Diet that tames epilepsy!

Epilepsy is one disease that is dreaded because of the uncontrollable seizures associated with it. However, in some individuals, a way to ensure a seizure-free life may involve having to go on a special diet that is high in protein and low in carbohydrate, reports Sade Oguntola.

Imagine that your child with epilepsy could have seizures less frequently, by eating more protein and less carbohydrate. Apart from helping some people shed unwanted pounds, this popular diet referred to as Atkins diet can also effectively diminish epileptic seizures in adults too, when drugs and other treatments fail or cause complications, said a new study.

For almost a century, doctors have always prescribed an eating plan called the ketogenic diet to treat children with epilepsy. This diet often consists of a short period of fasting, strictly limits fluids and drastically restricts carbohydrates. It appears to limit or even eliminate seizures, possibly by generating the build-up of ketones, compounds the body produces when it derives calories mostly from fat.

Some of the largest studies to scientifically test this diet’s efficacy took place at Johns Hopkins in the mid-1990s was led by paediatric neurologists John Freeman, M.D., and Eileen Vining, M.D.

The effectiveness of the diet to reduce frequency of seizures in adults, the study tried out in over 30 adults with epilepsy, between 18 to 53 years, who had tried at least two anticonvulsant drugs without success and had an average of 10 seizures per week. They were restricted to 15 grammes of carbohydrates a day with a few strawberries, some vegetables, or a bit of bread.

The patients kept diaries with a record of their dietary intake and how many seizures they had. The researchers then examined the condition of each patient at the first, three and six months, after starting the diet.

The findings revealed that about a half the patients had experienced a 50 per cent reduction in the frequency of their seizures by the first clinic visit. About a third of the patients halved the frequency of seizures by three months. Side effects linked with the diet, such as a rise in cholesterol or triglycerides, were mild. A third of the patients dropped out by the third month, unable to comply with the restrictions.

Reporting on the results in the February issue of Epilepsia, Eric H. Kossoff, M.D., an assistant professor of neurology and paediatrics at the Johns Hopkins University School of Medicine, said “Fourteen patients who stuck with the diet until the six-month mark chose to continue, even after the study ended, a testament to how effective the diet worked to treat their epilepsy.”

Kossoff said though the modified Atkins diet would not be a good fit for all patients, “It opens up another therapeutic option for adults trying to decide between medication, surgery and electrical stimulation to treat intractable seizures.”

There are a number of diets being tried to help people with epilepsy. The ketogenic diet (KD), a high fat, adequate protein, and low carbohydrate diet, is the most well known of dietary therapies amongst the epilepsy community. It was initially devised in 1921 to “mimic the anticonvulsant effects of fasting, which were known to suppress seizures.” Because the KD is high in fat and low in carbohydrates, the body is forced to burn fat for energy, a process called ketosis.
In 2002, Johns Hopkins researchers began testing a modified version of the Atkins diet in children with epilepsy. The modified diet shares the high-fat focus of the ketogenic diet, prompting the body to generate ketones. However, it allows more carbohydrates and protein, does not limit fluids and calories, and has no fasting period. When studies showed that the new diet prevented or curtailed seizures in children, the researchers began testing it for efficacy and ease of use in adults.

It has several drawbacks and side effects. The highly restrictive regimen requires accurate measurement of all foods and liquids to ensure consumption of the proper ratio of fats, carbohydrates and protein necessary to produce ketones. The diet starts with a brief fast and hospital stay during which time families are trained in the rigours of the diet. Side effects can include kidney stones, constipation and slowed growth.

The modified Atkins diet also requires no restrictions on calories, fluids and protein, and does not require a hospital admission and fast to begin. It also does not require the accurate weighing and measuring of foods, which may translate to better compliance with the regimen, researchers concluded.

Prof. Sola Ogunniyi, a consultant neurologist, said this form of diet that is rich in high-protein and has low-carbohydrate can significantly reduce the number of seizures in children. He said, it no doubt, can bring about a control in difficult to treat seizures because the seizures are not effectively controlled with drugs and other treatments.

He explained that when patients take this modified Atkin’s diet, the high amount of fat provides a substrate that ensures that the metabolic process in the brain cell that causes the occurrence of the abnormal discharges in the brain called epilepsy will be better controlled.

He declared that the Atkins diet would have to be used alongside other drugs and treatments to ensure that the frequency of seizures is reduced.

According to him, even right now in Nigeria, this method of treatment is not used in children because of the many restrictions that will have to go with it to ensure it is effectively carried out and the fact that most patients attended to respond very well to the drugs that are prescribed for seizures.

He said it might not be used in adult patients too because of the significant lifestyle alterations that may be required as well as the side effects it could have such as increase in blood cholesterol level and increased risk for kidney failure.

Why exactly the ketogenic diet works remains unknown, and it is notoriously difficult to follow, relying almost solely on fat and protein for calories. Consequently, doctors typically recommend it only for children, whose parents can strictly monitor their eating habits. The ketogenic diet is not prescribed for adults, who generally make their own food choices and often have difficulty complying with the diet’s strict guidelines.