The Ketogenic Diet; How to Make a Good Thing Better

The ketogenic diet has been a powerful tool for seizures forever.  Longer even then the drugs to treat seizures that are commonly used.

The unfortunate fact is that natural approaches to seizures are almost always the last tool recommended by neurologists, despite the fact that they typically perform better than medications.

Maybe one of the reasons that doctors don’t recommend natural approaches like the ketogenic diet because they require a much greater commitment to care than does taking a medication once or twice a day.  But this decision should ALWAYS be left up to the patient—it is not your doctor’s choice to decide whether or not you will make the commitment.

There are basically two “problems,” if you will, with the ketogenic diet.  One is compliance (needing to avoid carbohydrates can be too restrictive for some, especially with hidden triggers in all kinds of foods) and the other is effectiveness.

What if these two issues could be address with additional tools?  And what if these tools were the same?

This cannot be said of medication.  Let’s say you’re on Topamax for your seizures (for the sake of simplicity we won’t go into how often epileptic patients end up on multiple medications).  Really the only options for you to increase seizure control would be to increase the dose.  And along with that added dose comes greater side effects.

(And just in case you thought you’d try the ketogenic diet along with your medication, recent research suggests that certain anti-epileptic drugs can actually reduce the effectiveness of the ketogenic diet–this should be of grave concern to anyone on anti-epileptic drugs.)

And the risks of increasing your anti-epileptic drug dose includes getting shot by overzealous video game addicts who have played one too many zombie-killing games.  That and drooling on a new shirt.

Or you could always add another medication.  Although most often this is mere guesswork and just increases the side effect list without a real improvement in quality of life.

This is not going to be the case when you add tools to the ketogenic diet.  Adding tools could mean that you need to adhere to a slightly less stringent protocol or that you could get even better seizure control.  Just imagine living life on the edge by staring into a strobe light or going to see Blue Man Group.

Let’s cover these two options separately.

First has to do with modifications to the standard ketogenic diet.  Some of these are modifications, while some of them I’m including because they are diets that you should be aware of.  The best resource, unquestionably, is the Charlie Foundation, which was formed to promote the use of the ketogenic diet.

  1. Standard ketogenic diet—this one is the most restrictive, with a 4:1 ratio of fats to carbs/proteins.
  2. MCT ketogenic diet–this diet uses MCTs from coconut oil as the main source of calories, allowing for a higher carb intake and more variety in the diet
  3. Modified Atkin’s Diet (MAD)—the ratio is less restrictive at 1:1 of fats to carbs/proteins
  4. Glutamate/Aspartate Restricted Diet (GARD)—designed to restrict the intake of the excitatory neurotransmitter glutamate found in certain foods (the best resource on the specifics can be found here).

All of these can be extremely powerful natural tools for managing seizures.  The clinical studies have been done and the anecdotal stories from patients are everywhere.  I remain amazed by one particular group on Facebook specifically geared towards Diets for Epilepsy.  The specific knowledge of the people in this group has continually reminded me of how much I have to learn.

One of the problems with the ketogenic diet is that we just don’t really know how it works specifically.  There is lots of educated conjecture, but nothing to date has nailed it.  Some theories about how the ketogenic diet works include:

  • Alteration of the gut bacteria, changing the neurotransmitters released from the gut to a less excitatory pattern
  • Avoidance of gluten on the ketogenic diet (gluten has been established as a player in many persons with epilepsy)
  • Change in dietary fat intake since fat plays such a major role in brain cell function and health

Besides these theories, looking at it from a deeper biochemical level, ketogenic diets are known to increase levels of a compound in the brain called hypoxia-inducible factor-1α (HIF-1α).  HIF-1α is a compound that is released in response to lowered levels of oxygen.  Basically a protective compound released that causes the brain to go into “uh-oh” mode and snap to attention, leading to all kinds of VERY positive changes in brain cell function.

Besides HIF-1α, there is also evidence that the ketogenic diet can activate Sirt1 in brain cells.  For those of you not familiar with Sirt1, it is a gene that does all kinds of wonderful things in our body and is considered by some as a “longevity gene.”  Well-known is its ability to increase both the number and function of the mitochondria in cells.  More mitochondria means more ATP with less by products.  More ATP means a much healthier brain cell able to control firing and thus seizure activity.

Thanks to the author of this particular article, we can look at this mechanism of the ketogenic diet and see if there are other tools that we can use to make the ketogenic diet even more powerful.  The author suggests that the biochemical changes induced by the ketogenic diet can go as far as helping the brain cells “clean house;” removing damaged mitochondria within brain cells.

Here are some ideas of how we could help this process naturally:

  • Berberine, a compound found in certain herbs such as goldenseal.
  • Metformin (not a natural approach and not my preference, but if a drug like metformin could reduce or eliminate the need of far more toxic anti-seizure drugs, well….).
  • Compounds known to increase Sirt1 activity such as nicotinamide riboside and resveratrol.
  • Medium-chain triglycerides (found in coconut oil)
  • Compounds known to increase the formation of ketone bodies (the compounds formed during the ketogenic diet from the higher intake of fats and very low levels of carbs) like carnitine and hydroxycitrate.

These are just some of the tools that could work.  This list is practically endless as there are a lot of other natural compounds that affect this pathway.

Interestingly, many of these approaches are already well-known to patients using the ketogenic diet.  Carnitine and coconut oil are common additions to the diets of people on the ketogenic diet.

If these tools can help to increase the effectiveness of diets for epilepsy or can make less restrictive diets work for others, this would be a drastic change to the way medicine handles seizures.

If this type of approach seems to make more sense to you then guessing which seizure med you should try next, then I’d strongly advise you joining the Diets for Epilepsy Facebook group as well as getting your hands on a copy of my Migraines and Epilepsy book.

James Bogash

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.