About 60-65 percent of epileptic patients are seizure-free with antiepileptic drug treatment. The remaining 35 percent was drug resistant. A review of current studies published in Neurology, however, offers a promising alternative treatment for reduction of epileptic seizure – diets high in fats and low in carbohydrates.
Researchers seek to examine the high-fat, low-carbohydrate ketogenic and modified diets of Atkins in adults for the treatment of refractory epilepsy (drug-resistant epilepsy). Both diets have proven effective in kids, but they are not adequately studied in adults.
The updated Atkins diet and ketogenic diet contain high-fat foods such as bacon, eggs, mayonnaise, butter, hamburgers, and heavy cream, with some fruits, vegetables, nuts, avocados, cheeses, and fish.
The ketogenic diet is restrictive, not very palatable and is hard to implement logistically. The Atkins diet has been adjusted as an easier-to-execute type of ketogenic diet for use in patients with tough-to-treat epilepsy.
The fat-to-carbohydrate and protein ratios are as follows:
- Ketogenic diet: 3:1 or 4:1 [fat]:[carbohydrate 1 protein] ratio by weight, with 87-90% of calories derived from fat
- Modified Atkins diet: 0.9:1 [fat]:[carbohydrate 1 protein] weight ratio, with approximately 50% of calories derived from fat.
The typical American diet, on the other hand, derives about 50 percent of calories from carbohydrates, 35 percent from fat and 15 percent from proteins. US government recommendations for adults suggest 45-65 per cent carbohydrate calories, 10-20 percent fat and 10-35 percent protein.
Report author Pavel Klein, MB BChir, of Bethesda’s Mid-Atlantic Epilepsy and Sleep Center, MD, and an American Academy of Neurology member, says:
“We need new treatments for the 35% of people with epilepsy whose seizures are not stopped by medications. The ketogenic diet is often used in children, but little research has been done on how effective it is in adults.”
The scientists studied 5 ketogenic diet treatment studies in 47 adults and 5 modified Atkins diet treatment studies in 85 adults with refractory epilepsy.
Some patients achieved 50% or greater seizure reduction
Throughout all studies, 32 percent of ketogenic diet-treated patients and 29 percent of adjusted diet-treated patients at Atkins reported 50% or greater reduction in seizures. 9% of the ketogenic diet and 5% of the modified Atkins diet-treated patients have reported a decrease in seizure by more than 90%.
- Epilepsy is a chronic neurological condition characterized by recurrent seizures
- Epilepsy affects about 2.3 million adults and 467,711 children 0-17 years of age in the US
- About 1 in 26 people will be diagnosed with epilepsy at some point in their lives
- About 150,000 new cases of epilepsy will be diagnosed in the US each year.
For both diets, the positive effect on seizures occurred early, within days to weeks. The findings remained on a long-term basis but, unlike in infants, the effects did not seem to linger after the diet has been discontinued.
Both diets had similar side effects, and not severe. Hyperlipidemia, the most extreme, reversed after discontinuation of the medication and the most common side effect was weight loss.
Klein comments, “Sadly, the use of these diets in the long term is low because they are so complicated and restrictive. Most people finally avoid the diet due to the dietary and social constraints.
“However, these studies show the diets as another option for people with epilepsy are moderately to very effective,” he adds.
Both the ketogenic diet and the modified Atkins diet trials demonstrated low retention with 51 percent of ketogenic diet-treated patients and 42 percent of modified Atkins diet-treated patients stopping diet before completion of analysis. Even those with seizure frequency reduction of 75-100 per cent eventually stop the diet due to culinary and social constraints.
The authors conclude that current data for the treatment of refractory epilepsy do not provide evidence for the ketogenic diet and the modified use of the Atkins diet. They can only be used as a last resort, before more data are available.
Ketogenic diet and modified diet therapy with Atkins demonstrate modest efficacy but the effect is dramatic in some patients.