Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

The Effect of Ketogenic Diet on Serum Selenium Levels in Patients with Intractable Epilepsy


The aim of the present study was to evaluate serum selenium levels in children receiving olive oil-based ketogenic diet (KD) for intractable seizures for at least 1 year. Out of 320 patients who were initiated on KD, patients who continued receiving KD for at least 12 months were enrolled. Sixteen patients who had selenium deficiency at the time of starting KD were excluded. Finally, a total of 110 patients (mean age 7.3 ± 4.2 years) were included. Serum selenium levels were measured at baseline and at 3, 6, and 12 months after treatment initiation by using atomic absorption spectroscopy. Selenium deficiency was defined as a serum selenium level <48 μg/L at each visit. Repeated measure ANOVA with post hoc Bonferroni correction was used for data analysis. Mean duration of KD was 15.3 ± 4.3 months. Mean serum selenium levels were significantly lower at 6 and 12 months of KD treatment (66.2 ± 23.3 and 57.2 ± 16.2 μg/L, respectively) compared to pre-treatment levels (79.3 ± 25.7 μg/L) (p = 0.001). On the other hand, selenium levels did not show any significant difference at 3 months of KD treatment (70.0 ± 21.2 μg/L) compared to baseline levels (p = 0.076). A total of 54 patients (49.1%) were diagnosed with selenium deficiency, and oral selenium medication was initiated for these patients. No relevant clinical findings were detected, and echocardiographic findings were normal in all patients. The decline of the serum selenium concentrations after 6 and 12 months of ketogenic diet suggests that patients on this highly prescriptive dietary treatment need close monitoring of this trace element.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Fujii T, Ito Y, Takahashi S, Shimono K, Natsume J, Yanagihara K, Oguni H (2016) Outcome of ketogenic diets in GLUT1 deficiency syndrome in Japan: a nationwide survey. Brain and Development 38:628–637

  2. 2.

    de Luis D, Domingo JC, Izaola O, Casanueva FF, Bellido D, Sajoux I (2016) Effect of DHA supplementation in a very low-calorie ketogenic diet in the treatment of obesity: a randomized clinical trial. Endocrine (in press). doi:10.1007/s12020-016-0964-z

  3. 3.

    Castaldo G, Palmieri V, Galdo G, Castaldo L, Molettieri P, Vitale A, Monaco L (2016) Aggressive nutritional strategy in morbid obesity in clinical practice: safety, feasibility, and effects on metabolic and haemodynamic risk factors. Obes Res Clin Pract 10:169–177

  4. 4.

    Leonetti F, Campanile FC, Coccia F, Capoccia D, Alessandroni L, Puzziello A, Coluzzi I, Silecchia G (2015) Very low-carbohydrate ketogenic diet before bariatric surgery: prospective evaluation of a sequential diet. Obes Surg 25:64–71

  5. 5.

    Jansen N, Walach H (2016) The development of tumours under a ketogenic diet in association with the novel tumour marker TKTL1: a case series in general practice. Oncol Lett 11:584–592

  6. 6.

    Klement RJ, Sweeney RA (2016) Impact of a ketogenic diet intervention during radiotherapy on body composition: I. Initial clinical experience with six prospectively studied patients. BMC Res Notes 9:143

  7. 7.

    Di Lorenzo C, Coppola G, Sirianni G, Di Lorenzo G, Bracaglia M, Di Lenola D, Siracusano A, Rossi P, Pierelli F (2015) Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol 22:170–177

  8. 8.

    Frye RE, Rossignol D, Casanova MF, Brown GL, Martin V, Edelson S, Coben R, Lewine J, Slattery JC, Lau C, Hardy P, Fatemi SH, Folsom TD, Macfabe D, Adams JB (2013) A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel. Front Public Health 1:31. doi:10.3389/fpubh.2013.00031

  9. 9.

    Guzel O, Yılmaz U, Uysal U, Arslan N (2016) The effect of olive oil-based ketogenic diet on serum lipid levels in epileptic children. Neurol Sci 37:465–470

  10. 10.

    Moriyama K, Watanabe M, Yamada Y, Shiihara T (2015) Protein-losing enteropathy as a rare complication of the ketogenic diet. Pediatr Neurol 52:526–528

  11. 11.

    Suo C, Liao J, Lu X, Fang K, Hu Y, Chen L, Cao D, Huang T, Li B, Li C (2013) Efficacy and safety of the ketogenic diet in Chinese children. Seizure 22:174–178

  12. 12.

    Kang HC, Chung DE, Kim DW, Kim HD (2004) Early- and late-onset complications of the ketogenic diet for intractable epilepsy. Epilepsia 45:1116–1123

  13. 13.

    McNally MA, Pyzik PL, Rubenstein JE, Hamdy RF, Kossoff EH (2009) Empiric use of potassium citrate reduces kidney-stone incidence with the ketogenic diet. Pediatrics 124:e300–e304. doi:10.1542/peds.2009-0217

  14. 14.

    Kieliszek M, Błażejak S (2016) Current knowledge on the importance of selenium in food for living organisms: a review. Molecules (in press). doi:10.3390/molecules21050609

  15. 15.

    Benstoem C, Goetzenich A, Kraemer S, Borosch S, Manzanares W, Hardy G, Stoppe C (2015) Selenium and its supplementation in cardiovascular disease—what do we know? Nutrients 7:3094–3118

  16. 16.

    Wrobel JK, Power R, Toborek M (2016) Biological activity of selenium: revisited. IUBMB Life 68:97–105

  17. 17.

    Alehagen U, Alexander J, Aaseth J (2016) Supplementation with selenium and coenzyme Q10 reduces cardiovascular mortality in elderly with low selenium status. A secondary analysis of a randomised clinical trial. PLoS One 11:e0157541. doi:10.1371/journal.pone.0157541

  18. 18.

    Geerling BJ, Badart-Smook A, Stockbrugger RW, Brummer RJ (2000) Comprehensive nutritional status in recently diagnosed patients with inflammatory bowel disease compared with population controls. Eur J Clin Nutr 54:514–521

  19. 19.

    Ortega RM, Rodríguez-Rodríguez E, Aparicio A, Jiménez-Ortega AI, Palmeros C, Perea JM, Navia B, López-Sobaler AM (2012) Young children with excess of weight show an impaired selenium status. Int J Vitam Nutr Res 82:121–129

  20. 20.

    Billeter AT, Probst P, Fischer L, Senft J, Kenngott HG, Schulte T, Clemens G, Zech U, Büchler MW, Nawroth PP, Müller-Stich BP (2015) Risk of malnutrition, trace metal, and vitamin deficiency post Roux-en-Y gastric bypass—a prospective study of 20 patients with BMI < 35 kg/m2. Obes Surg 25:2125–2134

  21. 21.

    Coskun A, Arikan T, Kilinc M, Arikan DC, Ekerbiçer HÇ (2013) Plasma selenium levels in Turkish women with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol 168:183–186

  22. 22.

    Amare B, Moges B, Fantahun B, Tafess K, Woldeyohannes D, Yismaw G, Ayane T, Yabutani T, Mulu A, Ota F, Kassu A (2012) Micronutrient levels and nutritional status of school children living in northwest Ethiopia. Nutr J 11:108. doi:10.1186/1475-2891-11-108

  23. 23.

    Davis C, Javid PJ, Horslen S (2014) Selenium deficiency in pediatric patients with intestinal failure as a consequence of drug shortage. J Parenter Enter Nutr 38:115–118

  24. 24.

    Sirikonda NS, Patten WD, Phillips JR, Mullett CJ (2012) Ketogenic diet: rapid onset of selenium deficiency-induced cardiac decompensation. Pediatr Cardiol 33:834–838

  25. 25.

    Bank IM, Shemie SD, Rosenblatt B, Bernard C, Mackie AS (2008) Sudden cardiac death in association with the ketogenic diet. Pediatr Neurol 39:429–431

  26. 26.

    Bergqvist AG, Chee CM, Lutchka L, Rychik J, Stallings VA (2003) Selenium deficiency associated with cardiomyopathy: a complication of the ketogenic diet. Epilepsia 44:618–620

  27. 27.

    Hayashi A, Kumada T, Nozaki F, Hiejima I, Miyajima T, Fujii T (2013) Changes in serum levels of selenium, zinc and copper in patients on a ketogenic diet using Ketonformula. No To Hattatsu 45:288–293

  28. 28.

    Christodoulides SS, Neal EG, Fitzsimmons G, Chaffe HM, Jeanes YM, Aitkenhead H, Cross JH (2012) The effect of the classical and medium chain triglyceride ketogenic diet on vitamin and mineral levels. J Hum Nutr Diet 25:16–26

  29. 29.

    Mengubas K, Diab NA, Gokmen IG, Ataman OG, Cavdar A, Cin S (1996) Selenium status of healthy Turkish children. Biol Trace Elem Res 54:163–172

  30. 30.

    Al-Matary A, Hussain M, Ali J (2013) Selenium: a brief review and a case report of selenium responsive cardiomyopathy. BMC Pediatr 13:39. doi:10.1186/1471-2431-13-39

  31. 31.

    Zevenbergen C, Korevaar TI, Schuette A, Peeters RP, Medici M, Visser TJ, Schomburg L, Visser WE (2016) Association of antiepileptic drug usage, trace elements and thyroid hormone status. Eur J Endocrinol 174:425–432

  32. 32.

    Gashu D, Stoecker BJ, Bougma K, Adish A, Haki GD, Marquis GS (2016) Stunting, selenium deficiency and anemia are associated with poor cognitive performance in preschool children from rural Ethiopia. Nutr J 15:38. doi:10.1186/s12937-016-0155-z

  33. 33.

    Houghton LA, Parnell WR, Thomson CD, Green TJ, Gibson RS (2016) Serum zinc is a major predictor of anemia and mediates the effect of selenium on hemoglobin in school-aged children in a nationally representative survey in New Zealand. J Nutr 146:1670–1676

  34. 34.

    Martens IB, Cardoso BR, Hare DJ, Niedzwiecki MM, Lajolo FM, Martens A, Cozzolino SM (2015) Selenium status in preschool children receiving a Brazil nut-enriched diet. Nutrition 31:1339–1343

  35. 35.

    Manzanares W, Hardy G (2016) Can dietary selenium intake increase the risk of toxicity in healthy children? Nutrition 32:149–150

  36. 36.

    Navia B, Ortega RM, Perea JM, Aparicio A, López-Sobaler AM, Rodríguez-Rodríguez E, Research Group: UCM 920030 (VALORNUT) (2014) Selenium status in a group of schoolchildren from the region of Madrid. Spain J Hum Nutr Diet 27(Suppl 2):239–246

  37. 37.

    da Rocha TJ, Korb C, Schuch JB, Bamberg DP, de Andrade FM, Fiegenbaum M (2014) SLC30A3 and SEP15 gene polymorphisms influence the serum concentrations of zinc and selenium in mature adults. Nutr Res 34:742–748

Download references

Author information

Correspondence to Nur Arslan.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study has received ethical approval (Number of ethical approval: 2016/19-15) from the Ethics Committee of Dokuz Eylul University Faculty of Medicine. Written informed consent was obtained from parents of the children enrolled to the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Arslan, N., Kose, E. & Guzel, O. The Effect of Ketogenic Diet on Serum Selenium Levels in Patients with Intractable Epilepsy. Biol Trace Elem Res 178, 1–6 (2017).

Download citation


  • Children
  • Epilepsy
  • Ketogenic diet
  • Selenium