Researchers studied whether the ketogenic diet (a high-fat, low-carb eating plan) is safe for children with epilepsy that doesn’t respond well to medications. They followed 56 children on the keto diet for over 2 years and compared them to 40 children taking anti-seizure drugs instead. The study checked their heart health, blood vessels, metabolism, bones, and growth. The good news: the keto diet didn’t cause more problems than regular medications. However, all children—whether on keto or medications—had weaker bones than expected. The researchers concluded that the keto diet is still a reasonable option for treating difficult seizures in children, but doctors need to keep a close eye on bone health.

The Quick Take

  • What they studied: Whether the ketogenic diet (eating mostly fats and proteins, very few carbs) causes long-term health problems in children with seizures that don’t respond to regular medications
  • Who participated: 96 children total: 56 children who followed the keto diet for at least 2 years (27 on classic keto, 29 on a modified version), and 40 children taking anti-seizure medications instead
  • Key finding: The keto diet did not cause more heart, blood vessel, metabolism, or growth problems compared to regular medications. However, all children in both groups had weaker bones than normal, suggesting this is a concern with seizure treatment in general, not just the keto diet.
  • What it means for you: If your child has seizures that don’t respond to medications, the keto diet appears to be a safe option to try. However, doctors should regularly check bone health in all children with difficult-to-treat seizures, regardless of treatment type. This is not medical advice—always discuss options with your child’s neurologist.

The Research Details

This was a comparison study where researchers looked at two groups of children with hard-to-treat seizures: one group following the ketogenic diet for over 2 years, and another group taking multiple anti-seizure medications. The researchers measured many different health markers to see if either treatment caused problems. They checked blood cholesterol levels, did heart ultrasounds and electrical heart tests, measured bone density with special X-rays, and tracked how much the children grew. They also looked at special proteins in the blood and took body measurements.

The ketogenic diet group was split into two types: the classic keto diet (very strict, high fat) and the modified Atkins diet (a slightly less strict version). This allowed researchers to see if the type of diet mattered. All measurements were done after children had been on their treatment for at least 2 years, so researchers could see long-term effects rather than just short-term changes.

When children have seizures that don’t stop with regular medications, doctors need safe alternatives. The keto diet has been shown to help control these seizures, but doctors worry about side effects over time. By comparing the keto diet directly to medication treatment, researchers could figure out whether the diet causes unique problems or if any health issues are just part of having difficult seizures in general. This helps doctors make better decisions about which treatment to recommend.

This study has some strengths: it followed children for a long time (over 2 years), it measured many different health markers (not just one thing), and it compared two treatment groups directly. However, the study size was relatively small (96 children total), which means the results might not apply to all children everywhere. The study was done in one location, so the results might be different in other countries or populations. The researchers did thorough testing (heart ultrasounds, bone scans, blood work), which is a strength. However, this was not a randomized controlled trial (where children are randomly assigned to treatments), so we can’t be completely certain the groups were perfectly matched in other ways.

What the Results Show

The most important finding was that children on the keto diet did not have more heart or blood vessel problems than children on medications. No serious heart complications were found in either group. The researchers looked at special markers that predict heart disease risk and found high levels in all children, but these markers didn’t match up with actual damage to blood vessels—meaning the markers alone might not be reliable predictors in children with seizures.

All children in both groups had weaker bones than expected for their age. This was a significant finding because it suggests that having difficult-to-treat seizures itself—not the specific treatment—may affect bone health. The keto diet group’s bone weakness was mainly linked to how much the children moved around (ambulation), while the medication group’s bone weakness was more linked to cholesterol markers. This suggests different reasons for weak bones depending on treatment type.

Growth problems appeared in both groups but were more common in the modified Atkins diet group (45% of children) compared to the medication group (40% had weight loss). This suggests that the stricter dietary restrictions might affect how well children grow, though the difference wasn’t huge.

The study measured a special protein called selenium binding protein 1, which might be involved in heart disease risk, but the results didn’t show clear patterns that would help predict problems. The researchers found that how much children could move around was important for bone health in the keto diet groups—children who moved more had better bone density. This suggests that exercise might be especially important for children on the keto diet. The study also found that the two types of keto diets (classic and modified Atkins) had similar overall safety profiles, though the modified Atkins diet was associated with more growth stunting.

Previous research has shown that the keto diet can control seizures in children when medications don’t work, but doctors have worried about long-term side effects. This study adds important information by showing that over 2 years, the keto diet doesn’t appear to cause more problems than staying on multiple medications. Earlier studies had mostly looked at short-term side effects (a few months), so this longer-term comparison is valuable. The finding about weak bones in all children with difficult seizures is consistent with other research showing that seizure disorders themselves can affect bone health, independent of treatment choice.

The study had several limitations that readers should know about. First, it was relatively small with only 96 children, so results might not apply to all children everywhere. Second, it wasn’t a randomized controlled trial, meaning children weren’t randomly assigned to treatments—they were already on their treatments when the study started. This means the groups might have been different in ways that weren’t measured. Third, the study was done in one location (likely Italy, based on the journal), so results might be different in other countries with different populations. Fourth, the study only followed children for 2 years, so we don’t know what happens after that. Finally, some measurements (like the special protein markers) didn’t show clear patterns, making it harder to predict which children might have problems.

The Bottom Line

Based on this research, the ketogenic diet appears to be a reasonable treatment option for children with seizures that don’t respond to medications. It does not seem to cause more heart, blood vessel, or metabolic problems than staying on multiple medications. However, all children with difficult-to-treat seizures should have their bone health checked regularly with bone density scans, regardless of which treatment they’re using. Children on the keto diet should be encouraged to stay active and exercise, as movement appears to help protect bone health. Growth should also be monitored regularly. These recommendations have moderate confidence because the study was well-designed but relatively small.

This research is most relevant for parents of children with epilepsy that doesn’t respond to standard medications, and for neurologists and pediatricians who treat these children. It’s also important for children themselves who might be considering this diet. This research is NOT relevant for children with seizures that are well-controlled by medications—they should not switch treatments based on this study. It’s also not directly applicable to adults, as the study only included children.

If a child starts the keto diet for seizure control, seizure improvement typically happens within weeks to a few months. However, the health effects studied here (bone density, growth, heart health) develop over much longer periods. Parents should expect to see bone density results after at least 6-12 months of treatment, and growth effects may take 1-2 years to become apparent. Regular monitoring should happen every 3-6 months.

Want to Apply This Research?

  • Track weekly physical activity minutes (target: 150+ minutes per week of moderate activity like walking, playing, or sports) and monthly weight/height measurements to monitor growth. Record any seizure changes and energy levels daily.
  • Encourage daily movement and exercise as part of the routine—this appears especially important for children on the keto diet to protect bone health. Set reminders for scheduled bone density check-ups and growth monitoring appointments every 6-12 months.
  • Create a long-term tracking dashboard showing: (1) seizure frequency trends, (2) activity levels and exercise consistency, (3) growth measurements plotted over time, (4) appointment reminders for bone density scans and doctor visits, and (5) dietary adherence if using the app to track meals. Flag any concerning changes in growth or activity levels for discussion with the child’s doctor.

This research summary is for educational purposes only and should not replace professional medical advice. The ketogenic diet for seizure management should only be started under close supervision of a pediatric neurologist. Parents should not make treatment decisions based solely on this study. Individual children may respond differently to treatments, and what’s safe for one child may not be appropriate for another. Regular medical monitoring is essential for any child on the ketogenic diet or anti-seizure medications. Always consult with your child’s healthcare team before making any changes to seizure treatment or diet.