Understanding Epilepsy: A Nutritional Approach

Epilepsy is a brain disorder that can cause unprovoked, recurring seizures. It is the fourth most common type of neurological disorder worldwide and, although it can occur at any point in a person’s life, incidence is highest in the first two years. However, new epilepsy cases have been observed in older adults. According to the Centers for Disease Control and Prevention, an estimated 3 million adults and 456,000 children in the United States have epilepsy.

There are many different types of epilepsy and seizures, and it’s possible for people with epilepsy to have more than one type of seizure. Some seizures affect the entire brain (primary generalized seizures) and cause momentary staring spells (generalized absence seizures), while others cause a person to fall to the ground and shake, sometimes violently (tonic-clonic or grand mal seizures). There also are a variety of “focal seizures” or partial seizures that occur in only one area of the brain. Because seizures can occur for many reasons, a diagnosis of epilepsy is usually made after a person experiences two or more seizures at least 24 hours apart.

Epilepsy can be caused by an infection of the central nervous system, a stroke, brain tumor or a head injury, but sometimes there is no known cause. Epilepsy is a complex condition, so it’s important to consider a holistic approach to management, including nutrition.

The Role of Diet in Managing Epilepsy

Epilepsy is treated with a variety of medications and, in some cases, surgery, but about one-third of people with epilepsy are resistant to medical treatments. Because of the challenges in managing epilepsy with medications, research continues to explore nutrition and supplement treatments. The ketogenic diet, also known as keto, is one type of treatment that has been used since the early 1900s for epilepsy management.

This high-fat, moderate protein, low-carbohydrate diet creates a ketogenic metabolic state ─ meaning the body uses fat instead of carbohydrates as a primary source of fuel. Keto therapy is used for children and adults who don’t respond well to traditional epilepsy treatments. However, more research is needed on this diet’s efficacy on seizure control for adults.

Although the keto diet can help with managing epilepsy, it can be difficult to follow. All foods and drinks must be precisely weighed. Dietary fat accounts for 80% to 90% of total calories while only allowing a small percentage of calories from carbohydrates and protein, making it difficult to stick with the diet for an extended period of time. There also are other factors to consider when choosing this type of diet, including a personal history of metabolic disorders; picky eating; gastrointestinal issues; liver, kidney or heart problems; diabetes; or use of steroid medications, as well as lack of food access, storage or time.

Other dietary approaches include a less restrictive keto diet, known as a medium-chain triglyceride or MCT diet. The MCT diet includes more carbohydrates and a lesser amount of fat, mostly in the form of MCT oil. Two other types of diet therapy for epilepsy include a modified low carbohydrate diet and the low glycemic index diet. Both diets provide about the same amount of fat as the MCT diet, but the amount of protein tends to be higher. In the low glycemic index diet, the carbohydrates eaten are primarily from low-glycemic carbohydrate foods. All these eating plans, including the keto diet, can have side effects such as bloating, constipation, diarrhea, vomiting, lack of energy, abdominal discomfort and feelings of hunger, which can lead to people stopping the diet.

There are a variety of nutrients that have been studied in controlling seizures including omega-3 fatty acids from fish oil, vitamin D3, vitamin E, vitamin B6, as well as vitamin C and pyruvate, a compound that helps metabolize carbohydrates in the body. However, studies on these nutrients in the treatment of epilepsy are limited, so it’s still not clear on dosage safety and which types of epilepsy would benefit most, if at all, from these supplements.

Considerations for Dietary Treatment of Epilepsy

More treatments are needed for people with epilepsy, given the wide range of neurological disorders encompassed as well as the high number of people who don’t respond to medications. Research shows a nutritional approach using a classic or modified keto diet may be beneficial for some people with epilepsy, helping to reduce seizures. However, a keto diet is restrictive and requires management and oversight from a patient’s health care team, including a registered dietitian nutritionist and neurologist. This type of diet requires planning, tracking and monitoring.

Diet therapy should be tailored to address energy and nutrient requirements based on a person’s age, food preferences, socio-economic factors and caregiver or supporter ability to prepare a specific diet. A keto diet also can affect a child’s growth, so regular follow-ups with the child’s health care team are important, even if they are no longer following a keto diet.

A registered dietitian nutritionist trained in keto-diet management can provide dietary guidance, help monitor growth patterns (in children) and laboratory results, and ensure nutritional needs are being met. Multivitamins and minerals or specific supplements, such as vitamin D, may be needed due to risk of deficiency. The type of supplement also will need to be carefully determined, since many forms contain carbohydrates. Before considering a major dietary change for the treatment of epilepsy, be sure to consult with your health care team.