Effect of ketogenic diets on leukocyte counts in patients with epilepsy

Objectives: Ketogenic diets (KDs) have long been used to treat epilepsy and are being explored in a variety of diseases. Preclinical data suggest KDs affect inflammation and cytokine release. It is unknown whether KDs affect white blood cell (WBC) counts over time. This is particularly important in clinical populations who may be immune-suppressed at baseline, such as those with cancer or autoimmune disorders. Methods: A retrospective review of 125 consecutive adults seen at the Adult Epilepsy Diet Center (AEDC) was conducted. Clinical data regarding compliance, laboratory data, weights, and diet records were collected. A control cohort consisted of patients evaluated at the AEDC who elected not to complete a prescribed KD. Results: In 52 adults on KDs, there was a small but statistically significant decrease in WBC and absolute neutrophil counts at 6 and 12 months into KD therapy. There was no effect on lymphocyte counts. This pattern was also seen in a small population of patients with gliomas (n = 10) on KDs, most (n = 8) of whom had also received chemotherapy and radiation, putting them at risk for bone marrow suppression. Across both glioma and non-glioma groups, patients with pre-existing lymphopenia did not have further worsening of their counts on the KD. Conclusions: In this retrospective case-control study, a small but significant decrease in total WBC and neutrophil counts was observed in patients with epilepsy treated with the KDs. These patterns are similar in patients with and without gliomas suggesting baseline immunosuppression does not worsen with KD. These findings provide data for prospective confirmatory studies.