Low-carb diet reduces seizures for people with drug-resistant epilepsy

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A trial of 160 people found that pairing standard epilepsy therapies with a low-carbohydrate diet reduced seizures by more than 50 per cent in a quarter of participants

Health 4 January 2023

By Grace Wade

Pairing a low-carbohydrate diet with typical epilepsy medications can reduce seizures in people with drug-resistant epilepsy by 50 per cent.

Using low-carb diets to treat epilepsy began about a century ago but fell out of favour once anti-seizure medications were developed. However, nearly a third of the approximately 50 million people worldwide with epilepsy don’t respond to these drugs.

Manjari Tripathi at All India Institute of Medical Sciences, New Delhi and her colleagues recruited 160 people between 10 and 55 years old who had more than two seizures a month despite using at least three anti-seizure medications at maximum doses. The researchers advised half of them to follow a modified Atkins diet, which consists of eating only 20 grams of carbohydrates a day, drastically cutting down on the 275 grams recommended for adult daily consumption under US dietary guidelines. All participants continued standard epilepsy drugs. Caregivers tracked seizures and meals using a daily log, and participants completed a quality-of-life questionnaire before and after the study.

After six months, more than 26 per cent of those on the low-carb diet saw monthly seizures reduced by more than 50 per cent compared to the month before the trial. The same was true for only 2.5 per cent of the control group. The low-carb group also reported significantly greater improvements in quality of life, on average, compared to the control group.

Low-carbohydrate diets reduce seizures by inducing ketosis, which is when the body burns fat as its primary fuel, says Tripathi. There are many potential mechanisms for why this improves epilepsy including changes in the gut microbiome, inflammation and electrical signalling between neurons, she says.

Mackenzie Cervenka at Johns Hopkins University in Maryland says it is encouraging to see that the modified Atkins diet can be an effective treatment. Prior studies to treat epilepsy with diet often use the ketogenic diet, which requires calculating the ratio of carbs to fats in all foods. “That can be a lot more time consuming,” says Cervenka, meaning fewer people stick to it. “The modified Atkins diet is less rigorous with regard to preparation and monitoring,” she says.

Journal reference: Neurology, DOI: 10.1212/WNL.0000000000206776

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