There is more and more interest in the use of a diet to control epilepsy that is not controlled by currently prescribed medications. But this is not a new idea: if we roll back the clock, the first reports of diet affecting seizures were made ~500B.C.. In the early 1900s, the use of diet to control epilepsy really took hold with studies being performed in patient populations. The first documented use of dietary change for treating epilepsy was in 1911 when a pair of Parisian physicians, Gulepa and Marie,1 used a starvation diet for 20 children and adults with epilepsy and found less severe seizures as a result. In the 1920’s, physicians started using a ketogenic diet, which is more sustainable than starvation, as a treatment, but then it fell out of favor. More recently, ketogenic dieting has gained significant popularity in treating people with epilepsy (who do not respond to drugs) and has spawned great research interest in identifying how a diet reduces seizures.
Dr. Hugh W. Conklin, of Battle Creek, Michigan; and Bernarr Macfadden, a physical fitness guru, repeatedly reported the benefits of fasting for 3 days every 3 weeks for a variety of ailments. Macfadden became nationally famous by promoting this type of dieting for good health. In 1931 he tried to get in the favor of the presidential candidate, Franklin D. Roosevelt, as part of a strategy to be appointed as the first Secretary of Health.2
Conklin was an assistant to Macfadden and gained great attention with his successes in treating people with epilepsy via fasting. One thing that was learned was that it took 2-3 days of fasting to see the positive results. Ultimately this got the attention of a pre-eminent neuroscientist Wilder Penfield, of the Montreal Neurological Institute, who included fasting to treat epilepsy in his textbook.
Clearly fasting is not a sustainable approach for the long-term treatment of epilepsy. But would an alternative dietary strategy work? What happens when we fast? Well, we burn fat in our bodies as a source of energy to sustain life. Perhaps, a fat-based diet would work. Hence the birth of the ketogenic diet, (keto = ketone bodies derived from fat; genic = producing), which focuses on eating primarily high fat foods. In the 1920s, the fundamental principle of the diet was established and was shown to be highly efficacious. It provided long lasting treatment for patients, so long as they stayed on the diet. However, in 1938, with the development of new anti-epileptic drugs, the focus shifted away from understanding how the ketogenic diet works to the development of new anti-convulsant drugs. As a consequence, the ketogenic diet fell out of favor. But by 2000, there was great interest again.
The use of this diet needs to be supported by dieticians who help families understand what they can and cannot eat to remain ketogenic. CURE Epilepsy interviews registered dietician Robyn Blackford and advanced practice nurse Breanne Fisher from the Ann & Robert H. Lurie Children’s Hospital of Chicago, to discuss dietary details of the ketogenic diet.
But how does the diet work? We are not currently certain. However, I have my own pet hypothesis, from work in my laboratory. By removing carbohydrate energy sources that result in chemical changes in the brain, nerve cells become less excitable and less prone to generate a seizure. Carbohydrates give rise to a chemical called pyruvate. If we remove carbohydrate, pyruvate declines, and when it does, the ability of nerve cells to fire action potentials – the basis of a seizure – is reduced. A ketogenic diet decreases the consumption of carbohydrates and therefore pyruvates decline as well. It is possible that this lack of pyruvate leads to dampened excitability of the brain and results in the anti-convulsive effects of this diet.
Stay tuned for the results of the research on this diet that are being performed in many research labs. Maybe one day we will be able to provide a pill to mimic the beneficial effects of the diet while still being able to eat the occasional candy bar.
1Guelpa G, Marie A. (1911) La lutte contre l‘e’pilepsie par la de’sintoxication et par la re’e’ducation alimentaire. Rev Ther Medico-Chirurgicale 78:8–13.
2Wilkinson JF. (1997) Look at me. Smithsonian 28:136–151.