How Many Carbs Are on Keto for Epilepsy?

December 6, 2025 •

3 min read

The ketogenic diet has been shown to reduce or prevent seizures in many people, with some studies showing that over half of children on the diet experience at least a 50% reduction in seizure frequency. To achieve this, the diet imposes strict carbohydrate restrictions to induce a state of ketosis. How many carbs are on keto for epilepsy depends heavily on the specific diet variant prescribed and must be managed under medical supervision.

Quick Summary

The specific carbohydrate count for an epilepsy ketogenic diet depends on the version, such as the Modified Atkins Diet (MAD) or Classic Ketogenic Diet (CKD). Strict carb limits, ranging from less than 10 to 60 grams daily, are necessary for inducing ketosis and managing seizures, with the precise amount determined by a medical team.

Key Points

Strict Carb Restriction: The ketogenic diet for epilepsy severely limits carbohydrates to induce ketosis, a metabolic state that can reduce seizure frequency.
Varies by Diet Type: The exact carb count differs across epilepsy-specific ketogenic diet variants, such as the Classic Ketogenic Diet (CKD), Modified Atkins Diet (MAD), and Low Glycemic Index Treatment (LGIT).
Medical Supervision Required: Due to its complexity, this therapy must be supervised by a specialized medical team, including a neurologist and dietitian.
CKD is Most Restrictive: The Classic Ketogenic Diet is the most stringent, following specific fat-to-protein-and-carb ratios (e.g., 4:1) that result in very low daily carb intake.
MAD is More Flexible: The Modified Atkins Diet is a less restrictive alternative, allowing a fixed number of carbs per day (e.g., 15–20g for adults) without needing to weigh all foods.
LGIT Allows More Carbs: The Low Glycemic Index Treatment permits a higher carb intake (40–60g daily), focusing on foods that don't cause blood sugar spikes.
Monitoring is Crucial: Regular monitoring of nutrient levels, growth, and overall health is essential to manage potential side effects and ensure the diet's effectiveness.

Understanding Carb Limits on the Medical Ketogenic Diet

The number of carbohydrates allowed on a ketogenic diet for epilepsy is significantly lower than for general weight loss and varies based on the diet's specific protocol. For epilepsy management, the diet must be medically supervised and tailored to the individual, as even small deviations can affect ketosis and seizure control. The different diet variants—including the Classic Ketogenic Diet (CKD), Modified Atkins Diet (MAD), and Low Glycemic Index Treatment (LGIT)—each have specific carbohydrate parameters.

Classic Ketogenic Diet (CKD)

The CKD is the most restrictive version of the epilepsy ketogenic diet. It uses a specific ratio of fat to protein and carbohydrates combined, not a fixed carb count, typically 4:1 or 3:1. This means carbohydrates make up a very small percentage of daily calories, often 2–4% or as low as 8 grams per day. Precise weighing of food is necessary.

Modified Atkins Diet (MAD)

The Modified Atkins Diet is more flexible, effective for older children and adults. It focuses on a daily gram limit of carbohydrates, generally 15 to 20 grams of net carbs for adults and as low as 10 grams for children. Protein is less restricted, and weighing food is not typically required. Carb limits may be adjusted.

Low Glycemic Index Treatment (LGIT)

The LGIT is the least restrictive, allowing 40 to 60 grams of carbohydrates daily. The focus is on carbohydrates with a low glycemic index (GI) to maintain stable blood sugar.

The Role of a Medical Team

Implementing a ketogenic diet for epilepsy requires strict medical supervision. A team including a neurologist and dietitian tailors the diet by:

Personalized Calculations: Determining macronutrient ratios and calorie needs.
Individualized Meal Plans: Creating plans and educating on food choices.
Monitoring and Adjustments: Using tests to track ketosis and nutrient levels and adjusting the diet as needed.
Carb Tracking: Accounting for all carbohydrate sources, including those in medications.

Comparison of Ketogenic Diet Variants for Epilepsy


Feature	Classic Ketogenic Diet (CKD)	Modified Atkins Diet (MAD)	Low Glycemic Index Treatment (LGIT)
Carb Restriction	Very strict, often 2-4% of total calories	Restricted daily gram count (e.g., 15–20g for adults)	Moderately restricted, focused on low GI foods
Dietary Flexibility	Very low; requires precise weighing and measuring	Higher flexibility; allows for more protein and less weighing	Highest flexibility; no weighing required, focus on food choices
Fat Intake	Very high (80–90% of calories)	High (approx. 65% of calories)	High (approx. 60% of calories)
Protein Intake	Controlled and moderate to meet growth needs	Ad libitum (eat to satisfaction)	Moderate (20–30% of calories)
Implementation	Often requires initial hospitalization and fasting	Can be started at home without fasting or hospitalization	Can be started at home without fasting or hospitalization

Potential Challenges and Monitoring

Managing a ketogenic diet for epilepsy can involve challenges like constipation, high cholesterol, and nutrient deficiencies. Nutritional supplements are often needed. Regular monitoring tracks effectiveness and addresses side effects. Patient compliance can also be difficult due to the diet's restrictiveness.

Conclusion

The number of carbs on a ketogenic diet for epilepsy is a medically controlled aspect of treatment, varying by the diet variant used (CKD, MAD, or LGIT). The aim is to achieve ketosis for seizure management. A medical team is vital for ensuring nutritional balance, monitoring health, and supporting compliance. Anyone considering this therapy should do so under professional guidance. For more information, the Charlie Foundation offers resources for families using dietary therapies for epilepsy.

Frequently Asked Questions

The Classic Ketogenic Diet for epilepsy does not use a fixed gram count but is based on a ratio of fat to protein plus carbohydrates, typically 4:1 or 3:1. This results in a carbohydrate intake representing only about 2–4% of total daily calories, which can be as low as 8 to 15 grams per day.

For adults on the Modified Atkins Diet for epilepsy, the daily carbohydrate limit usually starts around 15 to 20 grams of net carbs. For children, the initial limit is often 10 grams per day, which may be adjusted after the first month.

Yes, the Low Glycemic Index Treatment is a less restrictive option for epilepsy. It allows for a higher carbohydrate intake of 40 to 60 grams per day, provided these carbs come from foods with a glycemic index of 50 or less.

The severe restriction of carbohydrates forces the body to burn fat for energy, producing ketones. The brain can use these ketones as an alternative fuel source, which has been shown to reduce neuronal excitability and decrease seizure activity.

For the Classic Ketogenic Diet (CKD), foods must be weighed to the nearest tenth of a gram to ensure the prescribed macronutrient ratio is met. However, the Modified Atkins Diet (MAD) and Low Glycemic Index Treatment (LGIT) are more flexible and generally do not require weighing food.

No, a medical ketogenic diet for epilepsy is much stricter and more specialized than a standard keto diet used for weight loss. It must be followed under the guidance of a medical team to ensure nutritional completeness, safety, and effectiveness for seizure control.

Even a single meal with excessive carbohydrates can interrupt the state of ketosis and reduce the diet's effectiveness for seizure control. Adherence to the prescribed carb limit is crucial for maintaining the therapeutic benefits of the diet.