There is very little evidence that modifying your diet can affect the number or severity of your seizures. However, some people do notice that certain foods seem to precipitate attacks (milk seems to do it for some people, chocolate or coffee for others). So it is worth looking at your diet to see whether seizures do tend to occur more often after some particular food or drink. If you think they do, test out your theory! Give up the food for a month and mark on your seizure chart the date that you gave it up. At the end of one month see if you have had fewer seizures than in the previous month. Then reintroduce the food into your diet, marking your chart with the date you started eating it again. After another month, check the number of seizures you have had. If your seizure frequency has gone up again, it might be worth eliminating that particular food for good. Sometimes this dietary modification works for an individual, even if we know of no scientific reason why it should.
EVENING PRIMROSE OIL
Evening primrose oil is a popular remedy, widely used to relieve symptoms in a huge variety of conditions, including eczema, premenstrual syndrome, rheumatoid arthritis and asthma. Although it is generally a very safe treatment, evening primrose oil should not be taken if you have, or have ever had, epilepsy, or if you have a strong family history of epilepsy. Evening primrose oil actually has the potential to precipitate symptoms of undiagnosed temporal lobe epilepsy.
THE KETOGENIC DIET
Fasting has long been known to be one way of reducing seizure frequency. What happens in fasting conditions is that body fat is broken down to produce energy. No one knows why this should reduce seizure frequency in people with epilepsy, but there is no doubt that in some it does. One theory is that the breakdown of fats on a large scale makes the body more acidic, and from experience it has been found that this acidity acts as an anticonvulsant.
The ketogenic diet is a diet which contains a very large proportion of saturated fat (animal fats and some vegetable oils), and a drastically reduced proportion of protein and carbohydrate, so that about 90 per cent of the body’s daily energy requirements come from fat. (In a normal, healthy Western diet fat provides 30-35 per cent of the daily energy needs.) So, just as happens in fasting conditions, the massive breakdown of fats makes the body more acidic, and this is probably why the diet tends to reduce seizure frequency.
There is nothing new about the ketogenic diet. In fact it is one of the oldest treatments for epilepsy. The real problem with the diet is that it is both extraordinarily nasty and very difficult to prepare. Very few adults ever tolerate it for long, though it is occasionally given to children as a last resort. But since the first really effective anticonvulsant drug, phenytoin, appeared on the market the diet has largely fallen into disuse, and nobody has much regretted its passing.
So why, now in the 1990s, has the ketogenic diet suddenly re-emerged, like Frankenstein, from what most people would consider a timely grave? The answer to this question provides a very good example of medication by media.
The diet’s new-found popularity is due largely to an American film producer whose child has epilepsy. Despite numerous visits to eminent neurologists who tried every possible drug, the child’s seizures proved almost impossible to control. In desperation the father researched epilepsy treatments in the local library and came across the ketogenic diet, which no one had suggested to him.
He introduced his child to the diet and was very fortunate in that the child’s epilepsy improved. He then made a video film describing the way the diet had miraculously transformed his child’s life (and, rather unfairly, how all the doctors he had seen had failed to help). The film was seen widely on television. A spate of articles in the popular press followed, and the ketogenic diet is now the rage in the United States; there are also signs that parents in many other parts of the world are starting to ask why this miracle treatment has not been prescribed for their children.
How effective the diet really is, is still a matter of medical debate. The enthusiasts (and they include some very eminent doctors) say as many as half the children who try it achieve a 50 per cent reduction in seizures. Those who are less enthusiastic, though equally reputable, quote figures of around 5 per cent or less. No one doubts that it works for some children, or that when it does fail it is often because it is difficult to apply properly, and heartily disliked by the child.
There are also questions about the long-term implications for a child’s health which most parents (and doctors) will probably want answered before they embark on the ketogenic diet:
• Will it make my child fat?
It should not do so if the diet is correctly balanced. The child’s total daily calorie intake should not alter; what changes is the balance of foods. Only if the child eats more than they need to satisfy their daily energy requirements will they get fat.
• Will it increase the chances of my child developing heart disease?
We are so conditioned to associate a high-fat diet with heart disease that it is difficult to believe that the ketogenic diet can be healthy. But in the short term at any rate there is no evidence that children who have been given the diet develop the fatty plaques in their blood vessels which are the cause of heart disease. However, for those few children who have a family history of high blood cholesterol (hyperlipoproteinaemia) the diet may be a real danger. Any child who starts the diet should be monitored carefully to check the levels of blood cholesterol.
• Are there any other health problems associated with the diet?
A few children develop kidney stones on the diet, and it
may also have an effect on the immune system, though there is no evidence that this effect causes any significant problems in the short term.
If you are tempted to put your child on the ketogenic diet:
Do not try it if your child’s epilepsy is already well controlled by drugs.
Do not try it unless you are able (and willing) to put a lot of time and effort into preparing your child’s food.
Do not try it unless you have a supportive medical team including a trained dietician to help you.
Do not try it if there is any family history of high blood cholesterol.
Think about how your child will feel. No child likes to be different. The child with epilepsy starts off with a built-in difference from other children which they have to learn to live with. It will not make them feel any better if they are debarred even from eating the same biscuits, buns, sweets, hamburgers, ice-creams – all the snacks and junk foods that their friends eat and which most children enjoy.
If you decide to try it:
Learn all you can about food preparation. A skilled cook can make the diet much more acceptable – even, its supporters would say, quite appetizing.
Encourage your child to become involved both in the choice of food and its preparation. They are much more likely to stick with it if they have some control over it.
Be prepared for a difficult time at first as the child’s body adjusts to the diet. To begin with the child may be irritable because their blood sugar is low, but after a week or two this should settle down.
Listen to your child. If they really hate the diet, and many do, ask yourself if it is worth putting them through it for what may be only a small reduction in seizures.
• If, after three or four weeks, there has been no improvement in seizure control, give it up.
WATER LOAD
Some years ago a medical scare story was published in the press suggesting that a certain brand of lemonade had been found to cause seizures. The facts were rather different; the lemonade was entirely innocent. The seizures were not lemonade-induced but due to the fact that it had been a hot summer’s day and the sufferer had drunk more than two litres of the stuff. He had given himself a huge ‘water load’ – too much liquid drunk too quickly, which is known sometimes to trigger a seizure.
When you are thirsty, do not drink huge amounts to quench your thirst. A glass of water is fine but if you drink, say, two or three pints all at one time you risk precipitating a seizure. There is no need to restrict your overall fluid intake, but try to drink little and often rather than allowing yourself to develop a real thirst that might make you want to drink very deeply.
*57\193\2*
LIVING WITH EPILEPSY: DIET AND EPILEPSYThere is very little evidence that modifying your diet can affect the number or severity of your seizures. However, some people do notice that certain foods seem to precipitate attacks (milk seems to do it for some people, chocolate or coffee for others). So it is worth looking at your diet to see whether seizures do tend to occur more often after some particular food or drink. If you think they do, test out your theory! Give up the food for a month and mark on your seizure chart the date that you gave it up. At the end of one month see if you have had fewer seizures than in the previous month. Then reintroduce the food into your diet, marking your chart with the date you started eating it again. After another month, check the number of seizures you have had. If your seizure frequency has gone up again, it might be worth eliminating that particular food for good. Sometimes this dietary modification works for an individual, even if we know of no scientific reason why it should.EVENING PRIMROSE OILEvening primrose oil is a popular remedy, widely used to relieve symptoms in a huge variety of conditions, including eczema, premenstrual syndrome, rheumatoid arthritis and asthma. Although it is generally a very safe treatment, evening primrose oil should not be taken if you have, or have ever had, epilepsy, or if you have a strong family history of epilepsy. Evening primrose oil actually has the potential to precipitate symptoms of undiagnosed temporal lobe epilepsy.THE KETOGENIC DIETFasting has long been known to be one way of reducing seizure frequency. What happens in fasting conditions is that body fat is broken down to produce energy. No one knows why this should reduce seizure frequency in people with epilepsy, but there is no doubt that in some it does. One theory is that the breakdown of fats on a large scale makes the body more acidic, and from experience it has been found that this acidity acts as an anticonvulsant.The ketogenic diet is a diet which contains a very large proportion of saturated fat (animal fats and some vegetable oils), and a drastically reduced proportion of protein and carbohydrate, so that about 90 per cent of the body’s daily energy requirements come from fat. (In a normal, healthy Western diet fat provides 30-35 per cent of the daily energy needs.) So, just as happens in fasting conditions, the massive breakdown of fats makes the body more acidic, and this is probably why the diet tends to reduce seizure frequency.There is nothing new about the ketogenic diet. In fact it is one of the oldest treatments for epilepsy. The real problem with the diet is that it is both extraordinarily nasty and very difficult to prepare. Very few adults ever tolerate it for long, though it is occasionally given to children as a last resort. But since the first really effective anticonvulsant drug, phenytoin, appeared on the market the diet has largely fallen into disuse, and nobody has much regretted its passing.So why, now in the 1990s, has the ketogenic diet suddenly re-emerged, like Frankenstein, from what most people would consider a timely grave? The answer to this question provides a very good example of medication by media.The diet’s new-found popularity is due largely to an American film producer whose child has epilepsy. Despite numerous visits to eminent neurologists who tried every possible drug, the child’s seizures proved almost impossible to control. In desperation the father researched epilepsy treatments in the local library and came across the ketogenic diet, which no one had suggested to him.He introduced his child to the diet and was very fortunate in that the child’s epilepsy improved. He then made a video film describing the way the diet had miraculously transformed his child’s life (and, rather unfairly, how all the doctors he had seen had failed to help). The film was seen widely on television. A spate of articles in the popular press followed, and the ketogenic diet is now the rage in the United States; there are also signs that parents in many other parts of the world are starting to ask why this miracle treatment has not been prescribed for their children.How effective the diet really is, is still a matter of medical debate. The enthusiasts (and they include some very eminent doctors) say as many as half the children who try it achieve a 50 per cent reduction in seizures. Those who are less enthusiastic, though equally reputable, quote figures of around 5 per cent or less. No one doubts that it works for some children, or that when it does fail it is often because it is difficult to apply properly, and heartily disliked by the child.There are also questions about the long-term implications for a child’s health which most parents (and doctors) will probably want answered before they embark on the ketogenic diet:• Will it make my child fat?It should not do so if the diet is correctly balanced. The child’s total daily calorie intake should not alter; what changes is the balance of foods. Only if the child eats more than they need to satisfy their daily energy requirements will they get fat.• Will it increase the chances of my child developing heart disease?We are so conditioned to associate a high-fat diet with heart disease that it is difficult to believe that the ketogenic diet can be healthy. But in the short term at any rate there is no evidence that children who have been given the diet develop the fatty plaques in their blood vessels which are the cause of heart disease. However, for those few children who have a family history of high blood cholesterol (hyperlipoproteinaemia) the diet may be a real danger. Any child who starts the diet should be monitored carefully to check the levels of blood cholesterol.• Are there any other health problems associated with the diet?A few children develop kidney stones on the diet, and itmay also have an effect on the immune system, though there is no evidence that this effect causes any significant problems in the short term.If you are tempted to put your child on the ketogenic diet:Do not try it if your child’s epilepsy is already well controlled by drugs.Do not try it unless you are able (and willing) to put a lot of time and effort into preparing your child’s food.Do not try it unless you have a supportive medical team including a trained dietician to help you.Do not try it if there is any family history of high blood cholesterol.Think about how your child will feel. No child likes to be different. The child with epilepsy starts off with a built-in difference from other children which they have to learn to live with. It will not make them feel any better if they are debarred even from eating the same biscuits, buns, sweets, hamburgers, ice-creams – all the snacks and junk foods that their friends eat and which most children enjoy.If you decide to try it:Learn all you can about food preparation. A skilled cook can make the diet much more acceptable – even, its supporters would say, quite appetizing.Encourage your child to become involved both in the choice of food and its preparation. They are much more likely to stick with it if they have some control over it.Be prepared for a difficult time at first as the child’s body adjusts to the diet. To begin with the child may be irritable because their blood sugar is low, but after a week or two this should settle down.Listen to your child. If they really hate the diet, and many do, ask yourself if it is worth putting them through it for what may be only a small reduction in seizures.• If, after three or four weeks, there has been no improvement in seizure control, give it up.WATER LOADSome years ago a medical scare story was published in the press suggesting that a certain brand of lemonade had been found to cause seizures. The facts were rather different; the lemonade was entirely innocent. The seizures were not lemonade-induced but due to the fact that it had been a hot summer’s day and the sufferer had drunk more than two litres of the stuff. He had given himself a huge ‘water load’ – too much liquid drunk too quickly, which is known sometimes to trigger a seizure.When you are thirsty, do not drink huge amounts to quench your thirst. A glass of water is fine but if you drink, say, two or three pints all at one time you risk precipitating a seizure. There is no need to restrict your overall fluid intake, but try to drink little and often rather than allowing yourself to develop a real thirst that might make you want to drink very deeply.*57\193\2*