Since the 1920s, studies have shown that diet can improve seizure control in individuals with epilepsy. While most of these studies are based on the classic ketogenic diet, newer studies suggest that less restrictive diets, such as the low glycemic index diet and modified Atkins diet, may also be helpful.
This article discusses how the foods you eat can decrease your seizure risk and which diet therapies may be beneficial to treat epilepsy.
How Does Diet Affect Epilepsy?
Although there is no solid evidence that a balanced diet directly affects seizures, anecdotal reports suggest that people who make simple, consistent dietary changes to improve the nutritional content of their diet often notice improvements in seizure control.
Additionally, a balanced diet that emphasizes whole foods and minimizes ultra-processed foods provides essential nutrients to keep energy levels stable and promote regular sleep patterns, which may play a role in seizure reduction.
Essential Foods and Nutrients for a Balanced Diet
When moving toward a balanced, whole foods diet, the Epilepsy Foundation suggests starting by eliminating foods with high amounts of simple sugars, a type of carbohydrate with a high glycemic index. Foods with a high glycemic index are quickly digested and can cause your blood sugar to spike and fall rapidly.
Examples of foods high in simple sugars include:
- Table sugar
- Sodas
- Fruit juice concentrate
- Syrups
- Candy
- Processed foods with added sugar, including cereals and baked goods
According to the 2020–2025 Dietary Guidelines for Americans, a healthy diet consists of nutrient-dense foods from all food groups and keeps you within your daily caloric needs.
The core elements of a balanced diet include fruits, vegetables, grains, low-fat dairy, protein, and oils, as follows:
- Fruits and vegetables: Colorful fruits and vegetables contain many vitamins, minerals, and antioxidants needed to maintain good health and protect against chronic disease. Studies show a diet high in vegetables provides seizure control. Adults should aim to consume 2 to 3 cups of vegetables and 1.5 to 2 cups of fruits daily.
- Grains: Grains, especially whole grains, offer many nutrients, including complex carbohydrates, several B vitamins, dietary fiber, and minerals that are important for the health and maintenance of your body. Good dietary sources of grains include quinoa, whole-grain bread, oats, and brown rice.
- Low-fat dairy: Dairy products offer many health benefits, such as building and maintaining strong bones. Fat-free or low-fat milk, cheese, and yogurt also provide nutrients many diets lack, including calcium, vitamin D, potassium, and protein. While more research is needed, some studies suggest low vitamin D levels may worsen seizures.
- Protein: Protein is vital in building and supporting muscles, the immune system, hormones, enzymes, and red blood cells. Good protein sources include lean meat, poultry, eggs, seafood, nuts, and legumes.
- Oils: Olive oil and oils from food, such as nuts, olives, avocados, and some fish, are high in heart-healthy monounsaturated and polyunsaturated fats that give you energy and help your body absorb certain vitamins.
Dietary Therapies to Try
When anti-seizure medications (antiepileptic drugs) and a balanced diet cannot control seizures in a person with epilepsy, dietary therapies may be recommended. The common feature of these diets is that they are low in carbohydrates and eliminate added sugars and sweets to improve seizure control.
Ketogenic Diet
The classic ketogenic diet for epilepsy is the most well-established dietary therapy for the condition. It has been used for nearly a century to reduce or prevent seizures in children who do not respond well to medications.
In the ketogenic diet, around 90% of calories comes from fat, while 6% comes from protein and 4% from carbohydrates. The goal of the diet is to induce ketosis—when your body burns fat for energy instead of carbohydrates (glucose).
When the body uses fat for energy, ketones are formed. Though many theories exist as to why the diet works, ketones are believed to be responsible for the benefits of the ketogenic diet for epilepsy, with higher ketone levels associated with improved seizure control.
Studies show that:
- Children who follow a ketogenic diet are up to 3 times more likely to become seizure-free and up to 6 times more likely to experience at least a 50% reduction in seizure frequency than children given their usual care.
- Adults who follow a ketogenic diet may be as much as 5 times more likely to achieve at least a 50% reduction in seizure frequency than adults given their usual care.
Because the ketogenic diet for epilepsy is very restrictive and often challenging to follow, most experts suggest that adults begin with a less restrictive diet, such as the low glycemic index or modified Adkins diet.
Low Glycemic Index Diet
Another popular diet for epilepsy is the low glycemic index treatment (LGIT) diet—a less restrictive variation of the ketogenic diet. The glycemic index rates foods on a scale of 1 to 100 based on how much they raise blood sugar.
The LGIT diet allows for an increased intake of low glycemic index carbohydrates, with a usual goal of 40 to 60 grams daily, or 10% of total daily calories. Similar to the ketogenic diet, it is primarily made up of fat. However, it does not restrict protein or fluids. Portion sizes are estimated rather than weighed, allowing you to enjoy a more flexible lifestyle that includes eating at restaurants.
Though the LGIT diet may not produce ketosis, it can contribute to a decrease in glucose metabolism and consistent glucose levels, which may have therapeutic effects on the brain.
While high-quality studies are still needed, clinical evidence suggests the effectiveness of the LGIT diet is similar to that of the ketogenic diet, with over 50% of people experiencing a reduced seizure frequency.
Modified Atkins Diet
The modified Atkins diet (MAD) is a liberalized variation of the ketogenic diet. Like the ketogenic diet, the MAD is high in fat and low in carbohydrates. However, it is more sustainable in the long run because it does not restrict fluid, protein, or calories. It also does not require weighing of foods.
The MAD allows for up to 20 grams of net carbs daily and strongly encourages fat intake. Around 35% of calories on the MAD come from protein. Because of the significant dietary carbohydrate restriction, people who follow the MAD typically produce ketones.
While additional studies are needed, studies have shown a 50% reduction in seizures in half of the people who followed the modified Atkins diet for six months. Many people were also able to reduce medications.
Epilepsy Foundation. Modified Atkins diet.
Work With a Healthcare Provider to Find the Right Diet
Although seizure diets have proven beneficial for some people, they can be restrictive and difficult to follow. If you are considering starting a ketogenic diet, low glycemic index treatment diet, modified Atkins diet, or any other seizure diet, talk with your medical team to see if it is a good fit for you. It’s also important to be carefully monitored by a dietitian to ensure you meet your nutritional needs.
Food-Based Seizure Triggers
Currently, no solid evidence suggests that any particular food can trigger seizures in a person with epilepsy. However, in reflex epilepsies, which are caused by an external stimulus (trigger) and are fairly rare, seizures can be triggered by eating specific foods. Triggers often differ from person to person.
In one 2020 review of studies that included data from 216 participants, the types of foods linked to the onset of reflex seizures were rice-based foods, spicy foods, meat and fish, oily foods, milk, hot food, cold food, bread, porridge, and strawberry syrup.
Of note, 67 participants had seizures with rice-based foods, while fewer than 10 experienced seizures after consuming the other foods.
Consumption of alcohol and caffeine, especially at high doses, may also increase the risk of seizures. However, some evidence suggests that chronic low-dose caffeine consumption may help protect against seizures.
Summary
Anti-seizure medications are the primary treatment to prevent seizures in epilepsy. A whole foods diet that includes foods from all food groups provides your body with all the essential vitamins and minerals it needs to function optimally. It may also help improve energy levels and help you keep a regular sleep pattern, which may help reduce the risk of seizures.
If seizures remain poorly controlled despite a healthy diet and medication, your healthcare provider may suggest the ketogenic diet or one of its variants, which are believed to have therapeutic effects on the brain. It is very rare for seizures to be triggered by specific foods.
Source: verywellhealth.com, Lindsey Desoto, Nicholas R. Metrus, MD
