Can the Ketogenic Diet Help Patients with Epilepsy?

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What is Parkinson’s Disease?

Parkinson’s Disease (PD) is a progressive neurological condition generally indicated by nerve cell damage and cell death. It results from a deterioration of dopamine producing cells in the brain (an area known as substantia nigra).

This lack of dopamine in the brain is what produces the symptoms of the disease such as tremors, rigidity and slowness of movement. Other symptoms, which can also occur in some people with Parkinson’s disease, include tiredness, confusion, depression and pain. The disease itself significantly impacts an individual’s quality of life.

Can the Ketogenic Diet Help Patients with Epilepsy?

What Causes Parkinson’s Disease?

The specific cause of PD is believed to be genetic abnormalities and/or environmental triggers such as infections (1). These causes affect mitochondrial function by increasing oxidative stress in the body, which is believed to be a key driver in the deterioration of the dopamine producing cells in the brain ( 2).

Under normal conditions, when oxidative stress occurs in the body, there are systems that are available to help counteract the negative effects. However, when the system becomes over loaded (as in the case of PD), they are unable to deal with the pressure and so free radicals (also known as Reactive Oxygen Species; ROS) are formed which cause cell death and destruction.

Is there a Cure for Parkinson’s Disease?

There is currently no cure for Parkinson’s disease with only a select few drugs and treatments available to best help manage the symptoms.

How Can the Ketogenic Diet Help Patients with Parkinson’s Disease?

In normal adults, the brain generally relies on the metabolism of glucose for its energy. The only other substrate that it can use is that of ketone bodies produced when following the ketogenic diet.

The ketogenic diet (KD) is a high-fat, moderate protein, low-carb diet that makes your body switch from glucose to fat and ketones as fuel. KD has been used as a treatment in refractory epilepsy for over 50 years and now there is a growing interest in the use of the KD for treatment in PD.

There exists a growing body of evidence to show that the ketogenic diet and specifically ketone bodies, can exert neuroprotective activity within the brain. Namely, studies that have been done in cells and animal models, have demonstrated that the ketones can promote antioxidant activity ( 3).

This antioxidant activity is what helps to decrease the free radical formation in the mitochondria and so protecting the cells from oxidative stress and injury ( 4).

Due to the proposed impact that ketones can have on mitochondrial function, it is hypothesised that they may be warranted as a treatment within PD.

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The Effect of Ketone Bodies - Animal Studies

In animal models, a certain type of substrate (known as 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine; MPTP) has been found to mimic that of PD. This means that researchers have been able to investigate the impact that ketone bodies may have on the disorder.

In one study ( 5), tissue cells of rats containing MPTP were infused with the ketone body β-hydroxybutyrate. It was found that the ketone body could protect the mitochondria from the toxicity caused by the MPTP by decreasing free radical production.

Another similar study also demonstrated that the ketone body D-β-hydroxybutyrate protects the neurons in the brain from cell damage ( 6).

The Effect of Ketone Bodies - Human Study

Whilst most of the work looking at the effect of ketone bodies in the treatment of PD has been done in cell and animal models, there is one small study that has been carried out in humans. Seven patients with PD volunteered to follow a KD for 28 days at home.

Only 5 out of the 7 completed the 28 days but the results showed a positive impact on PD scales (UPDRS). Symptoms that were shown to improve included resting tremors, freezing, balance, gait, mood and energy levels ( 7).

Although this is a very promising study, the limitations of the study do need to be highlighted. It is of course a very small sample size and even of the sample size, only 5 out of 7 could stick with the diet.

Likewise, the diet was only carried out for 28 days, so not really mimicking what it would be like to follow a KD as a lifestyle change. The KD that was followed was of the strictest 4:1 variety (90% of calories as fat, 2% from carbohydrates and 8% from protein). This could be what caused the low adherence rates.

From the work that has been carried out in adults with epilepsy, we can see that the same neuroprotective effects can still be found from a Modified Atkins Diet ( 8).

Meaning that for future research, placing people on a less restrictive form of the KD may warrant similar results with better attrition rates.

Take-Home Message

From the data that we have already on the ability of ketone bodies to help mend and protect neurons from oxidative damage, the Ketogenic Diet as a therapy option for the use in Parkinson’s disease would therefore appear to be very promising.

Many more well designed studies in human populations would be needed before a specific conclusion could be drawn.

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Emily Maguire, BSc, MSc
Creator of lowcarbgenesis.com

Emily Maguire

After completion of her BSc in Nutrition, Emily went onto study for an MSc in Obesity Science and Management. Author at lowcarbgenesis.com, she is keen to share the myths and truths surrounding the ever confusing and interesting topic of nutrition.

With over 7 years of experience working within the commercial weight loss sector, she has unprecedented insight knowledge into the use of alternative nutritional therapies, particularly that of the ketogenic diet.

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Comments (4)

Hi there!
I'm really interested in why adults are less compliant than children?  I'm guessing that it has to do with children being less independent, and therefore are more likely to eat what doctors/parents tell them too.  Also, maybe because children haven't lived their whole life eating certain foods that taste delicious but might not be good for their body, so children not as resistant to giving up those foods?
However, I'm wondering what the mindset is of the adults who are resistant?  And I'm wondering if this resistant behavior is similar in adults on other diets?
Maybe if the why behind the lack of compliance is better understood, it can be learned how to cater the diet plan to the adult patient.  Not change it anyway, but present/introduce it to the adult in a difference way.
I'm sure there is some wonderful research involving these ideas, and I'm wondering if anyone could direct me to it?  
Thank you!
Jess

Reply

Hello!
This is a great article. I have been on Keto for a year now and I have been living with epilepsy for 15 years now. My neurologist has seen a huge change in seizure control since I started. He encourages it with my medication. I just wanted to share my point of view of it. Can't wait to read more!
Britt

Reply

Great article, It is also important to note that up to 7% of adults can have a complete cessation of all seizures (me included.) Also important is that newer research done by Eric Kossoff has shown that the MAD diet is tolerated better and has as good outcomes as the classic Ketogenic diet (CKD) and should be the choice for anyone over the age of 2 if they are going to give a dietary approach a go. If clients to do not respond they can always become stricter and change to the more restrictive CKD.
One of the things I see often is that only those with refractory epilepsy are encouraged to try Keto. Many people who have their epilepsy managed with medication can also benefit from this way of eating often reducing or eliminating medications and their nasty side effects.
That is NOT to say all folks on medication should stop. But if you are on medications which are having multiple negative side effects or on multiple medications then you might want to try a medically supervised keto diet to see if you can reduce or eliminate any of the offending medications. Keto is not just for refractory epilepsy.
As for compliance, well that is an issue but personally, not having 8 seizures a day, not needing to be on medication which completely changed my personality, not being stranded in a  rural area unable to drive are more than enough reasons for me to stay compliant. And all of the great recipes out there like the ones on Ketodietapp make it easier than ever before.
If you have seizures, give keto a try but do it with good support from a knowledgeable dietitian and preferable a supportive physician.
Warmly,
Gillian

Reply

Hi Gillian , thank you for your insights and for sharing your experience!! This is just an introduction to this topic and more will follow soon. Emily has written a more detailed post on the 4 different approaches, including sample meals. I will share the next post in 1-2 weeks.

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