Reversing Epilepsy with Food: The Science and Success of the Ketogenic Diet
Research into the keto diet for epilepsy first began as early as 1921, when Dr. Rawle Geyelin first presented the findings of Dr. H.W. Conklin, who had effectively treated his epileptic patients using a carefully managed intermittent starvation protocol. The ketogenic diet is, of course, much more humane, pleasant, and sustainable than an intermittent starvation diet, yet has a nearly identical cure rate to intermittent fasting – when administered therapeutically and consistently, the keto diet has a 90% cure rate for epilepsy. While children were the main focus of the experiments in the early 1900s, and indeed, research does indicate that this diet therapy tends to have better results in children than in adults, therapeutic keto diets do effectively work to dramatically lower seizure rates in both children and adults with epilepsy. Anyone of any age, including even newborn infants, pregnant/breastfeeding women, and the elderly, can use this diet protocol as a way to lower seizure rates.Before continuing onward, I want to make note that the pathology of epilepsy and that of chronic pain and inflammation are, in fact, rather similar – both conditions involve over-excitation of neurons caused by high levels of glutamate and low levels of GABA. It’s also worth noting that many of the same pharmaceutical drugs prescribed for epilepsy are also prescribed for chronic pain, yet another telling fact that indicates the close relationship between these two conditions.
The ketogenic may also work as an epilepsy cure for other reasons as well, beyond reducing neuronal over-excitability. Indeed, ketone bodies themselves have anticonvulsant properties, and are present in higher amounts in the body, of course, when the body effectively switches into ketosis. The increase in ATP production that happens during ketosis is also important, since ATP also has anticonvulsant effects. The ketogenic diet leads to the following other effects that may all contribute to treating epileptic conditions as well:
- GABA circuit modulation
- Noradrenergic tone modifications
- Modulation of mitochondrial function
- Restricts glycolysis
- Increases ATP production
- Activates K-ATP channels in the mitochondria
- Improves antioxidant capacity
- Inhibits Reactive Oxygen Species
- Protects against negative effects caused by postictal hypoxia
- Alters the gut microbiome positively
- Produces intracerebral acidosis
The ketogenic diet is highly effective as a cure for epilepsy, and works to reduce or eliminate seizures even in situations where anticonvulsant pharmaceuticals don’t work. The vast majority of people who follow this diet consistently for at least 3-6 months – especially children – either become completely seizure-free or have a significant reduction in seizures. Noteworthy clinical improvements are often observable within just days of starting the ketogenic diet, though positive changes in hypsarrhythmia – chaotic, disorganized electrical activity in the brain of epileptic patients – may take a few months to improve. Thus, it’s key to be patient and consistent, and to be aware of other seizure management tools during the adjustment period with the ketogenic diet.
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The Ketogenic Diet for Seizures and Epilepsy During Pregnancy and Breastfeeding
Given the potential for congenital abnormalities and neurocognitive problems in children who were exposed to pharmaceutical antiseizure medications in utero, alternative treatment options are absolutely essential for women with epilepsy or related conditions who are already pregnant or who want to become pregnant. The ketogenic diet – and the related diets discussed below – are viable options that ensure the health of both the woman and the fetus. The ketogenic diet is also an effective treatment protocol for women with glucose transporter type 1 deficiency syndrome (Glut1DS) who are trying to conceive, pregnant, or breastfeeding; breastfeeding mothers can also help manage this condition in their babies by following a ketogenic diet themselves during the breastfeeding period. Though ideally the ketogenic diet (or a suitable alternative diet) should be started before pregnancy, it can be started during pregnancy with careful consideration.
One of the main concerns for women during pregnancy (and during breastfeeding) is nutrition of Self and Baby; specific nutrient needs must be met during pregnancy and lactation to ensure that both the woman and her baby are healthy and comfortable, nutrient- and energy-wise. Though some of the scientific literature available makes it seem like the ketogenic diet may or may not be suitable during pregnancy, the reality is that there are various cultures across the world where women eat a ketogenic diet for most of their lives, including during pregnancy and lactation. In fact, many of the foods that could be “prescribed” to be eaten in higher quantities on the ketogenic diet – things like cod liver oil, free-range eggs, and grass-fed meats, for example – are also the same foods that are traditionally recommended to women who are trying to become pregnant, already pregnant, or breastfeeding as foods that nourish both Mother and Baby, wholly and completely. One could even argue that a well-planned ketogenic diet may actually be healthier than a regular diet during pregnancy and breastfeeding, due to the specific nutritional needs of the body during these times.
One consideration however is that, during pregnancy, ketogenesis (ketone production) is accelerated, particularly during the third trimester. As such, while in healthy, non-pregnant women a daily intake of 50g or less of carbohydrates is required in order to switch the body into a state of ketosis, a woman’s permitted carbohydrate intake during pregnancy could potentially be somewhat higher than this. In other words, a pregnant woman may be able to eat somewhat more than 50g of carbohydrates per day without breaking a state of ketosis. That said, for women with epilepsy who are pregnant and need a safe, reasonably fast, and effective option for managing seizures, please note that the 50g carbohydrate intake allowance on the traditional keto diet is actually quite liberal if you take the time to plan ahead and consider your options! It’s more than enough of an allowance to be able to consume enough of the right vitamins, minerals, and other nutrients needed during pregnancy, and also to be able to fulfil cravings and more “emotional” food needs that may arise during pregnancy.
Given the variability of ketogenesis throughout each trimester of pregnancy, some experts recommend that pregnant women following the ketogenic diet monitor their blood ketone levels at home and make adjustments to their carbohydrate intake as needed. That said, if you feel good and your baby is growing and healthy, don’t change what you’re doing with your diet if it’s working; use the ketone blood readings as a guide to inform you about what your body is doing and how it’s responding to different dietary fluctuations.
The ketogenic diet can also be safely followed during lactation. During breastfeeding, energy needs are increased, and, like during pregnancy, higher carbohydrate intakes may also be tolerated – meaning that eating more than 50g of carbs won’t necessarily interfere with ketosis – in women following the ketogenic diet. In women who are switching to a keto diet, the same rule may apply, that is, that more than 50g/day of carbohydrates can be consumed without interfering with a state of ketosis. Again, a home ketone test can be helpful here, since indeed, the body goes through a lot of changes between birth and cessation of breastfeeding (no matter when you decide to start weaning). During or after weaning, it would be wise for a woman with epilepsy to lower her carbohydrate intake back down to 50g per day in preparation for the metabolic changes the body will go through in order to return to its normal state after the breastfeeding period. This can help prevent accidentally breaking a state of ketosis.
In any case, it’s essential that women who choose to follow the ketogenic diet while pregnant or breastfeeding plan ahead carefully to ensure adequate caloric intake. In other words: follow the diet, but make sure that you eat plenty within the macronutrient guidelines! Keep a stash of low/no carb snacks that sound good available at all times, and snack freely whenever you can.
If you are the kind of person who enjoys food and thinking about food, and know that you can “trust yourself” to make a food plan and stick to it (within reason and allowing for “permitted”, keto-friendly cravings), the ketogenic diet is quite safe. However, if you’ve been known to forget to eat, or if you don’t particularly enjoy thinking about food, consider enlisting the help of someone who does enjoy and is good at meal planning and food/nutrition planning. The ketogenic diet requires close adherence to macronutrient intake, and also careful consideration of micronutrient (vitamins, minerals, proteins, etc.) intakes, especially during pregnancy.
Also make sure to look at the ingredients of any nutrient supplements that you may be taking, since many supplements include rice powder or other carbohydrate powders that could interfere with the ketogenic diet in certain cases. Aim for supplement choices that don’t contain these ingredients, unless there are no other options available, and then account for these supplements in your daily macronutrient intake allowance.
How Mothers Can Treat Epilepsy and Seizures in Young, Breastfed Infants via The Ketogenic Diet
Breastfed infants with epilepsy and seizure conditions may also benefit from their mothers following a ketogenic diet. In one case report of a 2-month-old infant with intractable epilepsy, the baby’s mother chose to switch to following a ketogenic diet. After 3 months of following a therapeutic keto diet and after entering ketosis herself, the fat content of the mother’s breast milk increased from 2.7g to 6.8g per 100mL, and her baby achieved ketosis as well. After entering ketosis, the baby had a 75-90% decrease in seizures.
Indeed, most newborns are somewhat in a state of ketosis already, especially in the first days of life when they receive colostrum, a special type of breastmilk high in triglycerides (fats) and proteins but low in lactose. The unique macronutrient profile of breastmilk at this stage permits newborns to stay in a state of ketosis for about 2-5 days after birth; after this point, if the mother is eating a normal, non-ketogenic diet, the lactose levels in the breastmilk increase and the infant leaves a state of total ketosis. However, if the mother is eating a ketogenic or low-carb diet, presumably both she and her baby would remain in a ketogenic state beyond these initial 2-5 days after birth.
The Ketogenic Diet for Children and Infants with Epilepsy, Infantile Epileptic Spasms Syndrome (IESS), Febrile Infection-Related Epilepsy (FIRES), and Other Related Conditions
The ketogenic diet was initially studied as an epilepsy treatment in children. In fact, one of the largest ever studies done on the efficacy of the ketogenic diet was done on a group of 1000 children with myoclonic epilepsy in 1977, around a similar time to which the drug vigabatrin was developed for the same condition (note that vigabatrin carries a comparatively high risk of blindness, while the keto diet carries little to no risk at all). Drs. Samuel Livingston and Lydia Pauli worked to carry out this particular study – they found that a therapeutic ketogenic diet effectively cured childhood epilepsy in 54% of cases, with a further 26% of children showing significant improvements. Together, these two doctors treated approximately 33,000 pediatric epilepsy patients using ketogenic diet protocols during the 41 years that they were in practice.
In 1998, Dr. John Freeman conducted a study on the ketogenic diet for pediatric epilepsy, specifically in the form of IESS. He found that, after 6 months of a keto diet, 8% of the children with IESS were seizure-free, a further 31% were >90% better, 23% of the patients had a 50-90% improvement, and the remaining 39% had varying degrees of improvement in their symptoms of less than 50%.
The ketogenic diet may also help to manage cases of febrile infection-related epilepsy syndrome, otherwise known as FIRES. Research suggests that the keto diet should ideally be started within 1 week of diagnosis (in other words, it should be started as soon as possible), and that this dietary therapy should continue for at least 3 months should the patient respond well. During the acute phase of FIRES, following the ketogenic diet may help reduce seizure frequency by between 50-70%, thus also helping to improve cognitive function in children affected by this condition.
One study combined vagal nerve stimulation therapy with the ketogenic diet in pediatric FIRES patients. The researchers found that the combination of these two therapies, in comparison with only the keto diet, didn’t produce significant differences in terms of seizure frequency during any phase of FIRES. However, patients who received both vagal nerve stimulation and keto diet therapy appeared to have improved neurological outcomes and cognitive function at later follow-up appointments in contrast with the children who had only received keto diet therapy. Vagal nerve stimulation therapy, when performed in a conventional medical setting, poses undesirable risks, but other, safer methods for stimulating the vagal nerves at home do exist.
Special Mentions: The MCT Diet / The John Radcliffe Diet, the Modified Atkins Diet, and the Low Glycemic Index Treatment
Some people working to treat epilepsy at home may choose to follow the MCT diet – the “medium-chain triglyceride” diet – as a “step beyond” the standard therapeutic ketogenic diet. The MCT diet is essentially the same as the therapeutic ketogenic diet, but emphasizes consumption of medium-chain triglycerides (MCT’s) rather than long-chain triglycerides (LCT’s) as in the traditional keto diet. The reasoning behind this is that MCT’s are more easily converted into ketones in the body than other triglycerides, thus making it possible to consume somewhat less fat and more carbohydrates and proteins (within limits, still, of course).
On the modified MCT Diet developed in the 1990s, patients are expected to consume 30% of their calories in the form of MCT oils or fats, and another 30% from LCT oils or fats (the original MCT diet recommended a full 60% of calories being from MCTs, but this was difficult for a lot of patients to tolerate, thus the revision).
The Modified Atkins Diet (MAD) is another reasonably effective dietary protocol for patients with epilepsy – about 40-50% of patients will have a 50% reduction in seizures after 6 months of following the diet, and about 15% of patients are completely cured (or in other words, seizure-free). The Modified Atkins Diet is very similar to the ketogenic diet, but with somewhat different macronutrient proportions. On the MAD diet, proteins often make up around 35% of the patients’ daily macronutrient intake – a significant increase from the protein allowance on the therapeutic keto diet – and fats are strongly encouraged. Carbohydrates are limited to only 15-20 grams per day.
The MAD diet was first introduced when in the early 2000s, families and individuals who had been successfully using the ketogenic diet as a cure/treatment for seizures stopped monitoring macronutrient intake so closely. Yet, even when the macronutrients were “off”, these patients still remained free of seizures.
Finally, the Low-Glycemic Index Treatment (LGIT) is yet another keto-related diet protocol that can be effective as an epilepsy treatment. The macronutrient intakes for people following the LGIT diet are similar to those in a ketogenic diet, with a few modifications: the LGIT diet allows for between 40-60g of carbohydrates per day (with an emphasis on low glycemic carb sources), and generally incorporates fats in a proportion of 60% of the daily food intake. The LGIT diet also recommends that all carbohydrate sources be combined with either a fat or protein, since this slows the body’s metabolism of the carbohydrates, thus preventing the risk of a kind of “sugar spike” that could potentially break ketosis.
Though these diets aren’t always as effective as a traditional, therapeutic ketogenic diet, all of these alternative diets do have decent success rates for treating epilepsy, and are better than following a standard, carb-heavy diet in most cases. Given their more forgiving “rules” for macronutrient intakes, some people with restrictive budgets, picky eaters, or those who are in places where food options for the keto diet are limited in some way, may be able to follow one of these alternative diets more readily. Pairing these alternative diet protocols with other treatments for epilepsy is ideal, since a protocol that combines complementary treatments for a particular health problem is more likely to be truly curative.
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Resources:
• Wyss, Livia S. (2016). The Effects of the Ketogenic Diet (KD) on Inflammatory Pain. Retrieved September 17, 2025 from: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://core.ac.uk/download/pdf/232744072.pdf
• Edwards, Nicole (2022). Medium Chain Triglyceride (MCT) Diet. Retrieved November 14, 2025 from: https://www.epilepsy.com/treatment/dietary-therapies/medium-chain-triglyceride-diet#:~:text=The%20MCT%20ketogenic%20diet%20uses,down%20these%20fats%20into%20ketones.
• Sirven, Joseph I., et. al. (2022). Modified Atkins Diet. Retrieved November 14, 2025 from: https://www.epilepsy.com/treatment/dietary-therapies/modified-atkins-diet
• Faltersack, Kelly, et. al. (2025). Ketogenic diet therapy for epilepsy during pregnancy and lactation: An international survey exploring clinician perspectives. Retrieved November 14, 2025 from: https://onlinelibrary.wiley.com/doi/10.1002/epi4.70067
• John Hopkins Medicine (n.d). Timeline: Ketogenic Diet Therapy for Epilepsy | The Johns Hopkins Epilepsy Center. Retrieved November 15, 2025 from: https://www.hopkinsmedicine.org/neurology-neurosurgery/specialty-areas/epilepsy/keto-diet-timeline
• Scantlebury, Morris H., et. al. (2025). Ketogenic diet for infantile epileptic spasms. Retrieved November 15, 2025 from: https://onlinelibrary.wiley.com/doi/10.1002/epi4.70168
• Wang, Tianshuang, et. al. (2025). Vagus nerve stimulation combined with ketogenic diet versus ketogenic diet alone in the treatment of febrile infection-related epilepsy syndrome in children: efficacy and long-term prognosis study. Retrieved November 15, 2025 from: https://pmc.ncbi.nlm.nih.gov/articles/PMC12497667/
• Pfeiffer, Heidi H. (2022). Low Glycemic Index Treatment. Retrieved November 15, 2025 from: https://www.epilepsy.com/treatment/dietary-therapies/low-glycemic-index-treatment
