The convulsions or 'blanks', which last for seconds or minutes, are thought to be caused by a temporary upset in the brain’s chemistry, causing neurons to fire off faster than usual and in bursts.
Convulsions can be brought on by neurological problems such as a brain injury, a stroke, an infection and less frequently, a tumour. High levels of stress and panic attacks can also trigger a convulsion. So too can heart disease, especially irregular heartbeats, and blood sugar problems. Whatever the triggers, convulsions indicate that the brain is out of balance. An obvious place to start is to ensure an optimal intake of the brain’s best friends – nutrients.
Brain cells, neurons, run on either glucose or ketones, generated from fats in the liver. Knowing this the first perogative is to ensure a stable supply of fuels for neurons. Not eating, or eating high GL foods, could cause a dip on blood glucose which is the first potential for triggering a fit.
Epilepsy, especially in chidren but also in adults, has been successfully treated with a low carb ketogenic diet for over 100 years. I write about this in my book The Hybrid Diet. The most direct food source for making ketones is C8 oil., which is more effective in raising ketones than coconut or 'MCT' oil. Although this has yet to be tested in those with epilepsy, in those with pre-dementia(MCI) a trial giving participants two tablespoons of C8 oil daily improved neornal cell energy, faciliated the switch to ketone metabolism, and resulted in cognitive improvements. Neurons, if given the choice of fuel - glucose or ketones - preferentially take up and metabolise ketones. Therefore, it is worth exploring the effects of C8 oil on reducing fits, with or without a low-carb diet. C8 oil is a medium-chain triglyceride (MCT) and it is becoming clear that ketogenic diets high in MCTs 'directly inhibit AMPA receptors (glutamate receptors), and to change cell energetics through mitochondrial biogenesis.' according to UCL research. See also this review.
Glutamates can be excitatory or inhibitory. For example, the amino acid GABA switches off an adrenal response. It is therefore also worth considering that release of adrenal hormones under stress can be a trigger for a fit. There is reason, but no research that I know of, to explore low dose GABA (200mg to 1,000mg) in those whose fits are triggered by stress. Also, stabilising HRV as an indicator of switching off a stress research, may be achieved by practising midfulness or Heartmath. HRV is directly monitoring via a clip on ear sensor plugged into a mobile phone via the Inner Balance app. See my report on Heartmath.
OMEGA-3 FATS, PHOSPHOLIPIDS AND METHYLATION
Since the neuronal membrane is made by attaching omega-3 fat DHA (docosahexanoic acid) to phospholipids such as phosphatidyl choline to produce phosphorylated DHA, the attachment process being done by methylation, itself dependent on B vitamins, it makes sense to optimise your intake of both DHA and EPA(from which DHA can be synthesized), phosholipids and especially choline, as well as checking for methylation problems by testing blood homocysteine levels, and correcting accordingly. Methylation is especially dependent on vitamin B6, folate and B12, the latter being the most commonly deficient, especially among vegetarians.
In a study of infants 29% were deficient in B12 which can have serious neurological consequences, including fits, say the authors. B12 is best measured by a plasma holoTC test (holo-trans-cobalamin).
In a randomised controlled study giving epileptics either an omega-3 EPA rich or DHA rich supplement there was little difference between them, with both EPA and DHA supplemented individuals having more fit-free days than placebos. Those of placebo had 16.6 seizures per month, while those on DHA (417mg) had 11.9 and those on EPA(386mg) had 9.7. This represents a 42% reduction in seizures.
Choline is often lacking in the diets of pregnant mothers and sdupplementation during preganncy has been shown to enhance cognition. Choline is rich in eggs and fish but often lacking in a vegan diet with smasll amounts found in broccoli and nuts such as almonds . Choline, found in the key phospholipid phosphatidyl choline, is neuroprotective as shown in this review
Current thinking is that epilepsy should be view as a system-based issue affecting neuronal health. "This systemic component can be viewed from the perspective of a number of fundamental pathophysiological processes: inflammation, oxidative stress, glycation, and methylation capacity.' say the authors of a recent paper from experts at London's UCL.
Each of these processes are influenced by nutrition, and optimised with:
- An anti-inflammatory diet high in oily fish, nuts, seeds, fruit and vegetables, low in meat and dairy
- A high antioxidant diet - with plenty of vegetables, fruits, herbs, spices and other antioxidant rich foods
- A low GL diet to stablilise glucose balance.
- A diet with sufficient B vitamins, especially B6, folate and B12, and possibly zinc and TMG, all vital for healthy methylation as illustrated by a normal homocysteine level, below 10mcmol/l in adults or 7 mcmol/l in children.
The optimum nutrition approach can be highly effective, as Francis’s story illustrates.
While teaching classes in Oxford, Francis had a bad car accident. This left him with severe headaches, poor memory and concentration, severe depression but most of all, epilepsy. So bad was his epilepsy that he complained of what he called ‘epileptic storms’, sometimes daily. During the night he would often have five or six fits, despite being on anti-epilepsy drugs. His memory had so deteriorated he could no longer teach, and being epileptic, he found it hard to get work. Naturally he became depressed.
After years under medical supervision he decided to try some alternatives and was referred to me. He promised to avoid tea, coffee and sugar and we discussed how to eat a balanced diet, with plenty of fruit, vegetables and wholegrains – the ‘optimum’ diet.
I wanted to give him every chance to change and included high levels of supplements, including B3, B5 and B6, B12, choline, calcium, zinc, magnesium and manganese as well as other nutrients. Magnesium and manganese have both been shown to help epilepsy, while B5 and choline have a specific effect on memory.
When he came back after one month, he had made tremendous changes to his diet and had reaped the rewards of his efforts. ‘I am amazed at how well I feel,’ he commented and went on to tell me how he hadn’t had a single muscle tremor or panic attack. Three months later, he had still only had one epileptic ‘storm’. His brain is working better, his depression completely gone and he can sleep straight through the night, without any fits or muscle tremors.[*]
Differences in the nutritional status of those with convulsions or epilepsy and those without has been demonstrated by many researchers. The key nutrients that have frequently been shown to be deficient are folate, B12, the minerals manganese and magnesium, and essential fats.
Finding What Helps
Folate, a vitamin that is often low in those with mental health problems, is depleted by convulsions. This suggests that it is somehow involved. Ironically, anticonvulsant drugs such as phenytoin, primidone and phenobarbital further deplete folic acid. Combining a drug such as phenytoin with folic acid works better than giving the drug alone. In one study, epileptics were given the drug with either folic acid or a placebo and after a year, only those on folic acid reported substantially less fits.
However, folic acid could be a double-edged sword. Some uncontrolled studies suggest that folate supplementation may create epileptic fits in a minority of people. Several controlled studies, however, have failed to confirm this observation, suggesting that this effect must be very rare. With the guidance of your doctor, folic acid supplementation is well worth trying, although don’t expect immediate results.
Also worth supplementing is vitamin B6. Unlike folic acid, high doses of vitamin B6 can produce almost immediate results. The first research to identify a role for B6 in the treatment of epilespy in children took place in Japan in the 1980s. More than half the children with ‘infantile spasms’ responded very well to B6 supplementation, although the doses used were very high and caused side-effects in some of them.
In a more recent study at the University of Heidelberg in Germany, 17 children were given high doses of vitamin B6 (300 mg/kg/day orally). Five out of the 17 had immediate relief within two weeks, while after four weeks all patients were more or less free of seizures. No serious adverse reactions noted. Side-effects were mainly gastrointestinal symptoms, and were reversible after reduction of the dosage.
B12 deficiency, as discussed above, is very common and essential for neuronal health. B12 is only found in animal produce therefore those on a largely vegan diet must supplement B12 or eat fortified foods.
Magnesium, Manganese and Zinc
The mineral manganese is completely essential for proper brain function and, to date, four studies have shown a correlation between low levels and the presence of epilepsy, suggesting that as many as one in three children with epilepsy have low manganese levels. Supplementing manganese helped to reduce fits. In one study published in the Journal of the American Medical Association, one child who was found to have half the normal blood manganese levels didn’t respond to any medication, but on supplementing manganese had fewer seizures and improved speech and learning. Dr Carl Pfeiffer was the first to report the successful treatment of epilepsy with manganese. At the Institute for Optimum Nutrition we have frequently found that patients with convulsions or fits are manganese deficient and have no or fewer fits once supplementation is started.
Magnesium is another mineral well worth checking. Magnesium is also vital for proper nerve and brain function, and, once again, a number of researchers have found low levels in patients with epilepsy and reported fewer fits on supplementation. In animals, magnesium injections have also been shown to instantly suppress convulsions.
If a child is found to have low blood levels of magnesium, as many as 75 per cent respond, with fewer fits, according to research from Romania. Supplementing this mineral is especially helpful to those with ‘temporal lobe’ epilepsy. This is especially useful since people with this type of epilepsy rarely respond to conventional anticonvulsant drugs. It is also possible that pregnant women, deficient in manganese, may be more likely to have children with epilepsy.
It is also well worth testing for zinc. Once again, zinc levels have been found to be lower in children with epilepsy, and anticonvulsant drugs can further deplete this vital mineral. There is also some suggestion that too much copper and not enough zinc may increase the odds of having a seizure. Ideally, we need to take in 10 times more zinc than copper. Zinc is also a valuable ally for vitamin B6, since it helps convert B6 (pyridoxine) into the active form of the vitamin, called pyridoxal phosphate. It is highly likely that the few children who have had adverse reactions to very high doses of vitamin B6 may not have done so if given B6 together with zinc. Zinc, together with TMG (tri-methyl-glycine) also lowers homocysteine levels, thus normalising methylation.
In fact, most adverse reactions to vitamins or minerals arise when they are treated like drugs and given at very high doses without other nutrients, thereby completely ignoring the principle of synergy. For this reason I strongly recommend that any person who is experiencing fits, convulsions or epilepsy see a clinical nutritionist for a thorough nutritional workout.
This should involve both hair and blood analyses for magnesium, manganese and zinc, as well as folic acid. Levels of magnesium and folic acid are best tested in red blood cells. Depending on the results, a clinical nutritionist can work out what combination of these nutrients, often in high doses, are worth trying, together with basic multivitamin supplementation.
The optimum nutrition approach involving an all-round good diet and supplements programme is especially important since other nutrients have also been shown to have positive effects on mental health in those with epilepsy. These include B1, selenium and vitamin E.
Absolutely Essential: the Right Fats
Imbalances in essential brain fats is one of the hottest areas of research. It is highly likely, with so many people deficient in essential fats, and especially omega-3 fats, that ensuring an optimal intake and balance of essential fats may help reduce the incidence of fits in epileptics.
The anticonvulsant properties of the two EFAs in a ratio 1:4, omega-3 to omega-6, have been demonstrated in epileptic rats. Three weeks of EFA supplementation resulted in up to 84 per cent fewer rats having seizures, and up to a 97 per cent reduction in the duration of seizures. The experimenters postulated that the anticonvulsant effects of EFAs may be related to the stabilization of neuronal membranes in the brain.
It also works in humans. Researchers at the Kalanit Institute for the Retarded Child in Israel gave people with epilepsy 3g of omega-3 fats for six months and found a dramatic reduction in both the number and severity of epileptic seizures. A recent RCT discussed above reduced fits by 42% through saupplementation with EPA or DHA.
Amino Acids and Phospholipids
Many other ‘brain food’ nutrients may also be helpful for those with fits. This includes phospholipids such as phosphatidyl choline, and essential fats. Also potentially helpful are the brain’s master tuners – SAMe and tri-methyl glycine (TMG). A close relative, di-methyl glycine (DMG), produced remarkable results in one 22-year-old man with long-standing mental retardation, who had been having around 17 seizures per week despite anticonvulsant medication. Within one week of starting DMG, at 90mg twice daily, his seizures dropped to just three per week. Two attempts to withdraw the DMG caused dramatic increases in seizure frequency.
The amino acid taurine, which helps to calm down the nervous system, may also have a role to play. In animals studies low brain taurine concentrations have been found at the site of maximal seizure activity, and supplementing taurine was found to have a potent, selective and long-lasting anticonvulsant effect. Tarurine is a precursor for GABA.
However, the most powerful relaxant amino acid has got to be GABA, the brain’s peacemaker, because it acts directly as a neurotransmitter. One possible mechanism for explaining why anticonvulsant drugs work is that they block the activity of the excitatory neurotransmitter, glutamic acid, and thereby promote the inhibitory neurotransmitter, GABA. However, I would be cautious about supplementing GABA, and possibly large amounts of taurine, except under medical supervision This is mainly because animal studies have shown that rats prone to petit mal ('absence') seizures sometimes have too much of these amino acids. Another brain-friendly nutrient, DMAE, while potentially helpful, should also be given with caution.
Vinpocetine, an extract of the periwinkle plant (Vinca minor) may also help, according to research in Russia. This herbal extract does many useful things in the brain, It improves production of cellular energy in brain cells, and it widens blood vessels in the brain, thus improving transport of glucose and oxygen to the brain and their use once they get there. One theory is that epileptic fits may be caused by fluctuations in glucose or oxygen supplies to the brain, which might explain the positive effects of vinpocetine.
Check for Allergies
As with so many types of mental health problems, it’s well worth checking for allergies. One epileptic’s fits were proven to be induced by certain foods. Without knowing which, they were either given a minute amount of their ‘trigger’ foods or placebos, and only the foods brought on fits. Professor William Rea from Texas, renowned for his special sealed hospital wing that is completely free of all allergens, environmental pollutants and chemicals, designed specially for those with multiple allergies, has also found some epileptics stop having fits. One of his patients, a 29-year-old man with a four-year history of grand mal epilepsy as well as double vision, tachycardia, dizziness, oedema and spontaneous bruising, none of which had responded to the usual drugs, had complete relief after fasting for six days. When he was reintroduced to certain foods and chemicals he once more started having fits. For him, peanuts were the worst food. Another powerful trigger substance for some people with epilepsy is the smell of rosemary oil, found in many essential oil blends.
In summary, if you are prone to fits, convulsions or epilepsy and haven’t been checked out by a clinical nutritionist, there is plenty of room for hope.
- Eat a low GL diet, eating little and often to avoid blood sugar dips. Also, do you best to avoid hyper-adrenalisiation - stress and substnatial over-excitement, especially without eating.
- Experiment with either a low-carb ketogenic diet or a lower carb diet supplemented with 1-3 teaspoon/tablespoons of C8 oil. Start with the lower dose. Some people get abdominal symptoms - cramps and looseness if initial C8 opil dose is too high.
- Check your methylation with a homocysteine test. Yorktest.com have home-test kits. Use the code PH50 to get a £50 discount. if homocysteine is raised check your B12 levels. If low, supplement accordingly.
- Have your vitamin and mineral levels checked. If low in folate, B6, B12, magnesium, manganese or zinc, supplementation may well help.
- Make sure you are getting enough essential fats, from seeds, fish and their oils. Aim for 500mg a day of combined EPA plus DHA.
- Ensure you are getting enough phospholipids, especially choline, by eating six eggs a week and three servings of fish a week. if you are vegetarian then have either a dessertspon of lecothin granules or two 1,200mg lecithin capsules a day, high in phosphatidyl choline.
- Other brain-friendly nutrients, including amino acids such as GABA, choline, DMAE, taurine and vinpocetine may help, but they are best taken under professional guidance.
[*] Case supplied by Christopher Scarfe.