Ketogenic diet to fight epileptic seizures

Vincent van Gogh's 'The Starry Night' (1889) is without doubt among the most recognised paintings in modern history.

Yet, few know that he created it in a mental asylum where a doctor diagnosed his condition as epilepsy. While van Gogh is now hailed as a genius, back in the day, the Dutch artist was shunned because of his mental illness, hypothesis of which now includes epilepsy and bipolar disorder.

Van Gogh isn't the only genius to have suffered; poet Edgar Allan Poe, writer Lewis Carroll, and chemist Alfred Nobel too battled epileptic seizures. Although the condition has been known to mankind for centuries — epilepsy finds mention in the Bible (Matthew 17:14–18; Mark 9:14–29; Luke 9:38–42) — it continues to be veiled in myths and riddled by stigma.

"There are many beliefs like jhaad-phukh karne se thik ho jayega (brandishing with the broom and chanting mantras will cure epilepsy). But, this is a myth," says Dr Man Mohan Mehndiratta, Secretary General, Indian Epilepsy Society and Director, Janakpuri Super Speciality Hospital Society, New Delhi. "Epilepsy is not a mental health problem, it is a neurological condition," he said.

To raise awareness about the health condition, February 13 has been earmarked as International Epilepsy Day.

Don't blame the genes

India is home to an estimated 13 million people with epilepsy (PWE). Epilepsy may be genetic or idiopathic (where the cause is not known), says Dr Mehndiratta, who has more than 30 years of experience dedicated to epilepsy. "It can affect anyone, at any age," says the doctor, who is also the Vice President of the International Bureau for Epilepsy.

"In case of infants and children, it can be the result of perinatal injuries, trauma during child birth, or unhygienic conditions. In adults, epilepsy may be caused by neurocysticercosis, stroke, or even tumour," he said.

The disorder is characterised by recurring seizures — febrile, partial, or generalised tonic-clonic. "His head would tilt to one side, he would not be able to walk, stand ,or even sit upright," said Mumbai resident Sunita Gaddala about her son Yogesh. Now a healthy teenager, Yogesh was first struck by a seizure during a bout of fever when he was eight-months-old. They would occur every time he ran a temperature. "It soon came to a point when he started getting seizures even when he didn't have fever. He'd get about 30-40 seizures a day," she said. "Eventually, he became bed-ridden. We put him on medication but when the drugs failed, we started the ketogenic diet."

The diet fix

The Gaddalas approached Dr Janak Nathan, a neurologist, who has been propagating the ketogenic diet for uncontrolled epilepsy in India for the last two decades. "Under normal conditions, we use energy from glucose from our food," said Dr Nathan. "When we fast, there is an absence of glucose. So the body uses its stored fat as alternative fuel. The broken-down fat produces ketone bodies that help in controlling seizures," he said.

The high-fat, low-carbohydrate diet is carefully administered based on an individual's gender, age, type and frequency of seizures, says Dr Nathan. Dr Mehndiratta endorses the ketogenic diet for uncontrolled epilepsy, especially in children, but cautions that it must be "carefully prescribed and monitored".

Gaddala says that it took her a few days to get accustomed to the exact portions she'd need to give Yogesh. "While it was regular food like dal-rice, the diet was rich in butter, ghee, and oils. We observed a drastic change in the frequency of seizures, which stopped entirely after months of following this diet," says Gaddala.

Yogesh was consistently monitored every month and returned to a routine diet within two years. Despite the diet's high fat content, careful monitoring of the appropriate mix of fats ensure normal lipid levels are maintained, explains Dr Nathan, who has painstakingly "Indian-ised" recipes based on their caloric and keto ratio values. "Persons with drug refractory epilepsy like Yogesh would have only a one to two per cent chance of cure with anti-epileptic medications, but a 60 per cent chance with the ketogenic diet," he said.

Dr Nathan, a member of the International Epilepsy Society (ILAE)'s dietary therapy task force, who is now pioneering the diet for cancer, multiple sclerosis, autism, and Alzheimer's, says the ketogenic diet is effective for children as well as adults.

All about epilepsy

Epilepsy is defined as having 2 or more unprovoked seizures — the result of excessive electrical discharges in a group of brain cells.

Approximately 50 million people worldwide have epilepsy; Nearly 80% live in low- and middle-income countries, and majority of these are unable to get the treatment they need.

Seizures can vary from the briefest lapses of attention or muscle jerks to prolonged convulsions, loss of consciousness and control of bowel or bladder function.

Fear, misunderstanding, discrimination and social stigma continue to impact quality of life for people with epilepsy (source - WHO)