizure freedom reached as high as 55% with the ketogenic diet and 10 to 25% with the Modified Atkins Diet (MAD). The proportion of individuals who had 50% or greater seizure reduction was as high as 85% in the ketogenic diet and 60% in MAD.

Ketogenic Diet Therapy Should Be Tried Earlier in the Course of Treatment for These Conditions²

Conditions where diet therapy should be considered:

Angelman syndrome
Complex 1 mitochondrial disorders
Dravet syndrome³
Epilepsy with myoclonic–atonic seizures (Doose syndrome)
Glucose transporter protein 1 deficiency syndrome
Febrile infection–related epilepsy syndrome
Formula-fed (solely) children or infants
Infantile spasms
Ohtahara syndrome
Pyruvate dehydrogenase deficiency
Super-refractory status epilepticus
Tuberous sclerosis complex

Conditions where diet therapy could be considered:

Adenylosuccinate lyase deficiency
CDKL5 encephalopathy
Childhood absence epilepsy
Cortical malformations
Epilepsy of infancy with migrating focal seizures
Epileptic encephalopathy with continuous spike-and-wave during sleep
Glycogenosis type V
Juvenile myoclonic epilepsy
Lafora body disease
Landau-Kleffner syndrome
Lennox-Gastaut syndrome
Phosphofructokinase deficiency
Rett syndrome
Subacute sclerosing panencephalitis