By Marissa Teachman, MS, RD, CDN
In the medical field, we encounter a variety of dietary patterns among our patient populations. As medical professionals, it is hard to keep up with the trends, but we do our best! If you are reading this and wondering, “What exactly is the ketogenic diet?” It is a diet that is high in fat and low in carbohydrates to allow the body to primarily utilize fat (ketones) for energy instead of carbohydrates. The exact mechanism of the ketogenic diet in seizure prevention is still not exactly understood. The process is thought to be indirectly related to neurotransmitter activity within the brain involved with epileptic seizures.
The ketogenic diet typically has a 4:1 or a 3:1 ratio of fat to protein and carbohydrates. This ratio is required to go into ketosis. Let’s break that down a little: high fat, low protein and low carbohydrate. In general, any diet, including the ketogenic diet, may be prescribed by medical professionals as a tool to aid in the management of an acute or chronic disease. On the other hand, a diet may be followed for more personal reasons, such as weight loss or general health improvement. The purpose of this article is to provide some insight regarding the ketogenic diet and bring to light some alternatives diet therapies.
The Truth: The ketogenic diet was initially used in the pediatric population for epilepsy management.
High-fat, low-protein, and carbohydrate ratios were followed for the production of ketones to be used for energy instead of carbohydrates. As a result of this process, seizures would be more controlled. The ketogenic diet was often used as a last line of treatment, such as when medication management failed.
Myth #1: The ketogenic diet is safe and requires little to no medical oversight.
When following a ketogenic diet, there may be negative consequences, such as undesired weight loss, low blood glucose, and possible need for changes in medications and treatments if containing a source of carbohydrates. Here are some things to consider if prescribing or following a ketogenic diet:
– Is the patient at risk for hepatic steatosis, pancreatitis, and/or cardiac complications?
– Is that patient malnourished or at a weight where unintended weight loss would be undesirable?
– Need for close lab monitoring of blood glucose levels, lipids, liver function, amylase, lipase
– Ketogenic diets are contraindicated in pregnancy
– Elevated risk for vitamin deficiencies, including vitamin D
Myth #2: There is enough scientific evidence that ketogenic diet aids in the seizure management of adults
You may be wondering, is there a place for keto in adult seizure care? Today, science has limited evidence that ketogenic diets are beneficial to the adult population due to lack of adequate studies and poor compliance with the diet. More research is needed on ketogenic diets, their efficacy in adult seizure management, long term health outcomes, and disease prevention.
Alternative diets to ketogenic diets that can be offered to our patients include: the Modified Atkins diet, the Medium Chain Triglyceride (MCT) diet, and low- glycemic index diet (low-GI). The Modified Atkins diet includes a 1:1 ratio of fat to protein and carbohydrate, offering a greater variety of foods and less rigid parameters in comparison to the ketogenic diet. The Medium Chain Triglyceride diet utilizes MCT oil and MCT supplementation to provide 30% calories of total intake, additionally allowing long chain fatty acids, which are naturally occurring in foods, to be consumed. Literature supports the benefits of these two diets in the epilepsy population and may be both more nutritionally sound and more appealing to our patients.
The Low-GI diet focuses on consuming less refined foods (i.e., those with a high glycemic index) to help regulate the blood glucose response for managing chronic diseases, such as diabetes. The diet does not focus on the macronutrient content of food; however, it may help guide patients to a less processed diet. Lower GI foods include spinach, chickpeas, eggs, Greek yogurt, almonds, berries, broccoli, and kale. Higher GI foods include refined grains and simple carbohydrates, such as white bread, white rice, pasta, potato, corn, and candy.
Long story short, carbohydrates are our first and preferred source of energy. The sugar, fiber, calorieand nutrient density of foods are important to consider when trying to balance a well-rounded and sustainable diet. Consulting with the health-care team and treating the patient with individualized recommendations will prove beneficial to their medical care. Further, providers are encouraged to remember that there isn’t a ‘one size fits all’ approach to nutrition.
Chan L-N. ASPEN Adult Nutrition Support Core Curriculum. 4th ed. Silver Spring, MD: ASPEN; 2025; 664-665.