Finally a publication that explains how to fight cancer with a Ketogenic Diet. Easy to understand and follow. Great for helping those trying to follow this diet for someone who is battling, in our case Brain cancer. Thank you Ellen for all your hard work and dedication to keep this updated in a hope that we, as the readers and caretakers, can extend an awesome quality of life for those battling Glioblastoma Multiforme grade 4.
Let’s go back to the research assessing how the low-carb, high-fat diets such as the ketogenic diet affect your LDL levels. In the meta-analysis by Bueno et al., low-carb diets were shown to increase HDL twice as much as low-fat diets after randomized controlled interventions. It also showed that there was a small increase in LDL-C in low-carb subjects compared to low-fat diet subjects who experienced no increase.
With regard to Dr. Gonzales’ disagreement with Dr. Seyfried regarding ketogenic diets and cancer, it is known that cancer cells use glucose but not fatty acids for energy. Thus depriving cancer cells of glucose by means of a ketogenic diet is a logical approach. Beyond that, at the present time too little known about cancer metabolism to make any definitive statements about proper treatment. As lay people, we will leave the argument to medical professionals.
On a “normal” American diet, carbohydrate intake is high (about 40-60% of calories) while fat intake, and especially saturated fat, is limited. In contrast, carbohydrate intake on a keto diet is only about 2-4% of calories. When carb intake is low, meals are delicious and satiating. Hunger goes away, and more importantly, this dietary change has some powerful and beneficial metabolic effects on the human body, in part because it lowers blood sugar and insulin levels.
"Most of the work in this field is still pre-clinical, meaning it's been conducted in animal models," Angela Poff, a research associate in the Department of Molecular Pharmacology and Physiology at the University of South Florida, told U.S. News & World Report. "It's been done in various cancer types, but most of the work has been done in brain cancer specifically. But there's very little clinical data all around. There's some case reports and very small preliminary clinical studies in small groups of patients, usually very late-stage patients with various types of cancers. So in the clinical realm, which is the most important in telling us whether this is going to be useful, we have a long way to go."
Dr. Kossoff is a Professor of Neurology and Pediatrics at Johns Hopkins University in Baltimore, MD. He received his medical degree from SUNY at Buffalo School of Medicine in New York, followed by a residency in pediatrics at Eastern Virginia Medical School in Norfolk, Virginia. He completed a fellowship in child neurology and then pediatric epilepsy and clinical neurophysiology at The Johns Hopkins Hospital in Baltimore. He has been at Johns Hopkins since 1998.
I’m referring to a diet called the ketogenic diet, and an article that’s been making the rounds since last week entitled “Ketogenic diet beats chemo for almost all cancers, says Dr. Thomas Seyfried.” Of course, when I see a claim such as that, my first reaction is, “Show me the evidence.” My second reaction is, “Who is this guy?” Well, Dr. Seyfried is a professor of biology at Boston College, who’s pretty well published. He’s also working in a field that has gained new respectability over the last five to ten years, namely cancer metabolism, mainly thanks to a rediscovery of what Otto Warburg discovered over 80 years ago. What Warburg discovered was that many tumors rely on glycolysis for their energy even in environments with adequate oxygen for oxidative phosphorylation, which generates the bulk of the chemical energy used by cells. I described this phenomenon in more detail in a post I did four years ago about a drug that looks as though its anticancer properties come from its ability to reverse the Warburg effect.
My writer friend had been in touch with Dr. Kelley, thinking that with all the attention around him he might make a good subject for a successful book. But she wanted me to meet in person with Kelley, who happened to be in New York to discuss her book project. Frankly, as she explained to me, she needed my take on the man, whom she really couldn’t decipher – was he truly onto something useful and extraordinary with his odd therapy, or was he simply a huckster, taking advantage of vulnerable cancer patients, as the media had been insisting.
Keto will increase your cholesterol, because your body is getting more cholesterol from food. So guess what your body will do when you increase the dietary cholesterol…that’s right, it’ll stop producing its own cholesterol. Since 75% of your cholesterol is made inside your body, if you increase the amount that you eat, your body will cut that 75% down. Your body isn’t stupid. It knows what it needs.
Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD, “Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women,” JAMA. 2007;297(9):969-977. http://jama.jamanetwork.com/art icle.aspx?articleid=205916.
Cyclical ketogenic diet (CKD): If you find it difficult to stick to a very low-carb diet every day, especially for months on end, you might want to consider a carb-cycling diet instead. Carb cycling increases carbohydrate intake (and sometimes calories in general) only at the right time and in the right amounts, usually about 1–2 times per week (such as on weekends).
Hey David, You will definitely want to do everything you can to mitigate the mold issue. If you cannot remove it from your environment (or yourself from that environment) then you will want to use things like glutathione, liver support, activated charcoal, and daily detoxification strategies as much as possible. For the LDL testing, this is one of the best I know of https://drjockers.com/cardiopower-testing/
While there have not been large studies that show the relationship between the ketogenic diet and cancer, we will be publishing a case study about that topic. The author failed to comment that pediatric patients with epilepsy are on the diet for usually about 2 years with no harmful effects. Before the false studies about heart disease and fat, the low carb diet was a respected way to lose weight. Studies into our metabolism show we can use both fat and carbohydrate as fuel. So stepping away from our high carb diet- I am sorry to say that we eat more carbs since the 70s with most of it processed and we now use high fructose corn syrup to sweeten products and we have a wide spread childhood obesity problem. If cholesterol is a concern try plant sterols and stenals to block cholesterol from the receptors in the body. So much more can be said about a keto diet than this article states
There were some commonalities among the diets, of course; all these traditional people ate some animal products, and all consumed a fair amount of fat, whether from plant or animal sources. All the food was, of course, locally grown, locally harvested, or locally hunted, since these isolated groups lacked access to the industrialized food of modern “civilization.”
The body needs bile to break down and digest dietary fat, and the gallbladder is responsible for storing bile before its release into the small intestine. Removal of the gallbladder and gallbladder disease cause fat malabsorption and may make it difficult to follow a ketogenic diet. If you have had your gallbladder removed or have existing gallbladder disease, consult with your doctor before trying a ketogenic diet.
"The keto diet is primarily used to help reduce the frequency of epileptic seizures in children. While it also has been tried for weight loss, only short-term results have been studied, and the results have been mixed. We don't know if it works in the long term, nor whether it's safe," warns registered dietitian Kathy McManus, director of the Department of Nutrition at Harvard-affiliated Brigham and Women's Hospital.
Type 1 Diabetes: Lowering carb intake and increasing fat intake is also beneficial for people with Type 1, Type 1.5 diabetes and LADA. A low carb diet can help reduce the number and severity of hypoglycemic episodes, lower HbA1c test results and minimize future diabetic complications. Learn more in The Ketogenic Diet for Type 1 Diabetes e-Book or click on the book cover. These benefits are also possible for children with Type 1 and their parents should know that they have options.
In the 1960s, medium-chain triglycerides (MCTs) were found to produce more ketone bodies per unit of energy than normal dietary fats (which are mostly long-chain triglycerides). MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system. The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on 12 children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children. The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.
In fact, some researchers believe that the keto diet may be one of the best diets for preventing the growth of most cancers — especially those that are linked to obesity. This is because restricting carbs is a simple and effective way to improve mitochondrial function and protect our cells from the damage and inflammation that can lead to genetic mutation.
Neurological Function– A ketogenic diet may be neuroprotective since it increases energy production in the brain, limits the production of free radicals, limits neuronal excitability and increases production of GABA in the brain.27 28 Researchers have hypothesized that a ketogenic diet and, in particular, ketones might benefit neurological function in several conditions and situations, including Alzheimer’s, Parkinson’s, Friedreich’s ataxia, autism and traumatic brain injury. 29 30 In Alzheimer’s disease, it appears that brain cells become unable to use glucose for energy production; a ketogenic diet can provide an alternative fuel for the brain. 31 Several studies have found that giving patients with mild to moderate Alzheimer’s medium chain triglycerides (MCTs), a type of fat that is readily accessible for ketone formation, improves cognition, but the effects are more pronounced in those that do not carry the APOE e4 gene variant that is associated with increased risk of Alzheimer’s.32 33 34 Research is just beginning to explore these conditions, and a better understanding of how effective the ketogenic diet is in treating certain neurological conditions will likely be available in the near future.
Research has indicated that a ketogenic diet raises the stress hormone cortisol to increase energy levels in the face of reduced carbohydrate availability. However, it is still up for debate whether this increase in cortisol is harmful or innocuous. Nonetheless, I recommend taking extra care to manage your stress while on a ketogenic diet. Getting plenty of sleep, exercising, and engaging in a regular stress-reduction practice can help you keep your baseline stress levels low and reduce the potential for chronically elevated cortisol.
A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed, 24% occasionally prescribed the diet as a last resort, 24% had only prescribed the diet in a few rare cases, and 16% had never prescribed the diet. Several possible explanations exist for this gap between evidence and clinical practice. One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.
Selecting the right food will be easier as you become accustomed to the Keto approach. Instead of lean meats, you’ll focus on skin-on poultry, fattier parts like chicken thighs, rib-eye steaks, grass-fed ground beef, fattier fish like salmon, beef brisket or pork shoulder, and bacon. Leafy greens such as spinach, kale and lettuce, along with broccoli, cauliflower and cucumbers, make healthy vegetable choices (but you’ll avoid starchy root foods like carrots, potatoes, turnips and parsnips). You can work in less-familiar veggies such as kohlrabi or daikon.
Ketosis was a beneficial process the human body developed as an adaptation to times when food was unavailable (such as for these hunter-gatherers). However, you can effectively produce ketones too by limiting the carbohydrates in your diet to less than 80 grams daily and protein to no more than 1.2 grams of protein/per kg lean body mass. As the body adapts to the use of ketone metabolism over time, the hormone in the liver that is essential to ketone metabolism (known as FGF21) becomes more efficient.
HealingStrong Connect Groups meet monthly in various areas of the U.S. and South Australia to link others interested in natural strategies, holistic protocols, and local resources. Their groups focus on mind, body and emotional healing based on Biblical promises, as they believe the God of the Bible is our healer. For more information on how to start a group, or become involved in one, please go to: http://www.healingstrong.org/groups, and like us on Facebook at http://www.facebook.com/healingstrong.
With this rationale, VanItallie et al. [39, Class III] performed a feasibility study with PD patients and the ketogenic diet. They explored whether PD patients would be able to prepare the ketogenic diet in their homes and remain on it for at least 1 month. Of seven patients enrolled, five completed the study. They were monitored for ketone levels and weekly Unified Parkinson Disease Rating Scale (UPDRS) scores. All the patients lost weight. Interestingly, the mean decrease in UPDRS scores was 43.4%. A placebo effect is not ruled out, but this result at least suggests that the ketogenic diet was not harmful and certainly invites further study into its role in preserving neuron function in PD and other neurodegenerative diseases. The possibility that the diet may have altered levodopa absorption (and that this factor, rather than an effect of the diet on neuronal function, was responsible for the change) has not been studied rigorously .
Great article! I have been diagnosed with familial hypercholesterolemia, however, I am not concerned at all. I continue to follow a restricted calorie, zero carb ketogenic diet, that I have been doing strictly for the last year and a half. All of my health markers are excellent, except for LDL particle number and total, and it is the large buoyant type. I am middle-aged (46). I did get both a CT scan and tri-vascular scan, and got perfect scores for both. That alleviated any concerns that I might have previously had. Since this diet has improved my gut issues, bodyfat, blood pressure, insulin, blood glucose, mood, energy, A1C, CRP, etc., - basically every single health parameter I have tested, I am sticking with it! Thank you for clearing up the confusion surrounding LDL!
Rezaei, S., Abdurahman, A. A., Saghazadeh, A., Badv, R. S., and Mahmoudi, M. (2017). Short-term and long-term efficacy of classical ketogenic diet and modified Atkins diet in children and adolescents with epilepsy: a systematic review and meta-analysis. Nutr. Neurosci. doi: 10.1080/1028415X.2017.1387721 [Epub ahead of print]. doi: 10.1080/1028415X.2017.1387721
We’re also going to keep it simple here. Most of the time, it’ll be salad and meat, slathered in high fat dressings and calling it a day. We don’t want to get too rowdy here. You can use leftover meat from previous nights or use easy accessible canned chicken/fish. If you do use canned meats, try to read the labels and get the one that uses the least (or no) additives!
Yancy WS Jr, Westman EC, McDuffie JR, Grambow SC, Jeffreys AS, Bolton J, Chalecki A, Oddone EZ, “A randomized trial of a low-carbohydrate diet vs orlistat plus a lowfat diet for weight loss,” Arch Intern Med. 2010 Jan 25;170(2):136-45. http://www.ncbi.nlm.nih.gov/pubmed/20101008?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2.
So far the research has found energy restriction to significantly reduce growth and progression of numerous cancers including mammary, brain, colon, pancreas, lung, and prostate cancer. However, it is important to note that the best results are achieved from severe calorie restriction (<1,000 calories per day). If you are considering using calorie restriction along with your cancer treatment, make sure you consult your cancer care team first.
How ketosis helps with epilepsy isn't known, but it does. Researchers at Johns Hopkins University studied 150 children with epilepsy in one important study. After a year on the ketogenic diet, half of children had 50% fewer seizures. One fourth of the children reduced their seizures by 90%. After a few years on the diet, many of these children no longer needed medications at all.
[29:44] – There is increasing evidence for what Dave likes to call, the Alternative Glycogen Store Theory. Do leaner, athletic types of individuals seem to be more likely to be hyper-responders, in particular those with lower levels of triglycerides and high levels of LDL-C and LDL-P? Gary mentions Dr William Davis, from Wheat Belly, post on Lp(a) traits.
• Standard ketogenic diet (SKD) — SKD is the type I typically recommend for most people, because it is very effective. It focuses on high consumption of healthy fats: As I explain in my book, "Fat for Fuel," you should aim for having 70 to 85 percent of your total daily calories to come from healthy fats. For your protein intake, the general rule of thumb is to follow the formula of 1 gram of protein for every kilogram of your lean body mass.
LDL is often referred to as “bad” cholesterol because high levels have been linked to increased heart disease risk. By contrast, HDL is frequently called “good” cholesterol. One of HDLs main functions is to carry cholesterol back to the liver to be used as needed. Higher levels of HDL have been associated with decreased cardiovascular disease (CVD) risk.
Something that makes the keto diet different from other low-carb diets is that it does not “protein-load.” Protein is not as big a part of the keto diet as fat is. Reason being: In small amounts, the body can change protein to glucose, which means if you eat too much of it, especially while in the beginning stages, it will slow down your body’s transition into ketosis.
For patients interested in Ketogenic diet, it is vitally important that you talk with your health-care providers, says Alice Bender, MS, RDN, AICR’s Director of Nutrition Programs. “A dietitian is best positioned to talk with you about what is known regarding the pros and cons – especially to learn if this diet has any research showing the reasonable application with your particular type of cancer and if the ketogenic diet may even be harmful for you.”
As of the moment, there is no industry standard as to how many calories should be consumed in a restricted ketogenic diet, but there are published studies that provide estimates. In one example, a 65-year-old woman who was suffering from glioblastoma multiforme (GBM), an aggressive type of brain cancer, was put into a restricted ketogenic diet that started with water fasting and then proceeded to consuming 600 calories a day only.
He followed her advice, refused radiation, came to see me, and over the years he has proven to be a very vigilant, determined and compliant patient. Within a year on his nutritional program, which includes a high carb diet, his pain had resolved, his energy, stamina, and concentration had improved, and scans confirmed total resolution of all his original extensive disease – in complete contradiction to what Dr. Seyfried would predict or claim possible.
Now, Week 1’s shopping list is going to be long. I have to make the assumption you have nothing in your house. Many of the items are common items that most people will have already. These are all staples in my everyday cooking for keto, and should be considered an investment for your health. Once you have all of the items from week 1, there won’t be too much else to buy.
The ketogenic diet is a great thing for your health and biomarkers, as shown by research. However, there are many ways you can do it wrong and thus damage yourself. New research is showing that our understanding of cholesterol may be disrupted slightly but it doesn’t mean that too much cholesterol can’t damage your health. It’s still involved in the process of atherosclerosis.
Patients on the KD should be seen regularly every 3 months, and the family should be able to easily contact the diet team to resolve possible doubts and discuss adverse effects. In each evaluation, the seizure dairy and the child’s cognitive development and behavior should be observed (Auvin and Nabbout, 2011). It has been noted that it is possible to improve the cognitive development and behavior even without a change in the seizure frequency. Although some authors have reported no relationship between the efficacy and the level of ketosis, it is still recommended to measure the urine ketosis several times a week (Kossoff et al., 2009).
This is where we have to depart! Sorry to say but you’re on your own. You should have plenty of leftovers that are frozen, ready, and waiting! I know a lot of you out there have trouble with timing and are busy people – so making sure that some nights you make extras to freeze is important. All those leftovers you have in the freezer? Use them up! Create your own meal plan, at first using this as a guide, and then completely doing it yourself. Once you get the hang of it, it’ll be a sinch – I promise you 🙂
When the researchers examined the effect of the diet on mice that didn't have any gut bacteria — either because the mice were raised in a sterile environment, or because they were treated with antibiotics — they found that the keto diet no longer protected against seizures. "This suggests that the gut microbiota [bacteria] is required for the diet to effectively reduce seizures," study lead author Christine Olson, a UCLA graduate student in Hsiao's laboratory, said in a statement.
Chris, I’m missing the logic here. Even when carbohydrates are restricted, the body is going to take fats and glycogen and turn them back into blood sugar, i.e. glucose. Glucose is also the only fuel the brain can use, and when it is too high or too low, all kinds of alarm bells go off, and the body does everything it can to restore normal glucose levels. Ketogenic diet or not, blood sugar is going to stay pretty steady if all the normal regulatory mechanisms are in place. If there is glucose in the blood, there is glucose in the interstitial fluids, and cancer cells are never going to be starved for glucose. So if restricting carbs has any use in cancer therapy, it has nothing to do with preventing cancer cells from getting glucose. If there is no glucose in the blood, you are dead.
Feldman’s theory about why this happens is based on research he’s conducted on himself and hundreds of other low-carbers over the past two years. He states that the higher energy demands, lower body fat stores, and lower glycogen stores in these LMHRs trigger the liver to increase production of lipoprotein particles so that triglycerides (fat) can be transported to cells for use as fuel. Since cholesterol travels along with the triglycerides, blood cholesterol levels rise as the liver pumps out more lipoproteins to keep up with the body’s energy demands.
In 1921, Dr. R.M. Wilder at the Mayo Clinic proposed a diet for the treatment of epilepsy – which he referred to as a ketogenic diet – in which most of the calories were derived from fat, mimicking the biochemical changes of fasting.2 Today, children resistant to anti-epileptic drugs are still advised to follow keto diets to prevent seizures, always under the management of well-trained dietitians, of course. Indeed, according to the Epilepsy Society, the keto diet is considered to be a medical treatment.3
Try resistant starch. Resistant starch passes through the small intestine intact and therefore doesn’t count as a dietary carbohydrate. Instead, it travels to your large intestine, where it’s used to feed beneficial gut bacteria. Try adding a teaspoon of resistant starch, such as raw potato starch or green banana flour, to your keto smoothie each day to keep your gut happy.
Westman’s research on carb-restricted diets suggests they can help reduce appetite, spur weight loss and improve markers of heart disease. His findings aren’t outliers. From Atkins and South Beach to Mediterranean and Zone, low-carb, high-fat diets—or “LCHF” plans—are all the rage, and growing evidence suggests they’re a big improvement on the typical carb-heavy American diet. But the “keto” diet is the most carb-restrictive member of the LCHF gang.
As the Atkins diet makes abundantly clear, problem foods like gluten and dairy can slip into the strictest low-carb or keto plans. I often see patients "doing keto" with massive amounts of cheese or processed meats full of fillers, which is a terrible idea. These potential top food sensitivities increase inflammation and create problems with gut permeability, leading to leaky gut syndrome.
Jimmy Moore: Quite frankly. They’ve not been trained to teach you how to do nutrition, and then if they turn to nutrition they either leave it to the dietitian who has been trained in low fat, high carb diets or they’ll just “Well, the USDA my plate says blah blah blah.” They’re just parading what someone else has said. They’ve not done their own research. Just assuming that your doctor knows everything about what it takes nutritionally to make you healthy is a bad mistake.
Contemporary researchers like Dr. Thomas Seyfried and Dominic D’Agostino have argued that this dysregulated cellular energy production, or cellular metabolism, is actually what induces malignancy and that by extension, if we limit the fuels available for this process of fermentation, and the fuels are glucose, which is derived from carbohydrate in the diet, and glutamine, which is derived from protein in the diet, then we can actually starve cancer cells and either improve the results of conventional treatment or perhaps even address some cancers independently without conventional treatment.
The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter. Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.
The KD-induced synaptic stabilization is additionally related to changes in critical amino acids as a result of ketone metabolism. It has been proposed that KD interferes with the concentration of gamma-aminobutyric acid (GABA), the major inhibitory neurotransmitter. There is evidence in clinical practice of increased GABA levels in the CSF of patients on the KD diet (Wang et al., 2003). The decrease in aspartate levels promoted by KB lead to the synthesis of GABA. This occurs because of the inhibitory effect of aspartate on glutamate decarboxylase and the facilitation of the conversation of glutamate to glutamine in the astrocytes (Yudkoff et al., 2008). Not only can GABA be increased, but also other neurotransmitters such as adenosine A1 can be implicated in the anti-seizure effect of the KD (Szot et al., 2001). However, more evidence is needed.
Epilepsy is a disabling and common neurological disease, which can be controlled successfully in most patients with one or more antiepileptic drugs. Approximately 30% of patients with epilepsy have refractory epilepsy, that is, have a failure of adequate trials of two tolerated, appropriately chosen and used antiepileptic drug schedules to achieve sustained relief of seizures (Picot et al., 2008; Kwan et al., 2009). Some of these patients are not surgery candidates, so it is necessary to search for alternative treatments for epilepsy such as palliative surgery, neuromodulation, and a ketogenic diet (KD).
Over half of children who go on the diet have at least a 50% reduction in the number of their seizures. It can start to help after just one week, but more often it can take a few weeks up to several months to judge whether it will be effective. If the diet successfully controls seizures, it may be continued for several years under the supervision of the child's health care team. Many children on the ketogenic diet continue to take seizure medications but on average they require one less medication and often the dosage of remaining ones is lowered.