Fiber and the Ketogenic Diet for Epilepsy

By Ellen Sviland Avery, MS, RD, LD, CNSC

As many of you know, the ketogenic diet is a very high fat, moderate protein and low carbohydrate diet. Since carbohydrates are limited, this can also limit an important nutrient in the diet: fiber. In today’s KetoConnect post, registered dietitian Ellen Sviland Avery answers your questions about fiber and why it’s important for children on the ketogenic diet for epilepsy.

Why is fiber important?

Fiber is important in a healthy diet to maintain gut health.  It is recommended that children older than 2 years of age consume a minimum amount of dietary fiber equivalent to their age plus 5 grams of fiber per day. For example, a 4-year old child should consume at least 9 g of fiber per day (4+5=9). A safe range of dietary fiber intake for children is suggested to be their age plus between 5-10 grams of fiber per day. 1 Research has also shown that up to 55% of children don’t meet fiber needs with an oral diet. 2,3

How does this affect my child on the ketogenic diet?

As previously stated, fiber may be limited in the ketogenic diet. Fiber is primarily found in fruits, vegetables and grain products. Due to the low carbohydrate intake of the ketogenic diet, these foods are typically consumed in small quantities, limiting the amount of fiber consumed. Because of the lack of fiber and bulk in the diet, constipation is a common side effect. 4,5 Gastrointestinal symptoms, especially constipation, are seen in ¾ of all ketogenic diet patients.6

So how do I improve these side effects?

To help prevent or alleviate constipation with the ketogenic diet, talk to your child’s doctor or dietitian to ensure your child is receiving adequate fiber and fluid. Speak with the dietitian about foods that may be higher in fiber that will fit in your child’s ketogenic ratio. Sometimes just increasing the amount of fiber consumed by small amounts will help with constipation. If needed, the doctor or dietitian may also prescribe a fiber supplement or even a carbohydrate-free laxative. Do not give your child any laxative without first consulting with the medical team.

How can KetoCal help with fiber needs?

KetoCal 4:1 contains fiber to help meet your child’s fiber needs while on the ketogenic diet. One drink box of KetoCal 4:1 LQ contains 2.6 g fiber. The great thing about the fiber found in KetoCal is that it comes from a patented blend of six different types of fibers, rather than just one type. This helps to better resemble the blend of fiber one would get from eating a healthy diet. Talk to your dietitian to see how KetoCal fits into your child’s meal plan!


  1. Williams CL, Bollella M, Wynder EL. A new recommendation for dietary fiber in childhood. Pediatrics. 1995;96(5 Pt 2):985-8.
  2. Butte NF, Fox MK, Briefel RR, et al. Nutrient Intakes of US Infants, Toddlers, and Preschoolers Meet or Exceed Dietary Reference Intakes. Journal of the American Dietetic Association. 2012;110(12):S27-s37.
  3. Hampl JS, Betts NM, Benes BA. The ‘age+5’ rule: comparisons of dietary fiber intake among 4- to 10-year-old children. J Am Diet Assoc. 1998;98(12):1418-23.
  4. Dahl WJ, Niebergall EJ, Owen RJ. Implications of fiber inadequacy in the ketogenic diet: a case study. ICAN: Infant, Child, & Adolescent Nutrition. 2011;3(5):3.
  5. Kossoff EH, Zupec-Kania BA, Amark PE, et al. Optimal clinical management of children receiving the ketogenic diet: recommendations of the International Ketogenic Diet Study Group. Epilepsia. 2009;50(2):304-17.
  6. Bergqvist AG. Long-term monitoring of the ketogenic diet: Do’s and Don’ts. Epilepsy Res. 2012;100(3):261-6.

Top Five Books for Parents Learning About the Medical Ketogenic Diet for Epilepsy

If you are considering the medical ketogenic diet for your child, or perhaps your child is already scheduled to begin the medical ketogenic diet, you are likely seeking all the information that you can find to educate and prepare yourself. Even after your child starts the diet, you will likely continue searching for information and resources to support you in managing day to day. Many parents find books to be helpful, so for today’s KetoConnect blog post, we rounded up a list of five of our favorite books for parents learning about the medical ketogenic diet for epilepsy.

For more resources for parents learning about the medical ketogenic diet for epilepsy, check out our list of helpful YouTube videos and infographics.

ketodietsbookKetogenic Diets

This book, by the ketogenic diet team at Johns Hopkins Hospital, is a must-have for both parents and health care professionals.

The Keto Cookbookketocookbook

This ketogenic diet cookbook is co-authored by a mother of a child on the medical ketogenic diet and a ketogenic  dietitian. It provides a variety of tasty ketogenic recipe ideas.

Keto Kid: Helping Your Child Succeed on the Ketogenic Dietketokid

This book is written by a physician who is also the mother of a child on the medical ketogenic diet. It provides helpful tips for everyday management of the diet.

Fighting Back with Fatfightingback

This book is written by two mothers of children on the mediacl ketogenic diet for seizures. It provides practical tips for parents managing the Classical Ketogenic Diet or the Modified Atkins Diet.

Diet for Seizures: One Child’s Journeydietforseizures

In this book, a father tells about his daughter’s experience with the Modified Atkins Diet for epilepsy. This is a great read for parents, especially those interested in the Modified Atkins Diet.

Do you have feedback about these books or know of another useful book to add to this list? Please share in the comment section below!

The medical ketogenic diet should be used under medical supervision.

KetoCal is a medical food and is intended for use under medical supervision.

No Bones About It: Questions and Answers About Nutrition, Epilepsy and Bone Health

By Ellen Sviland Avery, MS, RD, LD, CNSC

Why should I be worried about my child’s bones?

Bone health is important for men and women, children and adults. As children, it is important to get enough calcium and Vitamin D starting during infancy. Inadequate calcium and Vitamin D during childhood can affect proper bone development.

Where can I find calcium and Vitamin D in my food?

Good sources of calcium include dairy products, calcium fortified orange juice and milk substitutes, sardines, dark green leafy vegetables (kale, spinach, collard greens) and calcium fortified cereals. Good sources of Vitamin D include salmon, tuna, shrimp, egg yolks, beef liver, mushrooms and Vitamin D fortified foods. Of note, Vitamin D can also be made in the liver from sunlight!

How much calcium and Vitamin D does my child need daily?

The Recommended Dietary Allowance for calcium for children aged 1-3 years is 700 mg/day, 4-8 years is 1000 mg/day, and 9-18 years of age is 1300 mg/day. For Vitamin D, the RDA for children aged 1-18 years is 600 international units (IU) per day.

How do I know if there’s a deficiency?

If you are concerned about a deficiency, be sure to discuss it with your child’s health care provider.

What does this have to do with my child with seizures?

Many common anti-epileptic drugs (AED) can cause disturbances with Vitamin D absorption. In a recently published study, decreased bone mineral density was seen more often when a child was on more than one AED (Vestergaard 2015). As we mentioned already, Vitamin D is necessary for good bone health. It is important to talk to your physician about ensuring your child is receiving adequate Vitamin D and calcium.

Now you might ask why we are focusing on bone health and the ketogenic diet. Typically, the ketogenic diet can be low in high calcium and Vitamin D foods as many of them contain carbohydrate, which is restricted in the ketogenic diet. The effect of diet on bone health is just one of the many reasons why it is so important to use the ketogenic diet only under medical and nutritional supervision. Your physician and dietitian that are helping you to manage your child’s ketogenic diet will help to ensure they are meeting the recommended dietary allowance’s (RDA’s) for calcium and Vitamin D. Most often, they will recommend a calcium and Vitamin D supplement to make up for any gaps in the diet. They may also check blood levels to look out for deficiencies in calcium or Vitamin D.

Again, if you have any concerns about your child’s diet and bone health, be sure to discuss it with your child’s health care team.


1. Vestergaard P. Effects of Antiepileptic Drugs on Bone Health and Growth Potential in Children with Epilepsy. Paediatr Drugs. 2015.