HIPPOCRATES: He cured epilepsy with diet and fasting. (Engraving by Peter Paul Rubens, 1638, courtesy of the National Library of Medicine.)
The ketogenic diet, a high-fat, adequate-protein, low-carbohydrate diet, is regaining popularity to treat difficult-to-control epilepsy, particularly in children.
The classic ketogenic diet contains a 4:1 ratio by weight of fat to combined amounts of protein and carbohydrate. The diet has proven to be effective in half of the patients who try it and very effective in one-third of the patients. It has given new hope to parents whose epileptic children status couldn’t be improved by anticonvulsant medication.
After stroke, epilepsy is one of the most common neurological disorders. It is estimated that if affects 50 million people worldwide. Most people with epilepsy can successfully control their seizures with medication. However, 20 to 30 percent fail to do so despite trying different drugs. Particularly for them, the diet is proving valuable in epilepsy management.
Knowledge about this diet isn’t new. Ancient Greek physicians treated diseases, including epilepsy, by altering their patients’ diets. In the book “Epidemics,” Hippocrates describes the case of a man whose epilepsy was cured with drastic diet and fasting.
Erasistratus, a Greek anatomist and royal physician under Seleucus I Nicator of Syria, stated, “One inclining to epilepsy should be made to fast without mercy and be put on short rations.”
In modern times, the first study of fasting as a treatment for epilepsy was conducted in France in 1911. A few years later, an osteopathic physician named Hugh Conklin from Battle Creek, Michigan, treated his epilepsy patients with fasting and obtained very good results.
Because he believed that epilepsy was caused by a toxin produced in the intestines, he recommended a fast lasting 18 to 25 days and a “water diet” to allow the toxin to be eliminated from the body.
In 1921, Dr. Rusell Wilder, at the Mayo clinic, coined the name ketogenic diet, based on previous research, to describe a diet that produced a high level of compounds called ketones in the blood through a diet consisting largely of fat and lacking in carbohydrate.
During the 1920s and 1930s, when there were only a few effective anticonvulsant drugs, this diet was widely used and studied to treat epilepsy. In 1938, with the discovery of phenytoin, an anticonvulsant drug, the focus changed to the development of new compounds of this kind.
The ketogenic diet has had a revival in recent times after it was found that children with difficult-to-treat epilepsy were more likely to find relief with the ketogenic diet than to benefit from trying a different anticonvulsant drug.
There is now evidence that adolescents and some adults can also benefit form this diet. However, children with a focal brain lesion are more likely to become seizure-free with surgery than with the ketogenic diet.
Although it can be very effective, the ketogenic diet may have complications. About 1 in 20 children on the ketogenic diet will develop kidney stones, which can be prevented to a certain extent by providing some specific supplements. In adults, common side effects include weight loss and constipation.
In addition, the diet can present some difficulties to caregivers and to the patients due to the time commitment involved in planning meals and measuring the ingredients, particularly because a strict adherence to the dietary plan is required.
However, since the diet can provide a cure to children without the use of dangerous drugs, it is an approach worth taking when dealing with this serious disease.
Dr. César Chelala is an international public health consultant.