Eating a balanced diet and maintaining adequate hydration are important, especially for people living with epilepsy. Here are some tips about nutrition that people with epilepsy should be aware of from a Mayo Clinic physician.
Bone Health
Bone health is important for everyone because of aging, but some people with epilepsy are at a higher risk of bone fracture for several reasons:
- Seizures can present a risk of fracture. In people with convulsive seizures or seizures that make them fall, also called drop seizures or atonic seizures, there is a higher chance of breaking a bone due to a seizure.
- Many anti-seizure medicines are associated with poor bone health and can lower vitamin D and calcium levels. This can cause weaker bones, a condition called low bone mineral density. These effects don’t happen right away, but even young people with epilepsy can have poor bone health and are at higher risk of bone fractures typically seen in older adults.
It’s important to maintain strong bones as you age. Staying physically active, such as by walking, swimming and participating in sports, in addition to eating a healthy diet can help keep bones strong. In people with low vitamin D levels, supplements are typically recommended. Check with your physician to see if you should be taking a supplement to help support your bone health.
Dietary Therapies
Dietary therapy for epilepsy has been around a long time — since the 1920s — but has gained renewed interest due to popular dietary trends. A ketogenic, also called keto, diet is a medical therapy used to treat hard-to-control seizures. A ketogenic diet is the strictest of the diet therapies used for epilepsy. It is a low-carbohydrate, high-fat diet that you should only use with the guidance of a doctor specializing in epilepsy and a dietitian. Below are some key considerations about a ketogenic diet:
- Meals and snacks have only 1 gram total of carbohydrate, also called sugar, and protein for every 3 to 4 grams of fat. This is known as a 3-to-1 or 4-to-1 ratio depending on the fat content.
- Fats typically come from butter, mayonnaise, heavy whipping cream and oils.
- The diet requires pre-planning for all meals and snacks, as well as making sure that there are no other sources of carbohydrates that could affect the success of the diet. Other sources include the carbohydrates in anti-seizure medications, which often need to be switched to low-carbohydrate tablet or capsule. These sources also include products that people use every day, such as shampoo, lotion, sunscreen and toothpaste.
- Many products are now advertised to be ketogenic, and you may see these labeled keto-friendly. It’s important to read the nutrition labels of these products to make sure that they truly are safe to use if you’re receiving medical dietary therapy for epilepsy.
- The diet is not a “healthy” diet. Your doctor typically monitors lab tests every few months to make sure that your body is tolerating the diet. Some people are not able to follow a ketogenic diet because their bodies cannot break down fats properly.
- Before starting a ketogenic diet, it is important to be screened for metabolic and mitochondrial disorders.
- Weight loss can be a side effect of the ketogenic diet. So the height and weight of children using the diet should be followed closely.
There are some less strict diets, such as the modified Atkins diet, that can be effective, particularly in children, and lead to a significant reduction in seizures. Another low carbohydrate diet, the low-glycemic index diet, also can be helpful for some people but does not lessen seizures as well as a ketogenic diet does.
Even if it’s not being used for epilepsy treatment, a low-carbohydrate diet, such as the Mediterranean diet, may be a good option for anyone looking for a healthier way to eat.
Pregnancy and Diet in Epilepsy
If you have epilepsy, you should learn about the risks of anti-seizure medicines and pregnancy, specifically an increased risk of birth defects in people taking certain medicines.
Folate, also called folic acid or vitamin B-9, is important for the development of the central nervous system in fetuses. Several anti-seizure medicines lower folate levels, particularly valproic acid (Depakote). This raises the risk of what are called neural tube defects. An example is spina bifida. Make sure that your diet includes good sources of folate such as dark leafy greens, beans, nuts, and whole grains and fortified grain products.
If you take anti-seizure medicine and are pregnant or planning to become pregnant, take up to 4 mg a day of folic acid, particularly if the medicines you take are associated with an increased risk of neural tube defects.
Supplements
Talk to your epilepsy care provider before taking any herbal or dietary supplements. When used with anti-seizure medicines, certain supplements can affect how the medicines work.
Some supplements can speed up or slow down how fast your body breaks down your anti-seizure medicine. This can lessen seizure control or cause side effects if medicine levels become too low or too high.
Tell your doctor about any supplements you’re thinking about taking to find out if a certain supplement is safe for you.
Learn more about epilepsy and care available at Mayo Clinic.
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Anthony L. Fine, M.D., is a pediatric neurologist and epileptologist at Mayo Clinic. His clinical and research focus includes the evaluation and treatment of epileptic encephalopathies, ESES and the electroclinical syndromes of CSWS and LKS. He also studies the diagnosis and management of genetic epilepsies and fetal and neonatal neurology.