By Dr. Mercola
This year marks the 20th anniversary of "First Do No Harm," a film directed by American movie director and writer Jim Abrahams. Based on real life events, the film relates the successful treatment of one boy's severe case of epilepsy using a ketogenic diet. Prior to the fictionalized family's discovery of the diet, their youngest son, Robbie, was given many pharmaceutical medications, some of which caused constipation, fevers, rashes and other harmful side effects, including at least one near-death episode.
Aspects of the storyline mirror Abrahams' own experience with his infant son Charlie, who makes a brief cameo appearance in the film as one of Robbie's playmates in the hospital. Charlie was diagnosed with epilepsy when he was just 11 months old. Similar to the mother in the movie, played by Meryl Streep, after Abrahams watched his son suffer through multiple daily seizures, the accompanying accidents and injuries, and a slew of pharmaceutical drugs, he became aware of the ketogenic diet through personal research.
As with the boy in the movie, within the first month of implementing the diet, Charlie became seizure and drug free. Charlie continued on the ketogenic diet for five years, after which he resumed eating regular food, and has never had another seizure since. "First Do No Harm" will give you a sense of the intensity and desperation that often accompany serious illness. You also will get a glimpse of the emotional and financial burdens placed on families facing a major health crisis.
Moreover, the film shines a bright light on the harm that is routinely inflicted by doctors and drug companies through what may appear to be guesswork and trial-and-error procedures related to the treatment of complex health issues. If you've had doubts that looking beyond conventional medicine is worth your time, "First Do No Harm" will remind you again that so-called "alternative approaches," such as the ketogenic diet, actually underscore the value of plain old common sense when it comes to optimizing your health.
Why Are Drugs Often the First Choice in Epilepsy Treatment?
As you may know, epilepsy is a neurological disorder marked by abnormal electrical discharges in the brain that trigger seizures. These sudden brief episodes can be intense and are generally characterized by altered or diminished consciousness, convulsions and involuntary movements. The Epilepsy Foundation suggests epilepsy is the fourth most common neurological condition, with an estimated 65 million people worldwide affected by it.1
Some 150,000 Americans are diagnosed with epilepsy annually, with children and older adults experiencing the highest incidence rates.2 The recurring seizures that accompany epilepsy can have a significant impact on a person's quality of life, given the heightened risk of accidents and injuries.
According to the Mayo Clinic,3 pharmaceutical drugs are the first and most commonly used treatment method for epilepsy. Unfortunately, it takes time and experimentation to find a suitable drug, and these medications are often accompanied by unpleasant side effects that can do more harm than good.
Some of the side effects range from the less serious — fatigue, rashes and weight gain, to the more serious — depression, inflammation of vital organs, such as your liver, and suicidal behavior. In the movie, after noticing that one of the other children in her son Robbie's hospital ward had died, presumably from the treatment administered to the girl for epilepsy, which included brain surgery, Streep's character gets angry. Shouting at her son's doctor and two other hospital employees, she asserts:
"There's something wrong here. There's something really, really, really wrong! I bring my kid to you people for help, and all you do is make him sicker. You give him one drug, and then he needs another drug to cure him of the first one.
And then he needs another drug to take away the side effects of that one! And another one and another one and another one. I mean, he, he has had a rash, swollen glands, a fever, constipation, hemorrhoids, bleeding gums, and he acts like a drunk, a zombie, a psycho. And it's not because of his sickness. It's because of your cure!"
If drugs are ineffective, as they were for Robbie, other potential interventions for epilepsy sufferers include:4
- Surgery: If your seizures originate in a small, well-defined area of your brain that does not interfere with vital functions such as hearing, motor function or speech, it may be possible to surgically remove the area suspected to be the source of your seizures
- Vagus nerve stimulation: An implanted pulse generator similar to a pacemaker stimulates your vagus nerve, stabilizing abnormal electrical activity in your brain; such treatment has been shown to reduce seizures by 20 to 40 percent
- Ketogenic diet: A diet high in healthy fats and low in carbohydrates that, for epileptics, is strictly monitored and medically supervised, the diet works for some, but not all epileptics
When Conventional Treatments Fail, Hopeful Alternatives Often Surface
Just as Streep was making plans to remove Robbie from the hospital where he had been treated unsuccessfully with toxic, life-altering drugs for months, Robbie's doctor was making plans to recommend brain surgery.
In desperation, Streep had been scouring medical journals and other publications for weeks when she stumbled across a book by Samuel Livingston, published in 1972, titled "Comprehensive Management of Epilepsy in Infancy, Childhood and Adolescence." When attempting to inform Robbie's doctor of her findings, Streep states:
"I've been doing some reading, and I've come across a treatment for epilepsy called the ketogenic diet. It's by a doctor from Johns Hopkins. And the diet, as best as I understand it makes the body go into a fasting state, and something about that fasting state stops the seizures."
In response, the doctor, who clearly is not a fan of a dietary intervention, sarcastically retorts:
"'The Comprehensive Management of Epilepsy in Infancy, Childhood and Adolescence' by Samuel Livingston. The bible on pediatric epilepsy. Every neurologist in the country owns a copy. With the exception of the material on the ketogenic diet, it's an invaluable piece of medical literature. The diet is not an approved treatment, but there have been a lot of studies.
Those studies are anecdotal, and not the kind of studies we base sound medical judgment on — not double-blind studies. The ketogenic diet is highly suspect. You have to starve the child to begin with, and what you feed him consists mainly of fat, which is not only unpalatable, but nutritionally inadequate and extremely difficult to maintain. I've seen it tried a few times, and my experience is that it simply doesn't work."
Streep is undaunted by the doctor's sarcastic response and becomes even more determined to travel to Johns Hopkins to have her son evaluated as a candidate for the treatment using the ketogenic diet. Within a matter of days, Robbie begins the diet and is weaned off his medications.
In short order, his seizures are diminished and then totally gone. His parents are amazed at his recovery. Streep discovers that the dietician helping Robbie with his new manner of eating had been administering the ketogenic diet at Johns Hopkins for more than 40 years. In response, Streep's husband in the film, played by Fred Ward, says:
"I mean, how many children have been given drugs and operated on, and not one of them was told of this diet? Something doesn't make sense. I mean, if all the doctors we've talked to know about this … ketogenic diet, even if they don't like it for some reason, don't they have to tell us about it? Can they really censor information like this?
How can there be joint decision making if they don't give us information and tell us the options? Didn't you say Doc Peterson, talked with his neurologist friends about Robbie — and not one of them mentioned the diet? … Just drugs and surgery. If [the diet] stands any chance of working, let alone a 1 in 3 chance of stopping his seizures altogether, why would they rob us of that hope?"
The Ketogenic Diet and Intermittent Fasting: A Powerful Combination
A ketogenic diet calls for minimizing carbohydrates and replacing them with healthy fats and adequate amounts of high-quality protein. I recommend a cyclical or targeted ketogenic diet for everyone, where you increase carbs and protein once you are able to burn fat for fuel on the two to three days a week you are strength training.
I believe this is healthy for most individuals, whether they have a chronic health problem or not. I say that because the ketogenic diet will help you optimize your health by converting from burning carbohydrates for energy to burning fat as your primary source of fuel. You can learn more about this approach to improving mitochondrial function in my latest book, "Fat for Fuel."
One of the most common side effects of being a sugar-burner is that you end up with insulin and leptin resistance, which it at the root of most chronic disease. Keep in mind that adopting the ketogenic diet along with intermittent fasting may further boost your results. Intermittent fasting is one of the most effective strategies I know of to shift your body from burning sugar to burning fat as your primary fuel.
While there are many different strategies, my favorite (and the one I personally used to become fat adapted) is to simply restrict your daily eating to within a six- to eight-hour window, which means you're fasting for about 16 to 18 hours each day. I have now increased that time to 20 to 21 hours per day of fasting.
This kind of intermittent fasting can also be a useful modality to help you make a more gradual transition to a ketogenic diet, as it helps break your body's addiction to glucose. In fact, eliminating sugar cravings is one of the most welcomed side effects of intermittent fasting. If you are overweight and have a serious disease, then I believe water fasting for a week or more is likely a better option.
Getting the Word Out About the Ketogenic Diet for Children With Epilepsy
After discovering the ketogenic diet and seeing how it transformed his son's life, Abrahams and his wife launched The Charlie Foundation to Help Cure Pediatric Epilepsy in 1994. After the organization expanded its mission and sought to apply the diet to conditions such as ALS, autism, cancer, Parkinson's and Type 2 diabetes, it was renamed The Charlie Foundation for Ketogenic Therapies.5 About his experience with helping his son, Abrahams said:6
"After monotherapy, and then endless drug cocktails failed, I started doing my own research and stumbled across the ketogenic diet — a nearly extinct, high-fat diet for kids with intractable epilepsy that was known to help control and often even stop seizures. With the advent of new drugs, the diet — once a first line of therapy — had fallen into disuse. However, we were able to find a dietitian who was familiar with it and who was willing to start Charlie on it right away.
His seizures went away in two days. He stopped taking drugs within a month, and his development returned. It was a miracle. After five years on the diet, he began to eat regular foods again and the seizures have never come back …
I asked Charlie's doctor why we had to learn about the diet on our own — why none of his other doctors had ever told us about it. He believed the diet would never become accepted as a conventional treatment because of the way our medical establishment shares information.
[After Charlie was healed], my life took on new purpose. The ketogenic diet had to be made an option — an early option. Because doctors weren't informing families about this treatment option, were misinforming them or were administering the diet improperly, this information needed to go directly to the families."
Since its inception, the Foundation has confirmed the:7
- Value of the ketogenic diet thousands of times anecdotally, as well as by a randomized controlled study,8 for the successful treatment of epilepsy
- Improvement of uncontrolled seizures in children and adults, with many becoming drug and seizure free and able to return to a normal diet
- Development of less restrictive versions of the ketogenic diet for use by a larger segment of the global epilepsy population
- Presence of more than 200 hospitals worldwide with ketogenic diet programs, which includes a requirement for all advanced-level epilepsy treatment centers in the U.S. to provide ketogenic diet therapy
- Creation of new applications of the ketogenic diet for ALS, autism, cancer, Parkinson's disease and Type 2 diabetes
Ketogenic Diet Also Effective for Adult Epileptics
While the ketogenic diet has a successful track record in treating epileptic children, adult studies have been somewhat scarce. A 2014 body of research published in Neurology9,10 analyzed two types of diets used to treat adult sufferers of epilepsy:
- Ketogenic diet, consisting of a 3-to-1-to-1 or 4-to-1-to-1 fat-to-carbohydrate-to-protein ratio, with 87 to 90 percent of calories from fat
- Modified Atkins diet, comprising a 1-to-1-to-1 fat-to-carbohydrate-to-protein ratio, with approximately 50 percent of calories from fat
In all, the results were very similar between the two diets: 32 percent of those on a ketogenic diet and 29 percent of those on a modified Atkins diet reduced their seizures by about half. A small subset of patients — 9 percent of those following a ketogenic diet, and 5 percent of those using a modified Atkins diet — reduced the frequency of their seizures by more than 90 percent.
While the beneficial effects were persistent as long as participants remained on the diet, the rates of acceptance and continuance of the diets were found to be low. More than half of all patients following a ketogenic diet discontinued it before the end of the study period, as did 42 percent of those on a modified Atkins diet. For those who stayed the course, however, the results were typically rapid and quite beneficial.
While it has been shown that children sometimes remain seizure free after discontinuing a ketogenic diet, adult epileptics very likely must maintain the diet indefinitely, or suffer a relapse. Dr. Pavel Klein, neurologist and director of the Mid-Atlantic Epilepsy and Sleep Center in Bethesda, Maryland, a co-author of the research, stated:
"Unfortunately, long-term use of these diets is low because they are so limited and complicated. Most people eventually stop the diet because of the culinary and social restrictions. However, these studies show the diets are moderately to very effective as another option for people with epilepsy."
How to Get Started With the Ketogenic Diet
As you will see below, the ketogenic diet recommended for epileptics is close to what could be considered an ideal way of eating for most people. In fact, I believe a cyclical ketogenic diet can be very beneficial for the vast majority of people, either alone or in combination with intermittent fasting.
The primary difference between someone struggling with a chronic disease such as epilepsy or cancer and people who have not yet been diagnosed with a chronic disease comes down to how strictly you must follow it and how long you have to maintain this type of regimen.
As a general rule, if you are insulin resistant, I recommend intermittent fasting along with a ketogenic-type diet for as long as it takes to resolve your insulin resistance. At that point, you can increase your number of meals. Regardless of whether you're intermittently fasting or not, I believe the following food guidelines will be beneficial for you — especially if you're trying to shed unwanted weight. Start by:
- Avoiding processed foods, refined sugar and processed fructose in excess of 15 grams per day and grains
- Eating whole foods, ideally organic and minimizing or ideally eliminating all processed foods
- Replacing grain carbohydrates with large amounts of organic vegetables, higher amounts of healthy fats and low-to-moderate amounts of high-quality protein; more information about protein follows below
- Consuming about 50 to 85 percent of your total diet in high-quality, healthy fats — saturated and monounsaturated fats from animal and tropical oil sources — including the following:
Butter made from raw grass fed organic milk
Cacao butter (raw)
Coconuts and coconut oil
Dairy (raw, grass fed)
Ghee, also known as clarified butter
Lard and tallow
Meat (grass fed, organic)
Organic pastured egg yolks
Seeds like black sesame, cumin, hemp and pumpkin
Unheated organic nut oils
Are You Eating Too Much Protein?
It's important to note that most Americans eat far more protein than needed for optimal health. On average, your body requires about one-half gram of protein per pound of lean body mass, which translates to about 40 to 70 grams of protein a day for most people. If you aggressively exercise, are a competitive athlete or are pregnant, you may need up to 25 percent more protein than average.
The rationale behind limiting your protein is significant. When you consume excessive protein, it activates your mTOR (mammalian target of rapamycin) pathway, which can help you gain large muscle, but may also increase your risk of cancer. There is also research suggesting the mTOR gene is a significant regulator of the aging process.11 Suppressing this gene appears to be linked to longer life.
To determine whether you're getting too much protein, first calculate your lean body mass by subtracting your body fat percentage from 100. For example, if you have 20 percent body fat, you have 80 percent lean body mass. Then write down everything you're eating for a few days, and calculate the amount of daily protein from all sources. You could simply Google each food to find out how much protein it contains. An easy tip to remember is that a 3 to 4 ounce serving of protein is about the size of a standard deck of playing cards.
Two Additional Considerations for Epilepsy
While it does not necessarily work for everyone, I wholeheartedly endorse cyclical or targeted ketosis as a first line of treatment for epilepsy and most all other chronic diseases. It is particularly beneficial if you are seeking a drug-free alternative, or have found drugs to be more detrimental than helpful, to managing your seizures. That said, two other considerations I want to mention that may help you manage your seizures are:
• Cannabis oil: Children with epilepsy can often find rapid relief using cannabis oil, although results vary, and not every child will respond well immediately. Dr. Margaret Gedde, owner and founder of Gedde Whole Health, located in Colorado, a provider of medical marijuana physician services, suggests about 25 percent of child epileptics experience a significant reduction in seizures within days or weeks when using cannabis oil.
• Vitamin D: Because having frequent seizures may interfere with your ability to get outdoors and get sun exposure, epileptics may be deficient in vitamin D. Some antiepileptic drugs can interfere with its metabolism, also leading to deficiency.
Because epilepsy is a disorder of the central nervous system, particularly your brain, and vitamin D is a neuroregulatory steroidal hormone that influences nearly 3,000 different genes in your body, your vitamin D levels can positively influence your condition. For starters, vitamin D can enhance the amount of important chemicals in your brain needed to protect your brain cells.
Changing Your Diet Now May Enable You to Avoid Drugs and Surgery Later
In a climactic scene in "First Do No Harm," when Robbie was being released from his local hospital so his mom could take him to Johns Hopkins to investigate the ketogenic diet, a family friend, who was also a licensed physician, told Robbie's doctor:
"When you and I became doctors, we swore an oath that said, 'First do no harm.' Now, if these folks want to try to control their son's seizures by changing what he eats — instead of drugs and surgery — well, I think they deserve that chance."
I couldn't agree more with this man's assessment — we all are worthy of high-quality, individualized medical treatment. No matter the medical advice or diagnosis you have received, I believe you can improve your health today simply by changing how and what you eat.
By making a commitment to a cyclical or targeted ketogenic diet with intermittent fasting now, you may be able to avoid drugs and surgery later. The ketogenic diet has been shown to improve the quality of life for epileptics, and I believe it can improve your quality of life, too!
To Learn More, Join Me at My Upcoming Live Lectures
If you are a physician and are interested in learning about how you can use the ketogenic diet and other therapies for cancer, heart disease, Lyme and neurodegenerative diseases like Alzheimer's and Parkinson's, please be sure and come to our ACIM conference in Orlando, Florida, November 2 through 4 at the wonderful Florida Conference and Hotel Center.
There will be a separate and less expensive track available to the public November 3 and 4 at the same location. Be sure to visit the conference page if you want to register for the event.