A gut feeling about the ketogenic diet in epilepsy.

The ketogenic diet has been used to treat intractable epilepsy for many years, yet the mechanism(s) underlying its effectiveness have not been completely elucidated. However, emerging evidence indicates that the ketogenic diet may correct or otherwise alter a 'dystopic' gut microbiota that exhibits altered fecal microbial composition compared to healthy individuals. Recent studies in animal seizure models also reveal altered gut microbiome, as well as changes in the composition of the microbiota after ingestion of a ketogenic diet. The effectiveness of the ketogenic diet in these animal models appears to be absolutely dependent upon the presence of gut microbiota. Further evidence suggests that effectiveness of the ketogenic diet in controlling seizures may be reliant upon the ability of specific bacterial populations to alter gamma glutamylation of amino acids and thus alter their uptake into the central nervous system. These studies suggest new directions for research in patients with epilepsy.