A nutritionally well balanced diet is important to maintain the healthy function of our brain and body systems and is part of maintaining a healthy lifestyle. A healthy lifestyle may assist with minimizing the number of seizures you experience as illness, poor sleep and some nutritional deficiencies are known seizure triggers in people with epilepsy.
There are many social and economic factors that have an impact on a person’s ability to maintain a healthy diet however, it helps protect against malnutrition and many diseases such as diabetes, heart disease, stroke and cancer.
Basics of a healthy diet:
- Plant foods should make up the largest portion of our diet
- Energy in (kilojoules/calories) should equal energy out (exercise/activity)
- Reduce salt intake to less than 5g per day (most salt in diets comes from processed foods)
- Reduce free sugar intake (added sugars, again in processed foods)
- Limit the amount of saturated fat and trans fats and ensure a small amount of healthy fats (extra virgin olive oil, nut and seed oils) for heart and brain function
- Choose water as your main drink.
More detailed information and guidelines can be found on the following websites:
The ketogenic diet has been used effectively as a treatment for drug refractory epilepsy (seizures not responsive to anti-seizure medication) for many years. It involves eating a diet high in fat and low in carbohydrates and this forces the body to burn fat for energy instead of glucose (ketosis). It is believed that the success of this diet comes from the changes in the microbiome of the gut combined with a reduction of excitability of the neurons in the brain as the body tries to conserve energy leading to a reduced seizure threshold.
The diet has been used successfully primarily in children but is suitable for any age group. It has been shown to reduce seizures in as many as 2 out of 3 children and some children have their seizures cease altogether.
The ketogenic diet can be very challenging to maintain and is not suitable for everyone. It requires family support, strong commitment and motivation and must be undertaken with the recommendation, guidance and supervision of the treating neurologist and a nutritionist/dietician. Regular blood tests need to be carried out and progress monitored carefully.
The very nature and unpredictability of seizures puts people with epilepsy at a higher risk of broken bones.
Anti-seizure medications (ASMs), are known to cause bone mineral density loss and can cause bone diseases like osteoporosis. ASMs can also alter the vitamin and mineral content of the blood which in turn can lead to other issues.
It is therefore important to discuss this with your treating doctor to identify the risks for you and what you can do to avoid problems and maintain your bone and general health.
Caffeine is a known trigger for seizures. Be mindful of how much caffeine you consume and avoid excessive amounts (coffee, tea, cola drinks, Mountain Dew etc). Be especially careful when considering energy drinks as they can contain very high amounts of caffeine.
Alcohol consumption can also be a trigger for seizures. Again, take care when consuming and avoid binge and/or excessive drinking. Alcohol consumption can also lead to bone density loss, poor sleep, risk taking behavior, missed medications & medication interactions making the risks of seizures even higher. Alcohol withdrawal can lead to severe seizures and should be undertaken with medical supervision for anyone with known epilepsy and/or severe alcoholism.
Cigarette Smoking is responsible for numerous serious health conditions and smoking to any degree is also related to bone density loss. A person who has a seizure whilst smoking is also at risk of burns and starting a fire.
Over the Counter and Prescription Medications all interact with each other in different ways and may cause the level of your Anti-Epilepsy Medications (AEMs) to be too high (toxic) or too low causing a seizure(s) to occur. Ensure you speak with a pharmacist about any possible interactions between your AEMs and other medications before you take anything new.
Illicit Substances may directly affect the brain and cause a seizure or interact with AEMs in an unknown way. The outcomes will vary greatly between different drugs and different people. Amphetamines, ecstasy, cocaine and heroin have all been shown to increase the frequency of seizures in people with epilepsy. The use of cannabis is also best avoided and is different from cannabis oil for epilepsy (see below link). For some people, using recreational drugs can actually trigger epilepsy and they can also be a risk factor for SUDEP (Sudden Unexpected Death in Epilepsy).
Medicinal Cannabis – cannabinoids
Lu X & Wang X, 2016, Hyponatraemia induced by antiepileptic drugs in patients with epilepsy, http://doi.org/10.1080/14740338.2017.1248399.
Westmark CJ, 2018, A Role for Amino Acid Balance in Dietary Treatments for Epilepsy, The Journal of Nutrition, https://doi.org/10.1093/jn/nxx044.
Singla S et al, 2017, Bone Health in Patients with Epilepsy: A Community-based Pilot Nested Case-control Study, Ann Indian Acad Neurol, 2017 Oct-Dec; 20(4): 367-371.https://nutritionaustralia.org
Goswami JN & Sharma S 2019, Current Perspectives On The Role Of The Ketogenic Diet In Epilepsy Management, Neuropsychiatric Disease & Treatment 2019; 15: 3273-3285 https://doi.org/10.2147/NDT.S201862
Reviewed September 2021