Nutrition Interventions for Children with Special Health Care Needs

Chapter 22
Section 3 - Condition Specific Nutrition Interventions
Ketogenic Diet for Seizure Disorders
Renee Williams, MEd, RD, CD
Updated by Elaine Cumbie, MA, RD, CDE, CD
The Ketogenic Diet (KD) is an established, effective nonpharmacologic treatment
of many types of epilepsy. It is a high fat, adequate protein, and low carbohydrate
diet. Ketosis occurs when the body’s carbohydrate intake is limited and fat from the
body or diet becomes the primary energy source for the body. The exact mechanism
of the diet’s anticonvulsant and antiepileptic effects is not known. However, it has
been proposed that changes in cellular metabolism resulting in increased metabolic
enzymes modifies the cell and decreases hyperexcitability, and hence a less
epileptiform state. Another speculation is that the antiepileptic effect is exerted via
neuroprotection. This may involve protection from free oxygen radicals or prevention
of apoptosis (1,2,3,4,5).
The beginning of the specific use of the KD dates to 1921 (5,6). The Mayo
Clinic’s 1921 article suggested that a high fat diet, adequate in protein and low in
carbohydrate could mimic the effects of starvation, thus producing seizure control.
The diet fell out of favor in 1938 when phenytoin (Dilantin) was discovered leading
to the era of medication treatment for epilepsy (5). Revival of the KD began in
the early 1990’s with a Hollywood producer and writer, Jim Abrahams and his son
Charlie. Charlie’s seizures were refractory to medications and other treatments.
Abrahams read about the KD, and took his son to Johns Hopkins Hospital to start the
diet. Charlie’s seizures stopped completely soon after starting the diet. Abrahams
created the Charlie Foundation, published a book about the KD, created a Dateline TV
program about the KD in 1994, and a made-for-television movie called, “First Do No
Harm”.
There are four KD approaches being practiced around the country (6). They are
1. Long chain triglyceride diet (classic or traditional KD diet)
2. medium chain triglyceride (MCT) diet
3. Modified Atkins diet
4. Low Glycemic Index Diet.
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