Dietary therapies may help reduce the frequency of seizures in children who don’t benefit from medication or surgery. Experts at the Pediatric Epilepsy Program, part of NYU Langone’s Comprehensive Epilepsy Center, recommend three different variations of the ketogenic diet for children who have epilepsy. They offer advice based on your child’s age and nutritional needs and the type of seizures or epilepsy they have.
Ketogenic diets are low-carbohydrate, high-fat diets designed to alter the body’s energy metabolism to favor the use of fat instead of sugar. These diets have been shown to reduce seizures in about 50 percent of children who begin them.
The classic ketogenic diet is used mostly in younger children with difficult-to-control, generalized epilepsy, such as Lennox-Gastaut syndrome, Dravet syndrome, tuberous sclerosis, and Angelman syndrome. However, it is effective for most types of epilepsy.
The classic ketogenic diet has the strictest guidelines: 70 to 90 percent of calories come from fat, with the remainder from protein and a small percentage from carbohydrates. The diet is intended to induce a metabolic state called ketosis. Ketosis causes the body’s cells to use energy substances called ketones, which are broken down from fats, instead of glucose, which is broken down from carbohydrates. This sustained ketosis has an anti-seizure effect in some children.
A dietitian at Hassenfeld Children’s Hospital at NYU Langone determines the right amount of fat, carbohydrates, and protein based on a child’s weight and overall nutritional needs. Meals and snacks are carefully weighed and measured to ensure the correct proportions of fat, protein, and carbohydrates. Meals typically contain high-fat foods, such as mayonnaise, oil, butter, or heavy cream, and calculated portions of fruit, vegetables, nut products, cheese, meat, fish, or poultry.
Even small deviations from this diet can reverse the beneficial effects and may cause a seizure. As a result, parents must be vigilant not only that the diet is followed, but also that their child’s medications, vitamins, toothpaste, and other products don’t contain sugar.
The modified Atkins diet is an alternative to the ketogenic diet. Children eat foods high in fat and low in carbohydrates, but on this diet only foods that contain carbohydrates are weighed and measured. Proteins and fats are allowed in larger amounts than on the classic ketogenic diet, and carbohydrates are calculated to not exceed 10 grams per meal.
This diet also offers more freedom in terms of calories, protein, and fat intake, making it attractive to older children who have busy schedules and higher calorie and protein needs.
A low-glycemic-index diet focuses on foods that have little impact on blood glucose levels. Although it’s not understood why, low blood glucose levels control seizures in some people.
The low-glycemic-index diet limits the type and amount of carbohydrates that can be consumed. It attempts to reproduce the positive effects of the ketogenic diet, although it allows for a more generous intake of carbohydrates: about 40 to 50 grams of total carbohydrate per day. A low-glycemic-index diet is also high in fat and protein, but unlike the classic ketogenic diet and the modified Atkins diet, it limits the type of carbohydrates that can be eaten. Only carbohydrates with a glycemic index under 50 are allowed.
Your child’s dietitian helps you calculate total carbohydrate intake and provides you with a list of foods with a glycemic index under 50.
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