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Ketogenic Diet Therapies for Epilepsy

The MUSC Health Ketogenic Diet

The ketogenic diet (KD) is a medical treatment for epilepsy that has been used for many years. When you are on a ketogenic diet you eat a large amount of fat, moderate amounts of protein, and a small amount of carbohydrates (sugar). For the “classic” KD the food must be weighed on a gram scale and there is no cheating allowed. More recently less restrictive versions of the KD are available that do not require a gram scale but still drastically restrict carbohydrate intake and decrease seizures. The diet requires a lot of hard work and preparation.  How the KD works is still not fully understood. The KD allows the body to use ketones (fat by-products) instead of glucose (carbohydrate/sugar by-products) as its source of energy. Many persons with epilepsy on the diet or their family members talk about how the KD decreases seizures and improves their quality of life.  Ask your epilepsy team about the KD if one or two medications have failed to help you, or if your medicine has side effects that make you feel bad. Anyone who gets all of their nutrition by formula or tube feeding should also consider the diet.

Some people have an immediate improvement on the diet, while others might need to be on the diet for up to three months before they know if it will help. You will work closely with your epilepsy team during this time to make any necessary adjustments to your diet and medications.  Research has shown that 1/3rd of persons on the diet experience very good results, 1/3rd experience some benefit, and 1/3rd experience no benefit or have difficulty staying on the diet.  Many times once the KD is started antiepileptic medications can be decreased or discontinued.  If the diet works for you, we recommend staying on it for up to two years and then slowly starting back on a regular diet.  The KD also includes various vitamin and mineral supplements needed to make sure the body gets optimal nutrition. A typical meal could be a small amount of scrambled eggs, 2 pieces of bacon and cream cheese. If a person with epilepsy has a feeding tube or is an infant on formula, the KD can be used as several formula options are available.  All of the KD options require a specially trained dietitian and epilepsy practitioners to make sure the optimal benefit from the diet is achieved while maintaining patient safety.  

Classic Ketogenic Diet:

  • Meals are carefully calculated by the dietitian.
  • Requires a gram scale as all foods are weighed precisely.
  • Typically started in the hospital over 3-4 days so patients can be observed closely.
  • Calories are controlled.
  • Easy to use for a person who has a g-tube or patients who are formula-fed.
  • Vitamin and mineral supplements are necessary.
  • Clinic visits and blood work every 3 to 6 months.

Modified Atkins Diet for Epilepsy (MADE):

  • MADE was developed at Johns Hopkins University as a less strict ketogenic diet. It is a good choice for those who are unable to adhere to the “classic” ketogenic diet’s strict guidelines. In this diet, ketones are achieved by reducing carbohydrates to 10 to 20 grams daily without limiting protein and still encouraging a high fat intake.
  • Does not require a hospital admission to get started as this diet is started outpatient.
  • Portion sizes are estimated and/or measured with household measurements.
  • Calories are not controlled.
  • Typically used in adults, adolescents and children who eat orally.
  • Vitamin and mineral supplements are necessary.
  • Clinic visits and blood work every 3 to 6 months.

Low Glycemic Index Treatment (LGIT):

  • The LGIT was developed at Massachusetts General Hospital. This diet focuses on both the amount and type of carbohydrate eaten. Carbohydrate choices must have a glycemic index of less than 50 and are limited to 40 to 60 grams daily. These carbohydrates are always eaten with a protein and fat source.  When the foods are eaten together, it slows digestion and the release of sugar into the blood.  
  • Does not require a hospital admission to get started as this diet is started outpatient.
  • Portion sizes are estimated and/or measured with household measurements.
  • Calories are not controlled.
  • Typically used in adults, adolescents and children who eat orally.
  • Vitamin and mineral supplements are necessary.
  • Clinic visits and blood work every 3 to 6 months.

What Happens Next?

  • First, check out the resources mentioned at the bottom of this page to learn more about the KD. 
  • Next, set up an appointment with the dietitian:
    • Pediatric (less than 18 years old): Call 843-792-3307 and ask to be scheduled with the pediatric neurology dietitian (Laura Dority). Your appointment will be on the 1st floor in the pediatric neurology clinic in Rutledge Tower.
    • Adult (18 and older): Call 843-792-3223 and ask to be scheduled with the adult neurology dietitian. Your appointment will be on the 2nd floor in the adult neurology clinic in Rutledge Tower.
  • You will meet with a dietitian to review the diet. You will need to be weighed and measured. You will be provided with a lab order for baseline labs to be done fasting before starting the diet.
  • You will need to purchase a gram scale (only for “classic” ketogenic diet) to weigh your food. Vitamin supplements and urine dip sticks will be required for all forms of KD.  Insurance may or may not cover the cost of these items.
  • For the classic KD, plan to be available to MUSC for an inpatient admission for three to four days. Your dietitian will teach you how to make your special meals using the scale.
  • For the MADE/LGIT, plan to be available for a one to two-hour educational session as an outpatient. Your dietitian will guide you on meal planning.
  • You will have check-ups with your dietitian and blood draws every 3-6 months to make sure you are doing well on his medical diet.  

Resources

Nutrition Services

Nutrition Services at MUSC Health can help you create an individualized ketogenic diet plan. Please call 843-792-3307 (pediatrics) and 843-792-3223 (adult) or e-mail Laura Dority at kenla@musc.edu to learn more about the ketogenic diet program at MUSC Health.

Diet therapies for epilepsy are medical therapy and should never be started without a dietitian's guidance and your health care team's approval.

 

Scheduling

To make an Epilepsy appointment, please call 843-792-3223.

Refer a Patient

Call our 24-hour referring physician service, MEDULINE, at 800-922-5250