Ketogenic diet for seizures, refractory epilepsy - Does a high fat diet reduce the risk for seizures?
March 26 2017 by Ray Sahelian, M.D.

A ketogenic diet is a high-fat, low-carbohydrate diet that induces excess production of ketone bodies, which are incompletely burned fat molecules. This diet has been used since the 1920s to control epileptic seizures that do not respond to drug treatment. For more information on epilepsy.

How does the ketogenic diet work?
During glucose restriction, ketone bodies and polyunsaturated fatty acids may enhance mitochondrial respiration and ATP production, and decrease reactive oxygen species production. Ketone bodies can reduce oxidative stress. Ketone bodies may attenuate spontaneous firing of ATP-sensitive potassium channels in central neurons. The ketogenic diet alters the fundamental biochemistry of neurons in a manner that not only inhibits neuronal hyperexcitability but also induces a protective effect.
   My thoughts and hypothesis: I am aware that fish oils help reduce the risk of cardiac arrhythmias by helping stabilize neuronal excitability. I wonder if fish oils or eating fish could have the same benefits in brain tissue, helping reduce neuronal excitability and thus reducing the occurrence of seizures.

Glioma treatment
Journal of Lipid Research. 2014.  The Ketogenic Diet for the Treatment of Malignant Glioma. The ketogenic diet (high fat, low carbohydrate and protein), caloric restriction, and fasting all cause a metabolic change; specifically, a reduction in blood glucose and an increase in blood ketones. We, and others, have demonstrated that these metabolic changes improve survival in animal models of malignant gliomas and can potentiate the anti-tumor effect of chemotherapies and radiation treatment.

Supplement with micronutrients
No To Hattatsu. 2013. Changes in serum levels of selenium, zinc and copper in patients on a ketogenic diet using Ketonformula]. The decline of the serum selenium concentrations and daily enteral intakes of selenium, zinc, and copper after 6 months on Ketonformula suggested that patients on this ketogenic formula needs close monitoring as well as supplementation of these trace minerals.

The role of a specific protein
The results of their research in mice suggest that resistance to seizures among people who eat a ketogenic diet is linked to a protein that modifies cellular metabolism in the brain. In tests with mice, researchers found that modifying the BCL-2-associated agonist of cell death protein led to altered brain metabolism and protected against seizures.

Reduce the risk of kidney stones
A 2009 study evaluated children being treated for seizures with the ketogenic diet at Baltimore's John Hopkins Children's Center. Children receiving the supplement potassium citrate were several times less likely than others to develop kidney stones. Dr. Eric Kossoff claims the ketogenic diet given many children whose seizures are not responding to medication starts biochemical changes that eliminate seizure-triggering short circuits in the brain's signaling system. But, the low-carbohydrate diet causes a buildup of calcium in the urine and a small percentage of those on it form kidney stones.

Ketogenic diet studies
2006 ketogenic diet study
Long-term use of the ketogenic diet in the treatment of epilepsy.
Dev Med Child Neurol. 2006. Groesbeck DK, Bluml RM, Kossoff EH. The Johns Hopkins University School of Medicine, USA.
Long-term outcomes of the ketogenic diet in the treatment of epilepsy have not previously been reported. A retrospective chart review of children treated with the ketogenic diet for more than 6 years at the Johns Hopkins Hospital was performed. In all, 28 patients (15 males, 13 females), currently aged 7 to 23 years, were identified. The median baseline seizure frequency per week at diet onset was 630 (range 1-1400). Diet duration ranged from 6 to 12 years; 19 remain on the diet currently. After 6 years or more, 24 children experienced a more than 90% decrease in seizures, and 22 parents reported satisfaction with the diet's efficacy. Ten children were at less than the 10th centile for height at diet initiation; this number increased to 23 at the most recent follow-up. Kidney stones occurred in seven children and skeletal fractures in six. After 6 years or more the mean cholesterol level was 201mg/dl, high-density lipoprotein was 54mg/dl, low-density lipoprotein was 129mg/dl, and triglycerides were 97mg/dl. Efficacy and overall tolerability for children are maintained after prolonged use of the ketogenic diet. However, side effects, such as slowed growth, kidney stones, and fractures, should be monitored closely.

2007 ketogenic diet study
Dr. Thomas N. Seyfried at Boston College, Chestnut Hill, Massachusetts evaluated the efficacy of KetoCal, a ketogenic diet formulated to treat unresponsive epilepsy in children, in mice implanted with a malignant mouse brain tumor and a human malignant glioma, a brain tumor that responds poorly to drug therapy. The mice were fed a regular, high-carbohydrate diet, unlimited amounts of KetoCal, or restricted amounts of KetoCal. Growth of the two tumors was reduced from 35 percent to 65 percent in mice given restricted KetoCal, compared with mice receiving normal or KetoCal diets that were unrestricted. Survival was also significantly longer among mice receiving the restricted KetoCal diet. Blood sugar levels were significantly lower and circulating ketone bodies significantly higher in mice fed the restricted KetoCal diet, the researchers note. The restricted KetoCal diet starves the brain cancer cells by removing molecules needed for cell growth and survival. While the normal brain cells are sustained by ketones, the tumor cells can't metabolize ketones. Nutrition & Metabolism, February 2007.

2008
The ketogenic diet has been proposed since the 1920s as a way to control seizures in children with recalcitrant epilepsy that does not respond well to prescription drug treatment. Dr. Elizabeth G. Neal, from University College London, randomly assigned a group of children who were having at least seven seizures a week despite anti-epileptic medication therapy, to a standard diet or a ketogenic one. After three months, children on the ketogenic diet had more than one third fewer seizures, while seizure frequency increased in children on the standard diet. The most common side effects with the ketogenic diet were constipation, vomiting, lack of energy, and hunger. Lancet Neurology, online May 2008.

Emails
I was wondering if you had any opinions on the use of coconut oil in the context of a restricted carbohydrate diet (e.g. Modified Ketogenic) for patients taking antipsychotic medications. I thought this would be an interesting subject to look at given the predisposition to adverse lipid profiles and metabolic syndromes presented by the use of such medications. I understand such diets have beneficial properties in addressing such conditions.
   A. Thus far I have not seen studies regarding the role of coconut oil in this condition.