Specialist Dietary Treatment
Ketogenic Diet Therapy for Epilepsy
A medically supervised dietary treatment that may help some children and adults manage seizures. Learn what it involves, how it is monitored and what to ask your healthcare team.
Medical supervision is essential.
Do not begin ketogenic dietary therapy for epilepsy on your own. It requires assessment, a prescribed plan, education and ongoing monitoring by a trained team.
Do not fast, restrict fluids or change medication to try to bring on ketosis. A general “keto” weight-loss diet is not a substitute for epilepsy dietary therapy.
The Basics
What is Ketogenic Diet Therapy?
Ketogenic dietary therapies change the balance of fat, carbohydrate and protein. They are designed to alter metabolism in ways that can reduce seizures in some people.
The treatment is tailored to the individual. Your team considers your epilepsy, nutrition, other conditions, medications and practical needs.
How does it work?
The diet changes how the body uses energy and produces ketones. Its effects on seizures are complex and are not explained by ketone levels alone.
Higher ketone readings do not automatically mean better treatment. Follow the monitoring goals set by your clinical team.
Who may benefit?
It may be considered for some people with drug-resistant epilepsy and certain epilepsy syndromes or metabolic conditions.
It is not suitable for everyone. Assessment must identify conditions that could make the diet unsafe and consider other treatment options.
Can Adults Use This Treatment?
Yes. Ketogenic dietary therapies are used in adults as well as children. The type of diet, support needs and monitoring may differ.
For example, Toronto Western Hospital has an adult Epilepsy Diet Clinic. Ask your clinician about an appropriate referral and confirm current arrangements with the receiving clinic.
Different Versions
Types of Dietary Therapy
Approaches include the classical ketogenic diet, MCT-based diet, modified Atkins diet and low glycemic index treatment. They differ in food allowances and preparation.
Your team selects an appropriate approach. Do not choose ratios or carbohydrate limits from an online plan.
Meals & food preferences
Your dietitian will teach you how to plan and prepare meals. Depending on the prescription, ingredients may need weighing or another structured method of measurement.
Discuss cultural preferences, allergies, food access, school or work routines and meals away from home.
Tube feeding & nutrition
Dietary therapy can sometimes be provided through prescribed formulas or adapted feeding plans. Your team will determine the appropriate method.
Vitamin and mineral needs must be assessed. Use only the supplements and formulations recommended by your team.
From Interest to Assessment
How Can I Begin?
1. Ask about referral.
Talk with your neurologist or epilepsy clinician about whether dietary therapy could be appropriate. Programs and waiting times vary.
2. Complete the assessment.
The team reviews medical and nutrition history, medicines and relevant investigations. This helps determine suitability and establish a baseline.
3. Learn your plan.
You will need practical education about food preparation, fluids, supplements, monitoring and what to do during illness.
4. Begin with clinical support.
Starting may take place in hospital or as an outpatient, depending on the person, diet and program. Follow the team’s instructions rather than a general starting schedule.
How Effective is It?
Some people have substantial seizure reduction, some become seizure-free and others do not benefit enough to continue. Results differ between people, diets and epilepsy conditions.
Your team will agree on goals, a review period and how to judge benefit. Keep seizure records and discuss tolerability and daily-life impact alongside seizure numbers.
Risks & Monitoring
What Side Effects Can Occur?
Possible problems include constipation, nausea, vomiting and difficulty maintaining the plan. Other risks can include low blood sugar, metabolic acidosis, kidney stones, changes in blood lipids, nutritional deficiencies and effects on growth or bone health.
These effects should not all be treated as minor. Your team will explain warning signs, monitoring and when to seek urgent care.
Ask for clear instructions about illness, dehydration, persistent vomiting, unusual sleepiness or other concerning symptoms.
Tests & follow-up
Monitoring may include blood or urine tests, nutritional review, weight and growth assessment, and ketone checks where instructed.
The schedule depends on the person and program. Stay in contact with the team between appointments if concerns arise.
Medication & other products
Tell the diet team about every medicine and supplement. Formulations may contain carbohydrate, but do not substitute products yourself.
Medication reduction is not automatic. Any change must be directed by your prescriber.
How Long Does Treatment Continue?
Duration depends on the condition, response, side effects and practical circumstances. Your team will review whether continuing is worthwhile.
If stopping is appropriate, follow a supervised plan. Do not abruptly abandon the diet or change medication independently.
Practical Preparation
Questions to Ask Your Diet Team
- Which dietary approach is appropriate, and why?
- What tests and follow-up will be needed?
- What will food preparation involve?
- How can the plan fit allergies, culture, finances and daily routines?
- Which supplements and medication formulations should I use?
- What should I do during illness or if I cannot follow the plan?
- Who should I contact for urgent advice?
Recommended Resources
Use educational resources alongside your prescribed plan. Ask your team to approve recipes and preparation methods before using them.
About this information: This webpage is subject to continuous review by Epilepsy Ontario to help keep the information current. This material is for informational purposes only and should not be used for self-diagnosis or as a substitute for professional medical advice, diagnosis or treatment. Consult your healthcare provider about your own health and care.
Acknowledgement: Contributors to the original May 2018 page were Jennifer Fabe, Christine Williams-Dyjur, Dr. Eduard Bercovici and Nicole Turner. This reorganized version should not be taken as a new clinical review or endorsement by those contributors.
Clinical references:
International Ketogenic Diet Study Group: Children (2018) ·
International Recommendations: Adults (2021).
