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Ketogenic Diet

The ketogenic diet is a high fat, very-low carbohydrate, moderate protein diet that was developed in the 1920s to treat epilepsy before drugs were available. Though the diet was an effective therapy, it fell out of favor as antiepileptic drugs were introduced. It regained favor in the 1990s as researchers at Johns Hopkins Hospital and activist parent advocates demanded access to this dietary alternative. There are now over 80 clinics in the United States that offer ketogenic dietary therapy. Parents should ask their child’s neurologist for recommendations for clinics close to them if the neurologist himself doesn’t offer the therapy.

Scientists believe that ketogenic diet works by changing the metabolism of the brain, which normally relies solely on glucose (blood sugar) for energy. When carbohydrates are severely limited, the body responds by producing ketones from fat in order to feed the brain. This higher level of ketones in the blood is called ketosis. The precise mechanisms by which the ketogenic diet controls seizures are complex. Research into the exact biochemical processes for its antiepileptic effect is ongoing, but recent studies indicate that elevated blood ketones and stabilized blood sugar levels are responsible. (Masino & Rho 2012) Additionally, ketones themselves may offer neuroprotective effects to brain cells. Since there are several underlying causes of epilepsy, its potential effectiveness in any individual child is unknown. 

Despite being high in fat, the ketogenic is considered a safe treatment for children. Higher cholesterol and triglyceride levels usually normalize after a few months of treatment (McDonald 2018) and children on the diet are given multivitamins and other supplements to compensate for the lack of fruits and vegetables. In general, children also continue to take antiepileptic drugs while on the diet. After 2 years of successful treatment, children are often weaned off the diet to resume previous foods. If the diet does not succeed in reducing seizures after 3 months, other treatments are considered.​

Because of its popularity as a treatment for weight loss and diabetes, many cookbooks are now available for the ketogenic diet. These books often include child-friendly recipes. However, they may need to be modified to strictly adhere to macronutrient ratios and limit carbohydrates to achieve “therapeutic ketosis” (a higher level of ketosis than is required for weight loss or blood sugar control). Ketogenic formulas and shakes, including hypoallergenic ones, are available for infants as well as children who use a gastrostomy tube.

There are certain specific conditions, mainly metabolic (e.g. carnitine deficiency), for which the ketogenic diet is contraindicated. As such, implementing the ketogenic diet should always be discussed and coordinated with your neurologist before starting.

The ketogenic diet is now being studied as an alternative and complementary treatment for autism, brain tumors, traumatic brain injury, and degenerative neurological conditions. As such, children with these conditions may be able to enter experimental studies using the diet at treatment.​

Additional Reading

  • The Ketogenic Diet and Modified Atkins Diet: Treatments for Epilepsy. 2016. 6th edition. Written by Johns Hopkins neurologist Dr. Eric Kosoff, this book contains up-to-date and detailed level of information about implementing the ketogenic diet for children.

  • The Keto Cookbook: Innovative Delicious Meals for Staying on the Ketogenic Diet. 2011. Dawn Martenz and Laura Cramp.

  • Keto Kid: Helping Your Child Succeed on the Ketogenic Diet. 2006. Deborah Ann Snyder.

  • International League Against Epilepsy