The notion of a dietary treatment for epilepsy is rooted in the writing of Hippocrates who described a man whose seizures were cured by fasting. The classic Ketogenic Diet (KD) was initially designed in 1921 at the Mayo Clinic. Although effective at controlling seizures, its restrictive nature limited widespread use. The discovery of several anti-seizure medications over many decades resulted in near extinction of the diet until 1994 when the parents of Charlie Abrahams started a foundation to advocate for the KD that completely arrested his seizures. In the 30 years since the formation of The Charlie Foundation, KDs for epilepsy have experienced a surge in use and research. Multiple randomized controlled trials and prospective studies have confirmed the response rate of approximately 50% in children and adults with medication-resistant epilepsy. Those who maintain KDs for two to three years may receive long-lasting benefits beyond their tenure on the diet. Charlie Abrahams who maintained the diet for five years has been off the diet and has since been seizure-free.

Variations of the classic KD have been designed in recent years to make the diet simpler to manage and more tolerable. All variations of KDs are referred to as “ketogenic diet therapies” (KDTs) and are high in fat, moderate in protein, and restricted in carbohydrate. (The abbreviation KDT is used throughout this program and is interchangeable with KD.) In the absence of significant carbohydrate intake, mitochondrial beta-oxidation of fat in the liver generates large quantities of ketone bodies (specifically acetoacetate and beta-hydroxybutyrate), which can be readily used as an energy source, unlike fatty acids. Through a series of complex mechanisms, the diet has been found to have an anti-inflammatory effect on the brain. Though not completely understood, research has confirmed in animals that mitochondrial, neuronal, and mammalian target of rapamycin (mTOR) pathways are positively affected, which may account for the anti-epileptic effect and improvement in brain function experienced in epileptic patients. 

New applications of KDTs for metabolic, mitochondrial, and neurologic disorders have emerged in recent years. Use of KDTs for glioblastoma brain cancer has shown benefit in inhibiting cancer growth and improving tumor response to traditional cancer therapies. As science continues to emerge for epilepsy and other applications, clinical and research opportunities for dietetic practitioners will also grow. A 2020 Cochrane Report has validated the use of KDTs in medication-resistant epilepsy based on numerous published studies. The American Academy of Nutrition and Dietetics published a practice paper in 2017 describing the role of the registered dietetic practitioner in KDTs for individuals with epilepsy.

This continuing education activity is designed to help you earn 6.0 continuing education credits for dietetics (CDR CPEU).