Eating well with epilepsy

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HealthWiki > Epilepsy and Seizures > Chapter 6: Living well with epilepsy > Eating well with epilepsy

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In this chapter:

 

In this chapter:

• Chapter 6: Living well with epilepsy
• Physical activity and exercise help our bodies
• Eating well with epilepsy
• Sleeping well with epilepsy
• Recipes for a ketogenic diet

Good nutrition is important for everyone. It supports physical growth, provides the energy needed for daily physical activities, and protects against illness and stress. Good nutrition is especially important for people with epilepsy since poor nutrition and its resulting tiredness, illness, and stress can trigger seizures.

Good nutrition ➙ Energy for physical activity ➙ Regular physical activity ➙ Less stress ➙ Fewer seizures caused by stress

In much of the world, people eat one main low-cost food and add other foods to make nutritious meals that meet the body’s needs. Highly processed “junk” foods, which contain lots of sugar, salt, and fat but little nutrition, are best to avoid. But if low energy is a seizure trigger for you, it may be better to eat junk food than to eat too little food—unless junk food triggers seizures too!

Timing medicine with food

Medicines, including the antiseizure medicines that need to be taken every day, cause some people to have nausea, diarrhea, stomach upset, or pain when taken with food. For others, problems happen when they take medicines on an empty stomach. When starting a new medicine, notice how your body responds.

• Take medicine with food if you feel side effects when you take it without eating, or
• take medicine on an empty stomach if you feel side effects when you take it with food. Once you discover what works best for you, take your medicine the same way every day, either before eating or after eating.

Eating and food-related seizure triggers

Food does not cause epilepsy. But for some people with epilepsy, certain foods may trigger a seizure. For example, food and drink that contain caffeine and sugar, such as coffee, chocolate, tea, and cola drinks, can cause problems if they make it harder to sleep well, because poor sleep is a common seizure trigger. Alcoholic drinks may also trigger seizures. Alcohol interacts with some epilepsy medicines, making them less effective or increasing their side effects.

Because triggers are different for everyone, it can be difficult to identify if a certain food or drink is a seizure trigger for you. And, not everyone with epilepsy has food or drink triggers. Talk with a health worker before making big changes to your diet.

For me, too much salt triggers my seizures.

I have had a seizure 3 times after drinking coffee.

I don’t have any food-related triggers.

What foods trigger seizures for you?

To find out whether a seizure was triggered by eating or drinking—or by not eating or drinking—ask yourself these questions:

• What foods were you eating before the seizure? Or had you not eaten for a while?
• Did the foods (or lack of food) also make you feel different in any other way?
• Was there another time you remember having a seizure after eating the same food or not eating anything for several hours?

Finding seizure triggers can take time. Noting and sharing details about a few seizures can help you and your health worker understand your eating patterns and food-related triggers.

Keep track of:

• Date of seizure
• What you ate or drank before
• What happened
• Has this food/seizure combination happened before?
• Did any other condition (heat, stress, tiredness, etc.) also happen before the seizure?

When you think certain foods or activities trigger your seizures, try to avoid them. Share what you are learning about your seizures with your health worker.

The most common types of seizures triggered by food or drink are focal seizures with convulsions, but any type of seizure can be triggered by eating.

Seizure trigger: Eating too much

Eating a large or heavy meal can cause a seizure for some people. This is most likely when the meal has a lot of carbohydrates, such as bread, pasta, or rice. Eating too much carbohydrates causes blood sugar levels to rise, and a little later, to decrease rapidly. For some people, the drop in blood sugar can trigger a seizure.

Sometimes there’s a big meal in front of me, but I just can’t finish it all. I stop eating when I feel like I’m about 80 percent full and save the rest for later.

The right amount of food is different for everyone. It is affected by age, amount of daily physical activity, how quickly the body converts food into energy, and other things. But a simple way to know the right amount for you is to notice when your stomach feels full. Then stop eating.

Here are some ways to avoid eating too much:

• Eat slowly. Chew each bite thoroughly. Some people count and chew each mouthful 32 times before swallowing to help themselves eat more slowly.
• Use smaller plates and bowls. This can help limit the amount of food you eat in one serving.
• Avoid skipping meals. When you skip a meal, it is likely you will be hungrier at the next meal, leading you to eat more, and more quickly.

Seizure trigger: Not drinking enough liquid

Drinking enough water can prevent seizures

Our bodies need water to function. Not having enough water in the body is called dehydration and is a common seizure trigger.

Because drinking water helps maintain body temperature, not drinking enough water can cause the body to overheat. This can also be a seizure trigger.

Prevent dehydration and seizures triggered by dehydration by drinking about 8 glasses of water throughout the day. Some people need more water than others, especially in hot weather.

SIGNS

Diarrhea, even if there are no other signs of dehydration.

Thirst. Remember that children and older people do not always say when they are thirsty.

Dry mouth and tongue. The inside of a person’s cheek is dry.

Urinating less often. Urine may be dark-colored. Older people, to avoid getting up or leaking urine at night, often drink too little in the evening.

Treatment for dehydration

A rehydration drink will help replace liquid the body has lost through dehydration. With diarrhea, food passes through the body too quickly and nutrients are lost. This recipe for rehydration drink also replaces some of those nutrients.

Recipe for rehydration drink

Water	+ a little salt	+ some energy food (sugar or rice or corn meal)	= rehydration drink

Seizure trigger: Skipping meals

Skipping meals can lower the amount of sugar in the blood, which can lead to having less energy. A sudden drop in blood sugar and energy levels causes seizures in some people.

These are some tips to avoid skipping meals:

Pay attention to your body’s signals that it is hungry. Eat when you feel hungry.

Carry water and snacks with you when you leave home.

Set regular meal times and try to eat around the same times every day. This can set your body’s clock to feel hunger at the same time every day.

Meal routines can be easier to keep when everyone is involved. Family members, friends, or caregivers can help by reminding each other about eating regularly, making it a group effort rather than one person’s job. Letting people know about your need to stick to a meal routine will make it easier to stay on track—others can gently remind you if you forget, without it feeling like pressure.

Fasting and epilepsy

Fasting means going without food for a period of time. Some people do not drink water while fasting, but others do. People fast for different reasons, including religious and spiritual ones, or for health reasons.

Tips for fasting with epilepsy:

Do what is best for your body. If you know that fasting without food and water is not good for your epilepsy, do not force it on your body. Find ways to adjust your fast so it does not harm your health. Talk with a health worker about how to make your beliefs work with, not against, your body.

Do not stop taking your antiseizure medicine. Taking antiseizure medicine every day is important during fasting. If you use meals or tea- or coffee-time as a reminder to take medicine, link taking medicine with a non-food daily activity instead.

Rest, sleep, and drink water. Try to get enough rest and sleep, at least 8 hours every day. If you choose not to drink water during a fast, drink lots of water before and after the fast.

Can I safely fast with epilepsy?

Salaam alaykum. My name is Rehab Magdy. I treat people with epilepsy and seizures. A concern for people with epilepsy in the Muslim community is how to fast safely. This is because during the holy month of Ramadan, we fast from before sunrise to sunset every day—no food, no drink.

Going without food or drink for almost 16 hours is a concern for people with epilepsy because it can affect sleep and cause dehydration, weakness, and tiredness, all of which are seizure triggers for some people.

After talking to many people with epilepsy before, during, and after Ramadan, I found that people who have focal, myoclonic, and absence seizures actually have fewer seizures when they are fasting during Ramadan. But this is not true for people with generalized tonic-clonic seizures.

Like many links between food, epilepsy, and seizures, fasting affects different people differently. Talk to a health worker who will support you to fast in the way that works best for you.

Food and antiseizure medicines

People using antiseizure medicines to manage their epilepsy need the same nutrition as a person without epilepsy. But the side effects of using some antiseizure medicines make it harder to get enough of these important vitamins and minerals:

Vitamin D: Some antiseizure medicines can cause low vitamin D levels, especially in young children and teenagers. Vitamin D helps the body use calcium better to strengthen bones.

Our body makes its own vitamin D when sunlight shines on skin, but the amount it makes depends on where a person lives and the time of year. For people with lighter skin, being outside in the sun for 15 minutes every day helps the body make enough vitamin D. Those with darker skin may need up to 30 or 40 minutes each day.

Foods with vitamin D include: milk, butter, egg yolks, animal fats, oily fish, and liver.

Calcium: The antiseizure medicine carbamazepine can lower calcium levels. Bones and teeth need calcium to be strong. It is also needed to make breast milk. Foods with calcium include: milk, curd, yogurt, cheese, ground sesame, almonds, beans (especially soy), and shellfish.

Cooking safely

People with epilepsy who enjoy cooking can be encouraged and supported to cook— not kept out of the kitchen! Making and sharing food with others is a central activity of many people’s lives—a necessary task to keep away hunger as well as a way to build community and express love and creativity.

Prevent injuries while cooking

To protect against injury and prevent accidents if a seizure happens while a person is cooking, the place where food is prepared and cooked can be made safer.

Be careful with sharp tools. Keep knives and scissors in a box with a lid or inside a drawer.

Avoid excess heat. Open windows or use a fan while preparing food. Wear light, loose clothing. Take breaks away from a hot stove.

Stay well rested. Don’t cook while tired, when seizures are more likely.

Watch for aura. If you sense a seizure is coming (aura), turn off the stove, sit down, and take a break.

Pay attention to fire and burn safety. Avoid cooking on open fires. On a hot stove, turn handles of pots and pans to the side when you are not using them. This can prevent injury if you fall or spill hot food during a seizure.

Find a kitchen buddy. Have someone with you when you cook on a stove or open fire. Cooking together can be more fun.

Cooking to feel bright in low moments

My name is Bright Bwalya and I have epilepsy. People ask, “How do you manage to live with epilepsy and still wear a smile on your face every day?” Well, a lot of positive practices help me when things get difficult. One of them is cooking. I love to cook. It relaxes me. When I cook, I go all out and try new and different things. Give me a stove, good ingredients (greens are a must!), a knife, and a nice chopping board, and I’m good to go. Dear friends with epilepsy: if cooking is your passion, try it out when those low moments hit. But be careful: If high temperature is a seizure trigger for you, you might specialize in making salads or cooler foods.

Special food plans to control seizures

For some people with epilepsy, especially children whose seizures are not wellcontrolled by medicines, special diets can lessen their seizures. One special daily food plan is called the “keto” or ketogenic diet (similar to the Atkins diet). This diet guides people to:

• Eat food rich in healthy fats (oil, meat, milk, butter, cheese, avocado, nuts, seeds).
• Eat higher protein foods (eggs, cheese, fish, other seafood, and meats such as chicken, beef, pork, and lamb). They have very low or no carbohydrates and fit well into a keto meal plan.
• Avoid foods with sugar and carbohydrates (bread, cassava, potatoes, pasta, sweets).
• Eat fruits and vegetables with less sugar and carbohydrates (melons, berries, avocado, greens, lettuce, and cauliflower).
• Avoid foods high in both protein and carbohydrates, such as legumes (beans, lentils, chickpeas) and grains (rice, wheat, corn). These are not part of a keto diet because they contain a lot of carbohydrates.

How low sugar, low carbohydrates, and more fats help epilepsy

A low carbohydrate and high fat diet helps manage epilepsy by getting the body used to a new main source of energy called ketones. The body produces ketones from fats. They are a different energy source than glucose, a form of sugar produced from carbohydrates, which is what our bodies are most used to. Because sudden increases and decreases in blood sugar levels are a common seizure trigger, keeping these levels steady by lowering sugar from carbohydrates helps to manage seizures.

Typical diet	Keto diet
Carbohydrates—45 to 65%	Carbohydrates—5 to 10%
Fat—20 to 35%	Fat—70 to 80%
Protein—10 to 35%	Protein—15 to 25%

We thought it would be hard to follow, but a nutritionist at the clinic helped us with the switch, and now our whole family is used to it.

Nina was 6 months old when her health worker suggested giving her foods from a keto diet to control her seizures.

Starting a ketogenic diet

A keto diet requires changing what you eat. It can take some time for your body to get used to the diet. Some people may switch all at once, while others may find it easier to reduce foods with carbohydrates over a few weeks.

It usually takes about 2 to 4 weeks for children and adults to get used to the new mix of foods and for the body to start using fat for energy instead of sugars. As the body adjusts, you might notice changes in energy, mood, or appetite. It is important to stick to the plan. Being on a special diet is similar to taking medicine—you need to follow the instructions every day for it to work properly.

See some easy-to-prepare and delicious keto recipes at the end of this chapter.

Talk about keto or other special food plans with a health worker who has experience with the care and treatment of people with epilepsy. Discuss these issues:

• Will it be possible for you to follow a food plan different from what you and your family are used to?
• Are the foods you will need available and affordable?
• Does the health worker know others who have tried this? What was it like for the person with seizures and their family?
• Can the health worker advise you on how to adapt the dishes you commonly cook to make them high in fats and low in sugars and carbohydrates?

Special diets are often designed in a health clinic or hospital. They include carefully measured amounts of particular foods. Sometimes, medicines may need to be adjusted when changing your diet. If you are interested in a ketogenic plan for yourself or your child, talk to a health worker with knowledge of epilepsy, nutrition, and local food, to make sure a change is safe.

IMPORTANT! People with Type 1 diabetes, liver, kidney or pancreatic diseases, or other metabolic disorders often cannot tolerate a ketogenic diet. Talk with a knowledgeable health worker.

Managing Keilah’s seizures with a keto diet

Keilah’s seizures started when she was 14 months old. Her first seizure was a generalized tonic-clonic seizure that lasted for 10 minutes. After the seizure, Keilah closed her eyes and went limp. Her mother was terrified that Keilah was dying and rushed her to the hospital.

Health workers thought Keilah’s seizure was from fever and gave her medicine for that. They also tried to find the cause of the fever but could not.

The next week, Keilah began seizing again. This time, she had multiple atonic seizures: her body went limp and her head dropped forward. Back at the hospital, health workers counted 3 head drops, and a few days later, Keilah was having over 100 head drops each day. The health workers gave Keilah antiseizure medicine, but it only made her seizures worse. So they asked her mother if she would agree to switch Keilah to the ketogenic diet instead.

At first, her mother was unsure. But she decided to try the keto diet. It took a few weeks to get Keilah used to the new foods and then to find the right dose of a different antiseizure medicine. With the new diet and medicine, Keilah had fewer seizures and they did not last as long.

After a few months, it became clear that the combination of diet and medicine was controlling Keilah’s seizures. They became less frequent until they seemed to stop completely!

In 2013, Keilah’s doctors held a workshop in Cape Town to discuss the importance of diet plans in epilepsy care. Almost 120 community health workers attended from all over South Africa. A network grew and organized trainings and community education in different cities. Two more clinics were opened to support children with epilepsy who could benefit from a keto diet.

When a nurse from an orphanage in Uganda heard about the keto diet, she started using it with a child whose seizures were not stopped by medicines.

She got advice by phone on how to adapt food available in her orphanage to a ketogenic plan for the child. She stayed in touch with the clinic in South Africa to track the child’s progress—and to celebrate when the seizures stopped!

The nurse produced a keto cookbook with recipes made from ingredients commonly found in Ugandan homes.

See some some ketogenic diet recipes that include foods common in different cultures.

Food security: Healthy eating for all

Healthy diets are possible only when there is enough food—grown, bought, or traded—for everyone. When the right to food is denied, hunger, malnutrition, and many health problems follow. Some people may need a special diet, like keto, to help with epilepsy. This is often more expensive. A family with limited resources is forced to decide between a healthy diet for one person or a healthy diet for other family members. This is not fair for the family or the community.

Food security means every person in a community has enough safe and nutritious food all year round to lead an active and healthy life. Although ensuring food security is the responsibility of every government, governmental corruption and actions by large corporations often prevent people from having access to the land and food needed to make sure that no one goes hungry. Strengthening food security is possible in communities with little or no government support. Some ways to do this are:

Grow vegetables and fruits in family, school, and community gardens. Even if they do not own land, people can grow food to support families, restaurants, and farmers’ markets.

Food cooperatives owned by the workers and the people who buy food there do not have to charge high prices to generate profits. Many food coops buy and sell locally grown food.

Farmers’ markets let farmers sell directly to people. This can mean lower prices for food buyers and better income for farmers. It also can help farmers and food buyers learn about each other and the challenges they face.

This page was updated:24 May 2026