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How does the ketogenic diet work?

The ketogenic diet helps the body achieve at state of ketosis, where it begins to use fat as the main source of energy instead of carbohydrates (glucose). Nutritional ketosis occurs when eating a balance of foods that provide just the right amount of fat, protein and carbohydrates. No one is sure exactly how the ketogenic diet therapy works to help treat epilepsy. When following the diet, a metabolic change occurs that changes brain chemistry. It may be due to the ketones causing an anti-seizure effect. Ketones are made when the body breaks down fat and leave the body through urine.

When managed through a specialized epilepsy center with an epileptologist and trained ketogenic dietitian, the ketogenic diet is a safe and effective way to treat epilepsy. It is a precisely calculated diet, which must be respected as if it were a prescribed medication with the goal of lowering the number and intensity of seizures not controlled by other therapies. However, complete seizure control is not always possible. Of all children treated with the ketogenic diet, more than half have a positive response. Your child may experience one or more of the following:

• Lower number of seizures
• Lower severity and intensity of seizures
• Lower length of time seizures happen
• Lower dose and/or decrease in number of anti-seizure medicine(s)
• Increased alertness

Although some forms of epilepsy are more likely to respond better to the ketogenic diet, it is not always possible to tell which children will and which will not.

Medical supervision by an epileptologist, nurse, pharmacist and a trained ketogenic dietitian is key to the success of the ketogenic diet. . Some children have a dramatic decrease in the number of seizures within the first week or two, while others do not improve for a few months. For this reason, we ask families to commit to the diet for at least three months. If ketogenic diet therapy works for your child, they will need to continue the diet for at least 2 to 3 years. The diet may be started in the hospital or at home. It usually takes 3 to 4 days for children with tube feedings to fully transition. If your child eats by mouth, it can take 3 to 4 weeks. Fasting is not required before starting. While on the diet, it is important for your child’s medical team to follow your child closely.

Before your child starts ketogenic diet therapy, your child will have:

• A neurological evaluation by an epileptologist and referral to start ketogenic diet therapy. The doctor will explain any medical concerns that may occur with starting the ketogenic diet.
• A meeting with a ketogenic dietitian trained to manage ketogenic diet therapy. The dietitian will explain the diet therapy in detail and review your child’s current nutrition plan
• Pre-ketogenic diet laboratory studies (labs) to rule out any metabolic disorders. Your epileptologist will order labs.

Once your child starts ketogenic diet therapy, your child will have ketogenic clinic visits scheduled one month after starting and then every three months or as often as your epileptologist recommends. At each visit, your child will have:

• A neurological evaluation by your epileptologist. Medicines your child takes will be adjusted in order to have the best seizure control possible.
• A nutrition evaluation by your ketogenic dietitian. Changes will be made to your child’s ketogenic diet plan as needed based on any nutrient deficiencies, medical concerns, tolerance etc. Labs will be repeated at each ketogenic clinic visit to monitor for any side effects your child might have while on the ketogenic diet.