Dietary changes for epilepsy: what can you expect?

Although medication helps many people reduce the frequency of seizures, some patients continue to experience symptoms. This has led researchers and healthcare providers to explore other strategies, including lifestyle and diet.

What we eat affects how our body uses energy, how stable our blood sugar remains and potentially also how excitable our brains are. In particular, the ketogenic diet, a diet very low in carbohydrates and relatively high in fats, has long been of interest in the treatment of epilepsy.

The link between diet and epilepsy is nothing new. The ketogenic diet was developed as early as the 1920s as a treatment for children with epilepsy, at a time when few effective medicines were available. Doctors such as Russell Wilder of the Mayo Clinic investigated how diet could affect the brain. Surprisingly, it turned out that some children experienced fewer seizures when their bodies switched to a different form of energy use. Although the diet later faded into the background with the emergence of anti-epileptic drugs, interest has grown strongly again in recent years.

In this article, we examine epilepsy from a broader lifestyle perspective, with diet as a central pillar. We look at what the science says about the ketogenic diet and therapeutic carbohydrate restriction, as well as other dietary patterns that may play a role. We also briefly discuss sleep, exercise, stress and psychological factors, as these elements are often linked to how the brain responds.

The aim is not to promise quick fixes, but to provide clear and practical insight into how diet and other lifestyle adjustments can contribute to a better quality of life.

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2. Key points of the article

• Epilepsy is a chronic neurological condition in which abnormal electrical activity in the brain leads to recurrent seizures of varying types and severity.
• Diet may play a role in reducing the frequency of seizures as energy expenditure, brain excitability and metabolism are closely linked.
• The ketogenic diet, developed in 1921, uses ketones as an alternative fuel source and can significantly reduce seizures in some patients.
• In children with treatment-resistant epilepsy, the ketogenic diet often yields strong results, whereas in adults, adherence to the diet poses a greater challenge.
• Not everyone responds in the same way to ketogenic therapy; genetic factors, metabolic response and lifestyle all play a role.
• Milder carbohydrate-restricted diets (often referred to as low-glycaemic index diets and very similar to therapeutic carbohydrate restriction) can offer comparable benefits with greater feasibility in daily life.
• An integrated approach combining diet, sleep, exercise and psychological support appears to offer the best chance of improving quality of life and seizure control.

3. What is epilepsy and how common is it?

Epilepsy is a neurological condition in which a person experiences recurrent seizures caused by a sudden disruption of electrical signals in the brain. Such a seizure occurs when groups of brain cells become temporarily overactive and no longer work together properly.

Not every seizure immediately indicates epilepsy: doctors usually diagnose epilepsy when a person has had two or more unprovoked seizures or is at a clearly increased risk of them (Beniczky 2025, Borowicz-Reutt 2024).

Frequent seizures can damage brain tissue and impair neural connections (Rho 2021). In rare cases, epilepsy can lead to death (VZinfo 2025).

Epilepsy is one of the most common chronic neurological conditions. It is estimated that around 200,000 people in the Netherlands live with epilepsy, corresponding to approximately 1 in 90 people (Epilepsie.nl).

According to national health data, there were approximately 65,000 people with epilepsy actively registered within the healthcare system in 2024. In the Netherlands, approximately 10,400 new patients with epilepsy were registered with their general practitioner in 2024. This means that every year, thousands of people are confronted with the diagnosis for the first time.

Furthermore, Dutch figures show that epilepsy is also a significant cause of hospital admissions and mortality. For instance, in 2022 there were nearly 7,800 hospital admissions related to epilepsy, and in 2024 nearly 400 deaths were recorded (VZinfo 2025).

4. How do epileptic seizures occur?

Epileptic seizures occur when the balance in the brain between ‘stimulation’ and ‘inhibition’ is disrupted. Some signals cause brain cells to become active more quickly (such as glutamate), whilst other signals actually inhibit this activity (such as GABA). When the inhibitory influence becomes too weak or the excitatory signals too strong, groups of brain cells can suddenly fire simultaneously, which can trigger a seizure (Mishra 2024, Rubio 2025).

Nutrition and energy use play a greater role in this than is often thought. Brain cells require a constant supply of energy to function stably. When the availability of glucose changes or when the body switches to using ketones as fuel, this can indirectly influence the balance between excitatory and inhibitory signals. Research shows that ketones can shift the ratio between GABA and glutamate towards greater inhibition, which may contribute to fewer seizures (Qiao 2024, Rubio 2025).

In addition, the functioning of the mitochondria, the cell’s powerhouses, appears to play an important role. More efficient energy production may make brain cells less sensitive to overstimulation. Some studies also suggest that changes in energy use may reduce the formation of harmful oxidative processes, which may have a protective effect against seizures (Mishra 2024, Rubio 2025).

Increasing attention is also being paid to the gut-brain axis. The gut microbiota influences how the brain responds via metabolic products and nerve signals. Changes in diet, particularly with ketogenic and low-carbohydrate therapies, can alter the composition of gut bacteria, which is associated with improved seizure control (Kim 2017, Rezaei 2018, Gupta 2021, Anand 2025, Zhu 2024, Barros 2026).

In adults who develop epilepsy later in life, it also appears that persistent low-grade inflammatory responses in the brain play a role. In children, there is strong evidence that seizures or convulsions in early life can trigger inflammatory processes that may later lead to epilepsy. This inflammatory process, also known as epileptogenesis, can lead to increased excitability of brain structures (McDonald 2018, Sumadewi 2023, Wang 2025).

This suggests that nutrition works not only directly through energy supply, but possibly also via communication between the gut and the brain.

5. The role of brain energy and glucose

Our brains are real energy consumers. Although they account for only about 2% of body weight, under normal conditions they use nearly 20% of total energy, mainly from carbohydrates converted into glucose. This constant supply of sugar keeps brain cells active and alert, but at the same time it can also affect how excitable the brain is (McDonald 2018, Rho 2021).

Glucose enables nerve cells to transmit signals rapidly. This is necessary for thinking, moving and reacting. In people with epilepsy, a highly glucose-driven metabolism can also have negative effects. Several review studies describe how high glucose availability can amplify electrical activity in brain networks, potentially lowering the threshold for a seizure. We observe this process in both children and adults (Rho 2021, Bartolini 2023).

This does not mean that glucose is ‘bad’ in itself. However, it does appear that the type of fuel and the stability of the energy supply influence how easily brain cells fire simultaneously. Furthermore, metabolic processes and inflammatory responses can reinforce each other, creating a vicious circle in which energy disruptions and neuronal overstimulation continue to fuel one another (Xu 2025).

6. The ketogenic diet: learning from history

The idea of using diet to treat epilepsy is not new. In 1921, Dr. Russell Wilder at the Mayo Clinic developed the ketogenic diet (with a maximum of 10% of total energy intake from carbohydrates) as a treatment for children with drug-resistant epilepsy. He discovered that prolonged fasting sometimes reduced seizures, but was difficult to maintain. 

The ketogenic diet was therefore designed to mimic the metabolic state of fasting: low in carbohydrates, high in fats and sufficient in protein, causing the body to produce ketones as an alternative fuel for the brain. This dietary adjustment is particularly useful for patients who respond poorly to anti-epileptic medication (Malinowska 2024).

Under normal circumstances, the brain primarily uses glucose. On a ketogenic diet, this shifts to ketones, such as beta-hydroxybutyrate. According to recent research, ketones can stabilise the brain in various ways. For instance, they appear to influence the balance between excitatory and inhibitory signals, with relatively more inhibitory activity. In addition, energy use may become more efficient, which may reduce the likelihood of sudden overactivity in brain cells (Husari 2020, Rho 2022).

In addition to the classic ketogenic diet (90% fat, 10% from a combination of protein and carbohydrates), other forms of carbohydrate restriction are also gaining increasing attention. Dietary adjustments such as therapeutic carbohydrate restriction/low-glycaemic index diets, modified Atkins and other carbohydrate-restricted approaches aim to achieve a similar metabolic effect, but are often easier to maintain than a classic ketogenic diet. These diets are slightly less restrictive in terms of carbohydrate intake (up to 50g/day) (Schoeler 2016, Kim 2017, Rezaei 2018, Husari 2020, Gupta 2021, Anand 2025).

Although the diet is not a miracle cure, history shows that carbohydrate restriction, in its various forms, can be a valuable addition. It should be noted that the ketogenic diet, in particular, can demonstrate the most robust scientific results. The idea that fuel choice influences brain excitability is once again an important area of research today.

7. Effectiveness of the ketogenic diet in epilepsy

In children

The ketogenic diet has been used for almost a century in children with drug-resistant epilepsy, and recent studies confirm that it remains one of the dietary interventions with the strongest evidence. A large systematic review shows that approximately 40% to 60% of children experience a reduction in seizures of at least 50% after starting ketogenic therapy. A smaller group, around 10% to 15%, may even become completely seizure-free (Kossoff 2021).

The effect appears to be particularly strong in specific epilepsy syndromes and in children for whom medication is insufficiently effective. A possible explanation is adherence to treatment, as parents are often heavily involved in monitoring the diet, and the greater metabolic flexibility of the child’s brain. Medical supervision remains essential, as the diet can also cause side effects such as gastrointestinal complaints or deficiencies if it is not followed properly (Martin-McGill 2020, Kossoff 2021, Abassi 2025, Sepehrar 2025).

In adults

Evidence is also growing rapidly for adults, but the picture is somewhat more complex. Studies show that here too, approximately 30% to 50% of patients can achieve a reduction in seizures of at least 50% with ketogenic diets or variants such as the modified Atkins diet (Cervenka 2021, Schoeler 2016, Sepehrar 2025).

However, other factors play a greater role than in children. Adults must fit the diet into their work, social situations and eating habits themselves. As a result, dropout rates are higher. Reviews report that adherence is often the greatest challenge, alongside practical barriers such as meal planning and social pressure. However, when patients stick to the diet, the clinical outcomes appear to be comparable to those in younger groups (Husari 2020, Schoeler 2016).

Neuroplasticity refers to the brain’s ability to strengthen or weaken connections between brain cells. In epilepsy, recurrent seizures can disrupt this balance, making neural networks more susceptible to new seizures. The ketogenic diet appears to influence this process in part through changes in brain energy and signalling pathways. 

Recent reviews suggest that ketones influence the transmission of brain signals involved in synaptic adaptation and repair mechanisms. Nevertheless, it remains unclear whether long-term metabolic shifts in children and adults have different effects on developing brain networks. Long-term research is therefore still needed (Faheem 2024, Mishra 2024).

In summary, the current literature suggests that ketogenic therapies may be a powerful adjunctive treatment for drug-resistant epilepsy, with clear effects in children and growing evidence in adults.

Why the ketogenic diet does not work for everyone: responders vs non-responders

Not everyone responds in the same way to a ketogenic diet. Recent reviews and meta-analyses show that approximately 35% to 60% of patients achieve a clear reduction in seizures (≥50%), whilst a large group experiences only limited benefit (Martin-McGill 2020, Jiang 2025). New studies suggest that genetic differences play a significant role: in some monogenic epilepsies, response rates are very high, whilst other subtypes respond significantly less (Rho 2022, Jiang 2025).

In addition, metabolic response appears to be important. Patients who achieve stable ketone levels quicker are more likely to show clinical improvement, suggesting that individual differences in metabolism determine how strongly the brain responds to ketones (Husari 2020, Rho 2022). Practical factors also play a role: adherence to treatment, dietary complexity and lifestyle can make the difference between responders and non-responders (Husari 2020, Schoeler 2016).

8. Gut–brain axis and epilepsy

In recent years, there has been a growing awareness that our gut and brain are closely interconnected. Via the so-called gut–brain axis, bacteria in the gut communicate with the nervous system through hormones, nerve signals and small metabolic byproducts. Diet plays a key role in this, as what we eat directly influences the composition of the microbiome and thus also the brain (Zhu 2024, Barros 2026).

In epilepsy, recent studies suggest that changes in gut flora are linked to brain excitability. Some bacteria produce substances that can support inhibitory signals in the brain, whilst others can exacerbate inflammatory processes. Chronic low-grade inflammation appears to lower the seizure threshold in some patients (Zhu 2024, Wang 2026).

In children, it has also been observed that an increased presence of Catenibacterium bacteria can prevent the ketogenic diet from being effective. Research into the link between the composition of the gut microbiota, epilepsy and whether or not patients respond to dietary changes is still in its infancy (Wang 2026). It is therefore too early to draw any substantiated conclusions.

9. Is the ketogenic diet safe?

To answer this question, we distinguish between children and adults.

Children

The ketogenic diet has been used for over a century as a treatment for children with epilepsy who do not respond to medication. In the Netherlands, it is officially recognised as a treatment method for these cases. The diet is usually followed for around two years, or for a shorter period if the seizures stop (Federatie Medisch Specialisten 2024). For epilepsy, this duration is considered safe under medical supervision. For other conditions, including ADHD, further research is needed into the long-term effects and safety. Long-term use can, for example, lead to growth delays.

Adults

For adults, the ketogenic diet is generally safe, provided they are under the supervision of a doctor and a dietitian to prevent nutrient deficiencies, electrolyte imbalances and digestive problems.

However, there are situations where caution is advised. People with rare metabolic disorders who cannot process fat properly should avoid this diet. In addition, adults taking medication should take extra care. For example, people using insulin for diabetes or lithium for bipolar disorder may find that the diet affects their treatment. It is suspected that when metabolism changes (e.g. due to diet), this also affects how the body absorbs and processes medication. Research in this area is still limited. In such cases, supervision by a doctor is essential.

Finally, the diet may lead to an increase in LDL cholesterol, also known as ‘bad’ cholesterol. Higher LDL levels are associated with heart disease, so people following the diet should have their cholesterol levels checked regularly.

Adherence

Adherence to the diet for adults often proves to be a major obstacle. It can sometimes be difficult to balance daily life, work commitments and social relationships with a ketogenic diet. It is more manageable when the diet is followed under supervision (Schoeler 2016, Cervenka 2021).

10. A milder dietary strategy for epilepsy

Not everyone is able or willing to follow a strict ketogenic diet. That is why there are milder variants that use the same metabolic principle and are more practical in daily life. Therapeutic carbohydrate restriction/low-glycaemic diets restrict carbohydrates less strictly (up to 50g/day), allowing for more flexible meals (Whitmer 2012, Rezaei 2017, Salehi 2023). The results are slightly less pronounced than with the ketogenic diet. Nevertheless, improvements of up to a 40% reduction in seizures are observed, with approximately 10% of patients becoming symptom-free (Kim 2017, Rezaei 2018, Gupta 2021, Budiputra 2023, Anand 2025, Sharawat 2025).

Because these variants are easier to follow, adherence to treatment and quality of life often improve, particularly among adolescents and adults where social and practical factors play a greater role. Even with these milder dietary adjustments, it remains advisable to seek medical supervision.

11. Effectiveness of other lifestyle adjustments in epilepsy

Although diet is a key factor, recent studies show that other lifestyle factors also influence seizure threshold and quality of life. They do not usually replace medication, but can have a supportive effect.

• Sport and exercise: It was long assumed that sport and exercise could trigger seizures, but recent review studies show the opposite. Regular moderate exercise appears to be safe and may even have a protective effect. Indeed, it appears that exercise does not cause an increase in seizures and can improve quality of life by an average of around 4–9% in both adults and children (Duñabeitia 2022, Jeng 2024). Even in children with treatment-resistant epilepsy, a six-month exercise programme was found to lead to improved fitness and quality of life, without an increase in seizure frequency (Ibañez-Micó 2024). Possible explanations include better stress regulation and more stable brain activity.
• Sleep: Sleep deprivation is a well-known trigger for seizures. Studies show that disrupted sleep-wake cycles increase the excitability of brain cells and may thus lower the seizure threshold. Studies suggest that stable sleep patterns and sufficient sleep are associated with fewer seizures and better cognitive performance in children (Liu 2023, Stirling 2022). Optimising sleep patterns (fixed bedtimes) appears to help reduce seizure frequency. Research into the relationship between epilepsy and sleep is still very much ongoing (Stirling 2022). On the other hand, it has also been observed that the disrupted brain networks fuelled by seizures can negatively affect sleep. As a result, sleep problems often become a vicious circle. Nevertheless, it has been noted that sleep regulation can lead to improvement (Stirling 2022, Liu 2023).
• Psychological: Around half of epilepsy patients experience stress, anxiety and depression. This can contribute to a lowered seizure threshold. Psychosocial interventions, such as cognitive behavioural therapy, mindfulness and stress management have been shown in review studies to improve mental well-being and daily functioning (Andualem 2024, Mercier 2024). Although the direct effect on seizure frequency is less clear, improved emotional stability may contribute to a higher seizure threshold. Further research is needed to substantiate the impact of psychological interventions in epilepsy.

Together, these lifestyle factors demonstrate that epilepsy care extends beyond medication alone: a stable daily routine appears to be a key factor.

12. Why lifestyle goes hand in hand with dietary changes

Dietary changes such as the ketogenic or low-carbohydrate diet rarely stand alone. Recent findings suggest that the effect is often greater when multiple lifestyle factors are addressed simultaneously. This is because different systems in the body influence one another via shared biological pathways such as energy metabolism, inflammation and stress regulation.

An integrated approach focusing on diet, exercise, sleep and mental health therefore appears to be more than the sum of its individual parts. Studies show that multidisciplinary programmes not only improve quality of life but also increase adherence to treatment. For patients, this means that small changes across multiple areas can, when combined, have a greater effect than a single isolated measure.

A multidisciplinary approach is therefore recommended to achieve good results.

13. Conclusion

Epilepsy is a complex neurological condition in which various factors together influence the brain’s excitability. Although medication often remains the cornerstone of treatment, there is a growing understanding that diet and lifestyle can play a valuable complementary role. Low-carbohydrate diets in particular have been well researched and can lead to a marked reduction in seizures in some patients. By shifting the body’s energy source from glucose to ketones, the brain appears to function more stably in some cases, which can raise the seizure threshold.

However, dietary changes are not a solution for everyone. Individual differences in metabolism, genetics and daily lifestyle help determine who benefits most. That is why milder forms of carbohydrate restriction are receiving increasing attention as viable alternatives. Furthermore, research shows that other lifestyle factors, such as sleep, exercise and psychological support, also play an important role in reducing triggers and improving quality of life.

The future of epilepsy care likely lies in an integrated, personalised approach. By coordinating diet, lifestyle and pharmacological treatment, a broader framework is created in which patients can gain greater control over their condition and improve their daily functioning.

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