There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[7]

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“Combining a super restrictive diet with long periods of non-eating is not good,” says Keatley. “The body will cannibalize its own muscle for energy if intake from food is too low but the body does not differentiate between something like a calf muscle or a heart muscle. Keep in mind all your important organs are made of smooth muscle and going on a diet like this may harm something like your bladder or lungs just as much as provide fat loss.”
But beyond that, experts aren't convinced that the keto diet has any other scientifically proven health benefits. In fact, it may have some distinct downsides. If you follow the keto diet incorrectly, for example (like by eating lots of saturated fats, versus healthy unsaturated fats), you're at risk of raising your cholesterol levels. “The best strategy to keep your heart healthy is to get as much fat as possible from unsaturated sources such as olive, avocado and canola oils, nuts, seeds, avocados, and olives," says Ansel.

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Conklin's fasting therapy was adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent endocrinologist Henry Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin's success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite only having studied the patients for a short time. Further studies in the 1920s indicated that seizures generally returned after the fast. Charles P. Howland, the parent of one of Conklin's successful patients and a wealthy New York corporate lawyer, gave his brother John Elias Howland a gift of $5,000 to study "the ketosis of starvation". As professor of paediatrics at Johns Hopkins Hospital, John E. Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.[10]

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The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[18] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to benefit from the ketogenic diet than from trying another anticonvulsant drug.[1] Some evidence indicates that adolescents and adults may also benefit from the diet.[9]
People claiming huge benefits of these supplements – despite the lack of solid scientific support – may sometimes have a financial reason to believe in the supplements. Some of these products are sold under a multi-level marketing arrangement, where sales people are paid based on commission. For example, the company Prüvit sells drinkable ketones, called KETO//OS with a multi-level marketing structure.
People use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases, and even acne, but there needs to be more research in those areas. Talk with your doctor first to find out if it’s safe for you to try a ketogenic diet, especially if you have type 1 diabetes.
Alex is a ISSN Sports Nutrition Specialist, Fitness Professional and certified Superhuman Coach who continues to expand his knowledge base and help people across the world with their health and wellness. Alex is recognized as the National Record Holder in Powerlifting and Indoor Rowing and has earned the title of the Australian National Natural Bodybuilding Champion. Having worked as a health coach and personal trainer for over a decade, Alex now researches all things health and wellness and shares his findings on this blog. Learn more about Alex's Credentials HERE.

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On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell's mitochondria (the energy-producing parts of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this by using fatty acids.[57] Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and most fatty acids do not cross the blood–brain barrier. However, the liver can use long-chain fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and partially substitute for blood glucose as a source of energy.[56]

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Fat (and the ketones produced from fat) are a readily available source of fuel. Once someone is fat adapted and in ketosis, they will find they can easily go hours (even days) without food and not have drastic energy level swings. And if someone is looking for a non caffeine, non-sugar 'pick me up' while in a ketogenic state, then supplemental ketone salts are the perfect answer.
Physicians of ancient Greece treated diseases, including epilepsy, by altering their patients' diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, covers the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, "One inclining to epilepsy should be made to fast without mercy and be put on short rations."[Note 5] Galen believed an "attenuating diet"[Note 6] might afford a cure in mild cases and be helpful in others.[11]
The ketogenic diet is a mainstream dietary therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and '30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][10]
It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]

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When you approach your normal body weight, the weight loss will slow. Just remember, a “normal” body weight differs from person to person depending on our genetics and environmental exposures and may not fit what we see in the popular media. The weight loss won’t go on forever. As long as you follow the advice to eat when you are hungry, you will eventually stabilize your weight.

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“the mitochondria – work much better on a ketogenic diet as they are able to increase energy levels in a stable, long-burning, efficient, and steady way. Not only that, a ketogenic diet induces epigenetic changes[6] which increases the energetic output of our mitochondria, reduces the production of damaging free radicals, and favours the production of GABA”

As per heartburn, studies done have shown that a ketogenic diet can have beneficial effects for those who have Non Alcoholic Fatty Liver Disease. A 2006 paper published in the Journal of Digestive Diseases and Sciences found that ‘Six months of a low-carbohydrate, ketogenic diet led to significant weight loss and histologic improvement of fatty liver disease’

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When something is popular, it’s pretty much a guarantee that people are going to come up with new or easier ways of doing it. Enter the lazy keto and dirty keto diets. With lazy keto, people try to limit their carb intake to 20 to 50 grams a day but don’t really track it; with dirty keto, people generally follow the same macronutrient breakdown as "regular" keto, but it doesn't matter where those macronutrients come from.
The first modern study of fasting as a treatment for epilepsy was in France in 1911.[12] Twenty epilepsy patients of all ages were "detoxified" by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients' mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[13]
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter.[1] Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[4][5]

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Dementia and Alzheimer’s Disease A small study published in February 2013 in the journal Neurobiology of Aging found that older higher-risk adults on a keto diet experienced better memory functioning after just six weeks. (11) Some experts, like Richard Isaacson, MD, director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and NewYork–Presbyterian in New York City, support low-carb diets for patients as one way to delay brain aging and possibly Alzheimer’s disease, the most common form of dementia.
A ketogenic diet – due to its extremely low carb intake – can help address insulin resistance and in turn help with suffers of PCOS. In fact, a pilot study has concluded that a ketogenic diet led to a significant improvement in body weight, fasting insulin, testosterone markets and LH/FSH ratio in woman with PCOS. Two woman even became pregnant during the study.
Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose).[19] Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.[56]

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It seems strange that a diet that calls for more fat can raise “good” cholesterol and lower “bad” cholesterol, but ketogenic diets are linked to just that. It may be because the lower levels of insulin that result from these diets can stop your body from making more cholesterol. That means you’re less likely to have high blood pressure, hardened arteries, heart failure, and other heart conditions. It's unclear, however; how long these effects last. 

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People use a ketogenic diet most often to lose weight, but it can help manage certain medical conditions, like epilepsy, too. It also may help people with heart disease, certain brain diseases, and even acne, but there needs to be more research in those areas. Talk with your doctor first to find out if it’s safe for you to try a ketogenic diet, especially if you have type 1 diabetes.

Finally, a feasibility study was done on 10 cancer patients in 2012. All patients followed a ketogenic diet for 28 days after exhausting every other cancer treatment option. The results of the study found that 1 had a partial remission of their cancer, 5 stabilized and 4 continued progressing. It’s important to remember that these individuals had tried all other forms of cancer treatment. 60% of these individuals then stalled or improved their cancer rates by following a ketogenic diet for 4 weeks.


Finally, a feasibility study was done on 10 cancer patients in 2012. All patients followed a ketogenic diet for 28 days after exhausting every other cancer treatment option. The results of the study found that 1 had a partial remission of their cancer, 5 stabilized and 4 continued progressing. It’s important to remember that these individuals had tried all other forms of cancer treatment. 60% of these individuals then stalled or improved their cancer rates by following a ketogenic diet for 4 weeks.

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But people who started following the keto diet noticed weight loss for a few reasons: When you eat carbs, your body retains fluid in order to store carbs for energy (you know, in case it needs it). But when you’re not having much in the carb department, you lose this water weight, says Warren. Also, it's easy to go overboard on carbohydrates—but if you're loading up on fat, it may help curb cravings since it keeps you satisfied.
There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child's meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[54]

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It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that a third achieved an excellent reduction in seizure frequency and half the patients achieved a good reduction.[18]

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Over 8–10 mmol/l: It’s normally impossible to get to this level just by eating a keto diet. It means that something is wrong. The most common cause by far is type 1 diabetes, with severe lack of insulin. Symptoms include feeling very sick with nausea, vomiting, abdominal pain and confusion. The possible end result, ketoacidosis, may be fatal and requires immediate medical care. Learn more

Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[56]
Before starting, ask yourself what is really realistic for you, Mattinson suggests. Then get your doctor’s okay. You may also work with a local registered dietitian nutritionist to limit potential nutrient deficiencies and talk about vitamin supplementation, as you won’t be eating whole grains, dairy, or fruit, and will eliminate many veggies. “A diet that eliminates entire food groups is a red flag to me. This isn’t something to take lightly or dive into headfirst with no medical supervision,” she says.

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The low glycemic index treatment (LGIT)[49] is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regimen. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[5] Although it is also a high-fat diet (with approximately 60% calories from fat),[5] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[18] However, the types of carbohydrates consumed are restricted to those that have a glycaemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]
It’s also common for people starting the diet to experience flu-like symptoms, such as headaches and fatigue. This side effect is so common that there’s a name for it: the keto flu. “You shed a ton of water weight at first, which can lead to dehydration,” Nisevich Bede explains. This can worsen the symptoms of the keto flu. To counter it, she recommends staying hydrated and loading up on electrolytes through electrolyte tablets.

There are three instances where there’s research to back up a ketogenic diet, including to help control type 2 diabetes, as part of epilepsy treatment, or for weight loss, says Mattinson. “In terms of diabetes, there is some promising research showing that the ketogenic diet may improve glycemic control. It may cause a reduction in A1C — a key test for diabetes that measures a person’s average blood sugar control over two to three months — something that may help you reduce medication use,” she says.
The remaining calories in the keto diet come from protein — about 1 gram (g) per kilogram of body weight, so a 140-pound woman would need about 64 g of protein total. As for carbs: “Every body is different, but most people maintain ketosis with between 20 and 50 g of net carbs per day,” says Mattinson. Total carbohydrates minus fiber equals net carbs, she explains.

A Cochrane systematic review in 2018 found and analysed eleven randomized controlled trials of ketogenic diet in people with epilepsy for whom drugs failed to control their seizures.[2] Six of the trials compared a group assigned to a ketogenic diet with a group not assigned to one. The other trials compared types of diets or ways of introducing them to make them more tolerable.[2] In the largest trial of the ketogenic diet with a non-diet control[16], nearly 38% of the children and young people had half or fewer seizures with the diet compared 6% with the group not assigned to the diet. Two large trials of the Modified Atkins Diet compared to a non-diet control had similar results, with over 50% of children having half or fewer seizures with the diet compared to around 10% in the control group.[2]
A study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[20] and followed-up by a report published in 2001.[21] As with most studies of the ketogenic diet, no control group (patients who did not receive the treatment) was used. The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction, and 3% were seizure-free.[Note 7] At 12 months, 55% were still on the diet, 23% had a good response, 20% had an excellent response, and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive, or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three, and four years was 39%, 20%, and 12%, respectively. During this period, the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction, and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free, but had had an excellent response.[21][22]

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Finally, a feasibility study was done on 10 cancer patients in 2012. All patients followed a ketogenic diet for 28 days after exhausting every other cancer treatment option. The results of the study found that 1 had a partial remission of their cancer, 5 stabilized and 4 continued progressing. It’s important to remember that these individuals had tried all other forms of cancer treatment. 60% of these individuals then stalled or improved their cancer rates by following a ketogenic diet for 4 weeks.

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The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[43] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in the hospital.[9]


In the 1960s, medium-chain triglycerides (MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides).[15] MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system.[16] The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[15] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[10]

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And science is now catching up, this review paper on ketogenic diets   as a form of cancer therapy concluded: “Although the mechanism by which ketogenic diets demonstrate anticancer effects … has not been fully elucidated, preclinical results have demonstrated the safety and potential efficacy of using ketogenic diets.. improve responses in murine cancer models”
Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][31][32] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy, and tuberous sclerosis complex.[9][33]
I have been diagnosed twice with post prandial reactive hypoglecemia since 37 years old ( now 70). Obviously my insulin levels shoot high and then blood sugar drops to 2.2. Can you give me any special advice on the Keto diet with regard to this. I have been diagnosed just recently with lipodema. I have been following diet for 3 weeks and my brain is already alot clearer.
The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[58] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[56]

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