Category: Grain Brain

New Study Validates Ketogenic Diet for Epilepsy Treatment in Adults

Epilepsy can be caused by a variety of different conditions including head trauma, infection, brain tumor, and stroke, but by and large most cases of epilepsy have no readily identifiable cause. Epilepsy affects some 2.3 million adults in America and close to half a million children. Further, about one in 26 people will be diagnosed with epilepsy at some point in their lives. It’s been estimated that there are approximately 150,000 new cases of epilepsy diagnosed in the United States each year and overall about $15.5 billion in medical costs as well as lost earnings and production are attributed to this disease.

The mainstay of treatment for epilepsy is pharmaceutical intervention. As I recently noted, more and more we are seeing surgical procedures being performed for those individuals who have not had a significant improvement with drugs. I indicated that at least some individuals are gluten sensitive and may benefit from a gluten-free diet which potentially could keep them from undergoing potentially life-threatening surgery as a treatment for their epilepsy.

But it is also important to understand that there’s another extremely effective dietary intervention that has proven itself quite useful in the treatment of epilepsy.

In 1920 a New York physician, Dr. Galen, reported at the American Medical Association convention that he had had significant success in treating epilepsy by initiating a program of fasting. At that time the only pharmaceutical interventions that were available included phenobarbital and bromides. Interestingly, the patient he treated was actually a young cousin who had aggressive seizures. On the second day of fasting the child’s epilepsy abated and did not return over the next two years of follow-up. Further studies appearing in 1923, 1926, 1928, all confirmed the effectiveness of fasting as an effective treatment for seizures.

Fasting is a way to produce a state of metabolism called ketosis. When a person is in ketosis, his or her body is utilizing fat as opposed to carbohydrate as a fuel, which, in this situation, becomes an alternative source of calories to power the brain.

To this day, a ketogenic diet, meaning a diet that is designed to increase the availability of fat while decreasing the availability of carbohydrate, remains an important tool that can be utilized in the treatment of children with epilepsy who do not have full response to medication.

Now a report, appearing several weeks ago in the journal Neurology, reveals that in fact, a ketogenic diet is also profoundly helpful in adults as well in terms of treating epilepsy. This research, published by investigators in Maryland, found that there was at least a 50% reduction in seizures in 32% of patients treated with a ketogenic diet as well as in 29% of patients who went on a modified Atkins diet. In fact, 9% of those placed on the ketogenic diet and 5% of those placed on the modified Atkins diet had a greater than 90% reduction in the frequency of their epileptic seizures. These diets were designed such that the bulk of calories, between 67% and 75%, came from fat. The study revealed that “the anticonvulsant effect occurs quickly with both diets, within days to weeks.” Interestingly, the most common side effect was weight-loss which the office indicated “maybe advantageous inpatients with obesity.”

Further, the authors revealed that only 60 to 65% of patients with epilepsy become seizure free using medication while 35% are resistant to the effects of medication. And they used these statistics to justify this study. They further stated that there has been an “exponential” growth in interest in using the ketogenic diet for the treatment of epilepsy.

The take-home message here is that patients with epilepsy have options beyond simple pharmaceutical intervention, and these include dietary changes which well-respected science is now validating as having significant efficacy. A fundamental cornerstone of the Grain Brain Program is profound reduction of carbohydrates and sugars while increasing “good” dietary fats. This approach tends to favor a low grade of ketosis which may well be the normal state of human metabolism. I have written extensively both on the site and in Grain Brain how this dietary approach has profound health-related benefits that relates to weight loss, metabolism, energy, reduction of inflammation, and even reduce risk for diabetes and cancer. This new report offers up yet another benefit to a higher fat lower carbohydrate dietary approach, in this case, for a disease that is devastating for so many.

In closing, I want to share with you a personal story of success I have had in my own practice.

Michelle is a 33-year-old woman who began having seizures at age 6 years. Over the years she was placed on multiple medications none of which was  successful either individually or in combination. At the time of her initial evaluation in June 2014 she was experiencing seizures approximately every six to eight weeks lasting approximately 3 minutes.

We placed Michelle on a gluten-free, ketogenic diet and for the first time she has become seizure free.

Finally, Michelle in her own words:

When I was six years old, I was diagnosed with temporal lobe, partial-complex epilepsy.  Over the years, I have seen multiple doctors and neurologists and I have been on every medication created to treat epilepsy, but I still continued to have seizures about every 6-8 weeks. For the most part, I have been able to lead a normal life achieving my college degree, getting married and having two happy, healthy kids but every time I had a seizure it was a cruel reminder that I was not everything I needed to be for my family. Many times after a seizure, I would be unable to work and care for them for days at a time.

I had been working with Dr. Donna Andrews and was able to understand that my seizures had to do with a lot more than the former doctors had explained to me. I was learning about how my blood sugar and stress levels affected my health and had experienced multiple stretches of three months without seizures but it was never consistent. Even though I knew I was headed in a better direction, I didn’t believe I could really be well.

After reading Grain Brain by Dr. Perlmutter, I called his office and was able to meet with him in person. When he read my past medical history he confidently prescribed the Ketogenic diet for me and his nutritionist worked to develop just the right set-up for my BMI. It seemed like a big change at first but really it has been much easier than I originally thought it would be. Now, after being on the diet, along with probiotics and supplements, I can say that I have been seizure free for over 4 months for the first time in over 20 years! My whole world is changing! I can work on getting my driver’s license! I can be what my family needs me to be! I believe God has used the Ketogenic diet to heal my epilepsy and I want to make sure everyone out there who is suffering from seizures has the opportunity to know about and try this amazing, risk-free treatment!


  • Lynn Dell

    Anyone who does a partial lobectomy without first insisting a ketogenic diet must be tried first should not be practicing medicine, in my opinion. And that quote that weight loss may be advantageous in patients with obesity must have been written by Captain Obvious. LOL!

    • susan henderson

      Sure but how would they make their money? The neurosurgeons would be out of business. Their whole system would collapse if they, honestly, did what was best for us.

      • Karen Edscorn Board

        That’s what I love about the Ketogenic diet – no one is getting rich off of it. The neurologists who recommend it are truly altruistic and care for their patients. Our son has been seizure free for the past 2 1/2 years on the Keto diet (previously having multiple seizures a day)

  • Lynn Dell

    I am so happy to read about your success, Michelle!

  • Lynn Dell

    I know I’m being a blog hog here, but you know how that recent study with Alzheimer’s patients that used a multi modality approach had so much success in slowing progression or reversing their respective disease processes? Someone should design a similar study for adults with epilepsy. The ketogenic diet should be part of it, and the type of fat consumed should be well regulated to reduce the more inflammatory fats and oils and promote more of the fats and oils that mitigate inflammation. Sleep quality should be optimized, stress reduction techniques, and of course certain supplements and probiotics. Maybe low levels of aerobic exercise, but I don’t know.

    We really don’t know the quality of fat the people consumed in this study. It is just my guess that the omega 3 and fats of wild caught fish and grass fed beef, etc. would be better for people with epilepsy. But I’d be willing to bet a small amount that the higher the quality of fat consumed, fat that is anti inflammatory, coupled with good sleep quality, the improvements seen would be more pronounced in cases like this, and I think the kind of fat that helps best ought to be established before a multi modality regime is designed.

    • Jane VanOsdol

      Lynn, is there a link for the Alzheimer’s study? Thanks!

    • Karen Edscorn Board

      Good points on the fats used and whether or not this was integral to their success (or lack of). Many children on the Ketogenic diet for seizures are encouraged to drink (or eat) heavy whipping cream with each meal. We steered away from cream pretty fast because it actually has a fair amount of carbs in it. We opted for other healthier fats, like olive oil, MCT oil, avocado, flaxseed meal, nuts, etc.

      • Brooke

        I am putting myself on this diet. I asked the dietician at my epilepsy support group and he was really against me going it alone. But I’m not getting any feedback from my dr. On this. How do I figure out what my carb intake for my bmi should be. I use all a love oils already but am new to MCT oil, I can only find recipes that put it in Bullet coffee and its bottle suggests salad dressing. Last do you test ketosis with pee sticks? If so how often?

        • Karen Edscorn Board

          The reasons you don’t want to go it alone is that it needs medical supervision — you can check ketones and blood sugar at home, but need script for the blood ketone strips (Precision). They are very expensive but insurance should cover. Urine strips aren’t very reliable – depends on how dehydrated or hydrated you are. Glucose needs to be checked as the diet can cause pronounced drops especially at beginning. Electrolytes need to be monitored for acidosis. Lipids need to be monitored. If you aren’t able to get medical supervision at this point in time, what I would recommend is to simply cut out sugar and gluten and eat modest amounts of other grains like rice (say 1/2 cup per meal) and then eat plenty of veggies (especially leafy green veggies) and lower glycemic fruit and moderate protein. Be generous with oils. MCT oil can be used just about anywhere you would use vegetable oils except you can’t fry at high temps. I bake with it, and beat it into mayo for dressings.

        • John

          Hi Brooke, I know you asked this four months ago but in case this helps you or others reading your post. The original research on The Modified Atkins Diet (MAD) by dr Kossoff cites 20 grams of net carbs a day, the same as Atkins induction (phase 1), irrespective of the BMI. I have gone it alone with great success and no side effects other than weight loss (which was probably good for me tbh). I recommend you go for it, just find all the resources you can, on MAD or Atkins phase 1. It’s hard (which is incidentally why these diets initially only were prescribed to children) but you can do it!

          Ketostix are good for motivation but don’t get too hung up on them. Being dehydrated makes them darker without your being more in ketosis. It’s not so much about amount of fat as it is carbs. That said, some suggest that coconut oil can help you attain ketosis faster. I find it good for satiety too. Add a spoon to your morning coffee!


      • Capri142

        Heavy whipping cream has 0 carbs , repeat ZERO carbs

  • Chanah Shapira-Stillman

    again, bears repeating that celiac should be ruled out as a cause. ketogenic diet is great for celiacs, especially since many have linked diabetes tendencies.

  • Jane VanOsdol

    So happy for you, Michelle! Praise God for this huge turnaround in your health!
    I will be working on this for my mom who is suffering with dementia and epilepsy.

  • Laney

    I am living proof of this as well but stumbled upon by accident even though my neurologist doesn’t believe in it and gets upset at the mention of Dr. Perlmutter. Funny Dr. Perlmutter was my very first neurologist when I moved to Naples approximately 22 years ago.

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  • Carla

    Michelle, I cried reading this article. I’m also 33, with temporal lobe partial/complex seizures. I have my degree, I’m married, with two happy healthy kids. I’ve had epilepsy since 16, been on numerous meds, and my neurologist just recommended me for brain surgery! I also have seizures every 6-8 weeks, lasting around 3 minutes, takes me a day or two to fully recover. I want to drive. I want to feel like a full fledged grown up for my family. This post has inspired me so much, and I pray I can follow through to the amount you have and find success!! I would love it if you could private message me if you happen to come across this post for any advice or guidance. Thank you!

    • S Joy

      Hi Carla this article has touched me greatly as it speaks very similarly of my life too. I would so welcome an opportunity to connect with you and / or MIchelle and find out what has worked for you… x

      • Carla

        That sounds so wonderful. Feel free to email me, carlabudd@gmail.com. I look forward to hearing from you, and Michelle please feel free to contact me as well.

    • Mayra


  • Salman Hamid

    There is one child here with cerebral palsy and consequently brain atrophy (shrinking) and epilepsy.
    Its spastic quadriplegic cerebral palsy.. The child cannot sit and stand… Dear Dr. Perlmutter,, Would you please recommend something for this child?

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  • Christopher Keene

    I once did the Atkins and lost 50lbs in 4 months. The diet was amazing. Strict but so worth it. Well 15 years I have put back on the wait. Im 235lbs and not feeling to great about myself. So I keep trying the Atkins diet and about a day into it I start getting Aura’s and feel like I’m about to have a seizure. So I stop it. I tried this 3x and Everytime it happens. I’m glad it worked for you.

  • Kathie

    I was diagnosed with temporal lobe partial complex seizures when I was 35. I took tegretol for many years. I went on a gluten free paleo-ish sort of diet on my own. I guess this is ketogenic, since it is low carb and higher in fat. I’m now seizure free and off medication. I am 64 years old. I have also experienced significant weight loss, not that I was fat before. Hard to believe you can eat all that fat and loose weight.

  • Mel

    My son has gone 5 months seizure free on Keto diet, but just had a break through seizure, while high in blood ketones. any suggestions to get him 100% seizure free? (I am not giving him any grains).
    And does protein lower ketone levels?

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  • Ashley Sandra

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  • Rachelle Hall

    The young man I know who has a seizure disorder is very thin already. What is recommended in that case since losing weight would not be recommended?

    • David Perlmutter

      For those looking to avoid weight loss on a Grain Brain lifestyle, you can increase the amount of healthy fats in the diet. However, given your friend’s health state, a nutrition protocol of any kind should be developed in concert with a physician. Has he tried to see a functional medicine practitioner?

  • Charlie

    Is she still under medication ?

  • Perch David


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  • Kat

    So so thankful for the Keto diet. My daughter was diagnosed with epilepsy two years ago, I heard about the diet the day before we got the diagnosis. Meds were pushed heavily by the neurologists but I asked for time (two weeks) to observe, record, and try cutting sugar. I didn’t expect immediate results, the neurologist didn’t expect any results. 7 seizures per day went to one per day, went to about 5 every few weeks (they happen in clusters). She’s not on a strict keto, I didn’t cut out all grain, starch, and fruit. It’s taken a lot of hard work, but has been completely worth it in my mind. Her EEGs are wild as ever, two years later, but her seizures are infrequent. The neurologists don’t push the meds, we have effective treatment with no bad side effects (I lost 20 pounds, that’s a great side effect). My tiny daughter didn’t lose weight as protein and fat make up most of her meals. She’s healthy.
    Even a reduction in sugar has made a world of difference. It makes an observable difference in behaviour for our autistic son too.

  • Jason Josh white


    I can call myself a miracle, one who had survived all odds against epilepsy and got cured through herbal medicine after several years on trioptal, Keppra and clonazepam. I am happy that it has been 10 years, I became totally seizure free.

    Through those dark days, waking up in fear, I thought I might not achieve my dreams of driving. It wasn’t what I ever wanted to deal with because all I ever wanted was to drive. Carry my friends and family around. Work and live a great life. But it all became a nightmare when I got my driver’s license at 18. I was diagnosed with seizure (tonic-clonic). I had frequent seizures, I used various medications. Worst was I could no longer drive. I was scared of life and everything around me didn’t make sense.

    After years of battling with seizure, I won through Herbal medicine called HILTON. At first I was in doubt, but I decided to give it a try, having spent a lot of money on doctors and drugs. I am so happy it came through for me over 10 years now, I have been seizure free. HILTON CURED ME!

    If you feel like you can try with herbs to get a seizure free life, I will advise you contact Doctor Mohan via his blog on http://www.seizurecure.blogspot.com

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  • Melody Horney

    I have a daughter with a traumatic brain injury. She is on multiple meds for seizures. The seizures are more under control these days. She occasionally has very short ones. She has seizures when she has an infection or UTI. It is sort of a blessing as she can’t speak.The problem is that she is less responsive, smiles less, eyes half mast sometimes .She had the car accident at age 19 and is 36. She is fed through a g tube. Does the keto diet work for TBIs?

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