100 Years of Keto… So Why Don’t More Doctors Use It? | Dr Eric Kossoff

Benjamin Hopkins (0:04)

Dr. Eric Kossoff, thank you so much for your time in advance. I really appreciate it, and I really enjoyed reading through the materials you sent through before. So yeah, just welcome to the show.

Eric Kossoff (0:13)

Yeah, thank you very much. I appreciate you having me here today.

Benjamin Hopkins (0:17)

I've had a lot of conversations with wonderful metabolic health scientists, practitioners, ketogenic diet practitioners and explorers and scientists in that world. And I often get to a place where this split between the science and medicine comes in the sense of if something works, but we have no idea how it works, does that even matter?

When it comes to epilepsy and the ketogenic diet, how effective can that be for children and adults? And do we know how it works?

Eric Kossoff (0:52)

Yeah. So the answer is very and absolutely we do.

Benjamin Hopkins (0:56)

Yeah.

Eric Kossoff (0:56)

So that used to be something we would hear absolutely 20, 30 years ago. You know, we don't know how it works. And the counter argument, interestingly, from a lot of us in the field used to be, well, we don't know how a lot of our seizure drugs work either, which is partially true, although we know how many of them work. But we have come a very long way in the last 20 years in understanding how ketogenic diet therapy helps suppress seizures. And it's complicated, but that doesn't mean it is unclear. It doesn't mean it's vague. We know it's much more complicated than just ketones. In fact, there are ketogenic diet therapies, like the Low Glycemic Index Treatment, where children don't even make ketones, yet they have seizure control. There's five different ketogenic diets that we use for epilepsy. And we know that the mechanisms are complex, and epilepsy is complex.

That's the other part of the story. There's hundreds of different kinds of epilepsy, many different reasons why children and adults have epilepsy, and why it works for some of those epilepsies may be coming to a different mechanism, so to speak, than any other form of epilepsy. So for infantile spasms, for example, a type of epilepsy, it might be that the ketones help.

But then for another form of epilepsy called absence epilepsy, maybe it's keeping your blood glucose stable is helpful for that form of epilepsy. And you could say, well, maybe for other kinds of epilepsy, it's the gut microbiome and the changes that happen in your gut microbiota that increase neurotransmitters that seem to suppress the ear. So it's very complex. It's an exciting time. I think the basic scientists and clinicians like me are talking more than we ever did. And they say, I think we have an interesting mechanism that we want to look at. And we say, that's great. What kind of epilepsy do you want to look at? And we're working together more than we ever did. Your first part of the question, I think, is pretty established. We know it does work for epilepsy. There's 17 randomized control trials. So the old argument that it's a therapy that was used at small institutions and only used in kids, that argument is long, long over. It is medically established. It is a standard therapy all over the world at academic epilepsy centers. It's one of many therapies, right? We've got drugs, surgery, neurostimulation, as we call it, using electricity to stop seizures, and then diet therapy. So it's one of the four major therapies out there.

We know it works in about half of the children that we use it for. And that's in data for kids that are pretty tough to treat. So if you use it sooner, which is, I think, where the new frontier is heading, using it maybe even first line, it probably works even better. Although that data doesn't exist yet, but it's coming.

Benjamin Hopkins (3:51)

We got over a century of research and data on the ketogenic diet for epilepsy now.

What have you found most surprising in trying to get widespread adoption of this in traditional medicine? Where I know well-intentioned medics where if I were to even suggest the diet could be on par with some sort of drug, a lot of them would look at me like you don't know anything, you're some sort of quack. But then you show the research and you build this real resistance. How have you dealt with that and what's your big experience in that sort of topic?

Eric Kossoff (4:28)

No, it's a good question, Ben. It's a nuanced question because you're absolutely right.

The Ketogenic Diet for Epilepsy has been around for 105 years, longer than any of our anti-seizure medications. But I think the medical education of physicians, of neurologists is medicines are helpful, medicines are not a lifestyle change. It's a lot easier to take a pill than to change your diet and there's no doubt about it.