On International Epilepsy Day, the world turns purple.

Buildings light up. Social feeds fill with ribbons. Stories of resilience, courage, and survival are shared, and rightly so. Epilepsy affects more than 50 million people globally, touching families, communities, and healthcare systems in ways that are often invisible to those looking in from the outside.

But behind the seizures, the diagnoses, and the medications, there is a quieter story that deserves to be told. It is the story of energy.

The Brain That Couldn’t Cope

The human brain is one of the most energy-hungry organs in the body. Although it accounts for only about 2% of our body weight, it consumes nearly 20% of our body’s energy to keep us thinking, moving, and alive. For most people, this energy comes primarily from glucose, a simple sugar derived from carbohydrates in the diet. 

But for many individuals living with epilepsy, especially those with drug-resistant forms of the condition, this system doesn’t work well. In up to about 30% of all people with epilepsy, seizures continue even after trying multiple medication regimens because glucose-based metabolism in the brain can be impaired, making neurons unstable and prone to misfiring electrical signals.

When the brain cannot access reliable energy, it reacts, and sometimes it reacts violently in the form of seizures. This means that seizures are not just neurological events; they are often metabolic crises where the brain is literally running out of the fuel it needs to function properly.

An Old Idea Rediscovered

Long before modern anti-epileptic drugs existed, doctors noticed something remarkable: when patients fasted, seizures often reduced or stopped altogether. Fasting, however, was not sustainable. But the metabolic state it created, one where the body shifts from burning sugar to burning fat,  sparked an idea. In the 1920s, the ketogenic diet was born. By dramatically reducing carbohydrate intake and increasing fat, the body enters nutritional ketosis, producing ketones, an alternative fuel source that the brain can use efficiently and consistently.

What began as a clinical observation became one of the most well-documented dietary therapies in medical history.

And it never stopped working.

A Different Fuel, A Calmer Brain

Ketones do far more than simply replace glucose.

When the brain shifts to using ketones as its primary fuel, energy delivery becomes steadier and more reliable. Neurons are no longer forced to depend on a system that may be compromised. Instead, they receive a fuel source that is metabolically efficient and inherently stabilising.

Ketones have been shown to reduce oxidative stress in the brain, improve mitochondrial function, and lower neuronal excitability, all factors that contribute to a calmer, more resilient nervous system. In simple terms, ketones help stabilise a brain that struggles with instability.

For many individuals, particularly children with severe or drug-resistant epilepsy, this metabolic shift has translated into fewer seizures, improved cognitive function, better quality of life, and, in some cases, complete seizure freedom.

But the story doesn’t end with energy alone.

Emerging research shows that ketogenic and low-carbohydrate therapies influence epilepsy through multiple interconnected pathways. Improved sleep quality and sleep architecture have been observed in individuals following ketogenic diets,  a critical finding, given the strong relationship between sleep disruption and seizure activity. A brain that sleeps better is often a brain that seizes less.

At the same time, ketogenic diets have been shown to alter the gut microbiome in meaningful ways. These changes affect the gut–brain axis, a communication network increasingly recognised for its role in neurological health and seizure susceptibility. Through this pathway, metabolic nutrition may influence brain function far beyond fuel delivery alone.

Taken together, these mechanisms reinforce an essential truth:
This is not alternative medicine.

This is metabolic physiology, grounded in biochemistry, neuroscience, and clinical observation.

More Than One Way to Heal

While classic ketogenic diets are still used in clinical settings, research over the last two decades has shown that benefits extend beyond rigid protocols.

Modified ketogenic diets, Modified Atkins diets, and whole-food Low Carb High Fat (LCHF) approaches have all demonstrated therapeutic potential. What they share is not perfection, but principle.

Rather than relying on rigid rules, these approaches share a simple physiological foundation: reducing carbohydrate intake lowers the body’s demand for insulin, allowing metabolism to become more flexible and responsive. When the body is no longer locked into constant glucose dependence, it gains the ability to switch efficiently between fuel sources. This metabolic flexibility supports more stable energy delivery to the brain and helps create an internal environment that is less prone to neurological stress and seizure activity.

At The Noakes Foundation, this understanding forms part of a broader truth: metabolic health underpins neurological health. The brain does not exist in isolation from the body. What we eat matters profoundly.

Power With Responsibility

Nutrition is powerful. And power must be handled with care.

Dietary therapy for epilepsy should always be implemented under medical supervision, particularly when anti-epileptic medications are involved. Individual responses vary; electrolyte balance, nutrient sufficiency, and long-term sustainability matter.

Why This Story Still Matters

Despite over a century of research, metabolic therapies remain underutilised and under-discussed in mainstream epilepsy care. Too often, food is dismissed as irrelevant, or worse, dangerous, when in reality, it may be part of the solution.

On International Epilepsy Day, awareness should go beyond colour and symbolism. It should include education, scientific honesty, and hope grounded in evidence.

Because sometimes, changing the fuel changes the future. And for many living with epilepsy, that change begins not in the brain alone, but on the plate.

References (peer-reviewed and evidence-based):

Neal EG et al., The ketogenic diet for the treatment of childhood epilepsy, The Lancet Neurology (2008)
Kossoff EH et al., Optimal clinical management of children receiving the ketogenic diet, Epilepsia (2009)
Masino SA, Rho JM, Mechanisms of ketogenic diet action, Epilepsia (2012)
Freeman JM et al., The ketogenic diet: one decade later, Pediatrics (2007) Cervenka MC et al., Ketogenic diet therapy for adults with epilepsy, Epilepsy Research (2016)

https://pmc.ncbi.nlm.nih.gov/articles/PMC6361831/

Mu Q et al., Ketogenic diet and epilepsy: mechanisms beyond ketone bodies, Epilepsy & Behavior Reports (2024).
https://www.sciencedirect.com/science/article/pii/S2590139724000590