Ketogenic Diet and Epilepsy
A Brief overview of how the Ketogenic diet can have an impact on patients with Epilepsy.
Overview of Epilepsy and Seizure
The clinical definition of epilepsy is an individual which has 2 or more unprovoked or reflex seizures occurring less then 24 hours apart or an individual who has a single unprovoked or reflex seizure with a high risk of recurrence. In total, 3.4 million people in the united states have epilepsy (cdc).
Seizures involve sudden, temporary, bursts of electrical activity in the brain that change or disrupt the way messages are sent between brain cells. These electrical bursts can cause involuntary changes in body movement or function, sensation, behavior or awareness — Epilepsy Foundation.
To Control Epilepsy we must develop control — over these “sudden, temporary bursts of electrical activity in the brain” that is, seizures. Electrical activity in the brain, while difficult to understand its complexity, is not mysterious or mystical — no, in fact it can be altered by numerous factors including diet. The key to this control over the brains electrical activity is neurotransmitters.
Neurotransmitters
Excitatory neurotransmitters “excite” the neuron and cause it to “fire off the message,” whereas Inhibitory neurotransmitters block or prevent the chemical message from being passed along any farther (Cleveland Clinic). In a normal brain these neurotransmitters strike a balance, but sometimes — for various reasons, this balance is disrupted.
The two primary neurotransmitters of concern are Glutamate — the most common excitatory neurotransmitter in the brain, and Gaba — An Inhibitory neurotransmitter in the brain. There are several medications which reduce Glutamate or Increase the amount of Gaba in the brain including Lamotrigine, Gabapentin, and Valproic Acid. Many patients find success with these medications, with one study finding that lamotrigine controls seizures in 63% of patients.
Overview of Ketogenic Diet
The Ketogenic diet has been used to treat epilepsy since arounds the 1920’s, according to study published in Frontiers of Neuroscience. The diet is essentially a diet with very low amounts of carbs, medium amounts of protein, and high amounts of fats. Becuase the body doesn’t have carbohydrates for energy, it begins to burn protein and fat for energy and producing a compound known as Ketone Bodies.
Ketone bodies synthesized in the body can be easily utilized for energy production by the heart, muscle tissue, and kidneys. Ketone bodies also can cross the blood-brain barrier to provide an alternative source of energy to the brain (Stat Pearls)
Ketogenisis breaks down fatty acids to produce acetone, acetoacetate, and beta-hydroxybutyrate molecules (Stat Pearls). As revealed in a study published in the Journal of Neurochemistry, when acetoacetate is present in the synaptomes the rate of GABA Synthesis is much higher.
Aspartate, which is also thought to have a role in seizures due to it’s excitatory status, is greatly decreased (up to 23%) after 7 to 10 days on the Ketogenic diet due to one of the products of Ketogenesis previously discussed — acetoacetate, decreasing the transamination of Glutamate to Aspartate.
There’s also debate on whether the levels of Glutamate is effected. Currently there is no evidence of this but some hypothesize that the transportation or metabolism is altered — there is some evidence of this, seeing as Glutamate is the main precursor for GABA, and since GABA synthesis is so vastly increased while Glutamate levels remain steady it is likely without an increase in production would indicate that metabolism is altered.
Why Ketogenic diet is only used for medication resistant epilepsy
Various reputable studies and articles published by various Physicians, scientists, dietitians, and epidemiologists state that, overall, they wouldn’t recommend the ketogenic diet to their patients as it simply isn’t a sustainable or reasonable way of eating. There are lots of solid reasons behind this — but that discussion is for another article. Overall, it’s important to recognize that the risk of chronic conditions like CAD, Hypotension, Hyperlipidemia, etc. isn’t really existant with medications like lamotrigine but is very possible with the ketogenic diet. Some links to resources about the diet are below:
