Heavy cream and butter don’t tend to be the focal point of most diets—much less diets that are capable of preventing epileptic seizures—but the ketogenic diet isn’t most diets. At first glance, the allowable foods list looks almost satirical: Bacon, mayo, eggs, and the aforementioned cream and butter are all fair game. But since the early-20th century, the high-fat, low-carb regime has been a widely accepted treatment for drug-resistant epilepsy in children.
Oddly enough, the diet can also work miracles with respect to weight loss, and not just in terms of the actual weight dropped. Earlier this month, researchers publishing in the academic journal Obesity Reviews reported that ketogenic diets not only help shed the pounds, but also suppress appetite—a two birds, one stone approach to transitioning out of obesity.
The keto diet’s link between metabolism and neuroscience, however, has remained somewhat cloudy until this month. Writing in the Journal of Lipid Research, scientists led by Masahito Kawamura, Jr. of Jikei University School of Medicine in Tokyo demonstrated that the diet—which decreases blood glucose levels and replaces them with compounds known as ketones—appears to increase the brain’s sensitivity to glucose while decreasing its excitability. Since seizures are the result of over-excitation in the brain, the authors hypothesized that the link between ketone levels and glucose-regulated cortical excitability helps explain the relationship between the keto diet’s metabolic and neurological effects. November 2014 has been a good month for ketones.
A Fat-Rich History
Epilepsy and diet have been linked just about as long as we can call history history. In Hippocrates’ fifth century BC text On the Sacred Disease, the Greek physician cites fasting as a cure for epileptic seizures. The relationship between fasting and seizures also surfaced in the Bible when Mark recounts Jesus’ curing of an epileptic child. When questioned by his disciples as to how he had accomplished the feat, Jesus replies, “This kind can come forth by nothing, but by prayer and fasting.”
Fasting elevates blood ketone levels. Indeed, the keto diet is often initiated with a one-day fast. The main course of the diet, however, consists of a shift from traditional carb-heavy meals to plates dominated by fats.
Biologically speaking, the same thing is going on, though. The substitution of fats for carbohydrates kicks the body into a puzzled sense of emergency. It has to burn something for energy, and without carbs to convert into glucose, it subcontracts the liver to break down the excess fats and convert them to—you guessed it—ketone bodies like acetone and beta-hydroxybutyric acid.
While the diet itself dates back to the 1920s, the advent of antiepileptic drugs like Dilantin in the 1940s curtailed its prescription. It wasn’t for another 50 years, the unexpected recovery of a boy named Charlie Abrahams, and a made-for-TV movie starring Meryl Streep that the keto diet saw a reemergence. Today, Johns Hopkins, where Charlie was treated in the mid-90s, still leads the investigative effort. While we may not consider the research to be groundbreaking in the same way we see comet landings and mind-control, just about anything is worth a shot up against the pathological monolith that is epilepsy.
The Egg We Still Can’t Crack
Imagine you’re giving a toast at your brother’s wedding. Your speech is light-hearted and touching. You poke a bit of fun at the new in-laws; toss in just the right amount of self-deprecating humor. You reflect on how proud Grandpa Jim would have been. You recount the anecdote about the dog and the sock. And then you conclude—but instead of showering you in tinkling laughter and gentle applause, all the wedding guests lock eyes and clap in unison. Just one simultaneous, apathetic superclap; over and over again. It’s pretty disturbing. You edge away and hide behind the cake.
Epilepsy is a 100 billion-person wedding party. When every neuron claps at the same time, the healthy chaos of normal brain function collapses into synchrony. Most epileptic seizures are nothing more than excess excitation across the cortex, which often leads to abnormal brain wave patterns. When this happens, you do more than hide behind the cake—you topple over in a seizure.
Generally speaking, the ketogenic diet is still a last-ditch treatment.
Drug-resistant, or refractory, epilepsy is characterized by the presence of seizures even after a patient tries two or more antiepileptic drugs. In refractory patients—including, recently, adolescents and adults—the ketogenic diet often does well, with one 2014 study reporting a 50 percent or greater reduction in the number of seizures for 45 percent of study participants.
Generally speaking, however, the ketogenic diet is still a last-ditch treatment—and one among dozens for epilepsy. That the hot new diet is a direct reflection of Hippocrates’ insights in 400 BC serves as a testament to the fact that epilepsy is still neurologically bewildering.