Steroids and the Diet: A Recipe for Success?

Epilepsy News From:

Tuesday, October 6, 2015

An important article was published in the July issue of Epilepsy and Behavior challenging a prior widely-held belief that had little fact to back it up. Namely, some have expressed concern that high dose steroids could NOT be used in combination with the ketogenic diet. There was a perception that steroids would negate ketosis and make the ketogenic diet less likely to work. Dr. Ville and her team from Paris questioned this misconception by studying 42 children who were treated with both high dose steroids and the ketogenic diet at the same time.

Most of these children, as one would expect based on requiring steroids, had infantile spasms or Landau-Kleffner syndrome: types of epilepsy in which steroids can help. The ketogenic diet was started using a 4:1 ratio following a 24-hour fasting period. All 42 children were on oral hydrocortisone (not ACTH) at an average dose of 3.5 mg/kg/day.

How did they do?

Fourteen responded to the diet and all maintained moderate to large ketosis. These 14 children were able to successfully come off steroids, which was part of the goal of trying the ketogenic diet in the first place. No child had infection (a theoretical risk of both steroids and the diet).

In summary, being on standing long-term oral steroids does not appear to be a reason to avoid the ketogenic diet. This is important for children with infantile spasms and Landau-Kleffner syndrome on steroids looking for another option for seizure control.


Ville D, Chiron C, Laschet J, Dulac O. The ketogenic diet can be used successfully in combination with corticosteroids for epileptic encephalopathies. Epilepsy Behav 2015;48:61-65.

New Products Options

Some new products are now available for ketogenic diet families. I do not “endorse” them, but several have been taste-tasted by me and others at ketogenic diet conferences and are quite tasty! Of course, make sure to discuss any new product with your ketogenic dietitian and team first before trying!

Authored by: Eric Kossoff MD on 10/2015

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