What is the ketogenic diet?

The classic keto diet for epilepsy is:

• Very high in fat

• Very low in carbohydrate (“carbs”)

• Low to moderate in protein

You may see this described as a 4:1 (or 3:1) diet. That means you eat 4 (or 3) grams of fat for every 1 gram of carbs and protein combined.

Normally, the body’s main source of energy is glucose, or blood sugar. But the makeup of the keto diet forces the body to use mostly fat for energy instead. In the brain, this shift to a different energy source may help decrease seizures.

How can this diet help you?

The keto diet has been around since the 1920s. Research shows that it may lead to less frequent seizures in children and adults with certain types of epilepsy. Some children become seizure-free. In fact, children on a keto diet may be up to 3 times more likely to become seizure-free than those receiving standard care.

Does this diet have any risks?

The classic keto diet is quite different from the usual healthy eating pattern. It allows for only very small amounts of some nutrient-rich foods, such as whole grains and milk. To start and follow the diet safely, you need to work with an epilepsy specialist and a registered dietitian nutritionist. You may need to stay in the hospital for a short time to help you get started.

This diet falls short on some nutrients. You will need to take vitamin and mineral supplements. Ask your dietitian for advice on this.

Possible side effects of the keto diet include constipation, kidney stones, high cholesterol, and slow growth in children. You may need to get regular blood and urine tests to check for problems. Your healthcare provider can help you deal with side effects if they occur.

For the best results from this diet, you should follow it strictly. Teens and adults sometimes find that difficult to do. If you are having trouble following the diet, let your dietitian know.

Which foods should you eat?

The keto diet uses math to figure out precisely how much you should eat of specific foods. There are computer tools to help your dietitian make these calculations. Your dietitian can create a food plan just for you.

It’s important to follow this plan exactly for every meal, every day. You may need to carefully measure and weigh your food.

Fats provide 85% to 90% of daily calories in the keto diet. Sources include butter, almond oil, coconut oil, olive oil, and avocado. Cream is another source of fat used in many keto-friendly recipes. Choose heavy (whipping) cream that is 36% or more milk fat.

Carbs make up only 2% to 5% of daily calories in this diet. Many fruits and vegetables fit into a very-low-carb eating plan. Examples are asparagus, broccoli, carrot sticks, salad greens, summer and winter squash, unsweetened applesauce, peaches, and strawberries.

Proteins provide 6% to 12% of daily calories in this diet. Sources include roast beef, lean ground beef, pork chops, chicken, turkey, salmon, cod, crab, cheese, and eggs.

Which foods should you pass up?

Carbs are strictly limited in a keto diet. Depending on your personal diet plan, you may be able to eat small amounts of foods with medium carb levels. Examples are low-carb breads, oatmeal, seeds, nuts, beans, unsweetened plain yogurt, and unsweetened soy drinks.

Higher-carb foods are limited even more. They include milk, sweetened soy drinks, pasta, rice, quinoa, potatoes, and sweet potatoes.

Skip the highest-carb foods altogether. Examples are white bread, candy, cookies, donuts, sodas, honey, jelly, and syrup.

Tips for following this diet

• Vegetables can be fresh, canned, or frozen without any added ingredients.

• Fruits can be fresh, frozen, or canned without added sugar. Don't have dried fruit.

• Fish, poultry, and meats can be baked, broiled, steamed, grilled, or pan-fried using nonstick pan spray. Don’t fry or add fat during cooking. Skip breading, gravy, and sauces.

Suggestions for planning meals

Below are some ideas for simple, tasty dishes that may fit into a keto diet. Be sure to tailor the ingredient amounts to your eating plan.

• An egg scramble made from a mixture of egg, butter, heavy cream, feta cheese, spinach, and mushrooms. Cook in olive oil to boost the fat content even more.

• A Cobb salad of mixed greens, chopped hard-boiled egg, sliced avocado, crumbled bacon, and shredded cheese. Top with olive oil and vinegar dressing.

• Sloppy Joes made from lean ground beef, tomatoes, onions, and celery. Hold the bun.

• A baked chicken breast served with zucchini cut into strips to look like noodles. Saute the “noodles” in olive oil and top with pesto.