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Heidi Pfeifer

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Heidi H. Pfeifer, RD, LDN, Clinical Dietitian Specialist ,
Massachusetts General Hospital
175 Cambridge Street
Suite 340,
Boston, MA 02114 


Throughout history dietary therapies, ranging from fasting to the Ketogenic diet have been used in the treatment of epilepsy.  Although these remain an efficacious method of treating seizures, they also remain difficult to maintain compliance.  Therefore, in 2002 we developed an alternative, the Low Glycemic Index Treatment.  In our experience with patients on the Ketogenic diet we found that patients were not only sensitive to the amount of carbohydrates that they received, but to the type as well.  This led us to the formulation of the low glycemic index treatment.
Glycemic Index is the measure of how high a specific food increases blood glucose levels, as compared to that of a standard, such as sugar.   There are several different factors that affect the glycemic index of food.   Factors lower glycemic responses include fiber, acidity and fat. 
The goal of the low glycemic index treatment for epilepsy is to focus on both the type of carbohydrate, those that have a GI of less than 55, as well as limiting the quantity of carbohydrate intake, with a typical goal of 40 - 60 gms per day.  Food is not weighed or measured, as in the Ketogenic diet, but are determined by approximate portion sizes  (i.e. 3 oz is equal to the size of a deck of playing cards).   This allows families a more flexible life style, including eating out at a restaurant without having to bring pre-measured food.  Patients’ individualized goals for protein and fat intake are based on their current caloric needs for continued growth and development. 

A typical distribution of calories on the low glycemic index treatment is approximately 60% fat, 30% protein and 10% carbohydrates.  Although this treatment is lower in fat than the Ketogenic diet, which provides 80-90% fat depending on ratio, it is still considered high in comparison to a normal diet.

The use of low glycemic index foods in the treatment of epilepsy is a recent development, although it has been used since the 1980’s for the treatment of other medical issues, such as Diabetes, Cardiovascular disease, Polycystic Ovary syndrome and Obesity.  Families often report that they find the low glycemic index treatment to be a healthier way of eating as it focuses, on avoiding refined sugars and encourages fruits, vegetables and whole grains.

Our studies have found that the low glycemic index treatment can be effective in the treatment of both generalized and partial onset seizures.  Seizures were reduced for the majority of patients, with a number of patients becoming seizure free.  
However, as with any anticonvulsant treatment, low glycemic index treatment is not without side effects.  These can include acidosis, constipation, and weight loss.  Therefore, we strongly encourage close monitoring and follow up by a dietitian and neurologist who have experience with this treatment. The incidence of epilepsy worldwide has been reported at 50 million people.  Therefore, the need for treatment alternatives remains paramount.

If you would like to hear a personal account of an individual on the LGIT, click on Rose’s story at

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