Nutrition and Epilepsy

Mark Rudderham, ND, Rachel Laff, BA, and Orrin Devinsky, MD

Nutrition plays a central role in health and disease processes. The body draws all of its resources except oxygen from the diet. What we consume and how much we consume determines these resources and can influence health and disease. The traditional balanced diet recommended by the American Dietetic Association (ADA) consists of a mixture high in carbohydrates, moderate in protein, and low in fats. Some researchers are criticizing this once accepted food pyramid model that was the framework for a healthy diet for nearly 30 years. Studies on the Atkins diet, a high protein, low carbohydrate diet, support its utility as an effective means for weight loss, but no evidence relates its effects on seizures or long-term safety (1). The ketogenic diet, which is high fat and extremely low in carbohydrates, can help control seizures in some patients (see Chapter 21). Fasting rarely provokes seizures, and actually may reduce seizure frequency by putting the body in a state of ketosis (2,3). Hypoglycemia could possibly provoke seizure activity, although it is not common (4,5).

Scientific data on the relationship between diet and epilepsy are very limited. Specific metabolic deficiencies rarely cause epilepsy, as in the case of pyridoxine (vitamin B6) deficiency. Such seizures usually occur very early in life and are exquisitely responsive to pyridoxine therapy. Mitochondrial disorders result from abnormalities in the energy producing organelle. Tissues such as the heart and brain, which have high energy demands, are sensitive to mitochondrial dysfunction. Certain diets (e.g., more frequent meals and snacks with some glucose and electrolytes) and supplements (e.g., antioxidants) may help some patients with mitochondrial disorders and secondarily improve seizure control (6,7). Even in this special and uncommon case, however, little evidence links dietary changes and improved seizure control.

For the vast majority of epilepsy patients, no evidence links dietary changes and either improvement or exacerbation of seizure activity. Many anecdotal reports arise from individual patients or families that certain foods (e.g., those with high sugar content) or additives (e.g., aspartame) can trigger seizures. Little evidence supports these associations when scientifically studied (8,9). Similarly, some patients with epilepsy take antioxidants and free radical scavengers, such as omega-3 fatty acids and vitamin E (10,11). Although some evidence suggests that this class of compounds may reduce cancer risk and slow the progression of neurodegenerative disorders such as Alzheimer's and Parkinson's disease (12,13), no evidence shows that antioxidants reduce seizure activity or the negative long-term effects of epilepsy, such as impaired short-term memory. In many physical data and laypeople's assessment, however, the benefits of nutritional and vitamin supplements outweigh the risks.

The more we understand the biochemical pathways behind disease, the more we understand the biochemical pathways behind healthy functioning. Further, as research and technology improve our ability to design effective medications, we gain important insights into what diet and nutrition provide for maintaining good health. Our knowledge of the neurochemical basis behind epilepsy is growing, but we must translate and supplement this with information about how epilepsy impacts the body's use of specific nutrients. Amino acids, vitamins, and minerals are essential components of daily metabolism, and may be affected to varying degrees by epilepsy. Studies are beginning to look at both the preventative and therapeutic roles nutrition can play in the treatment of epilepsy. Because of the broad spectrum of causes for epilepsy, treatments must be chosen carefully, and the findings of one particular study may not apply to all people with epilepsy.

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