As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. However, medium-chain triglycerides (MCTs)-made from fatty acids with shorter carbon chains than LCTs-are more ketogenic. Most dietary fat is made of molecules called long-chain triglycerides (LCTs). This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains, and sugar, while increasing the consumption of foods high in fat such as nuts, cream, and butter. This classic ketogenic diet contains a 4:1 ketogenic ratio or ratio by weight of fat to combined protein and carbohydrate. The classic therapeutic ketogenic diet was developed for treatment of paediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant medications. The original therapeutic diet for paediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories to maintain the correct weight for age and height. Side effects may include constipation, high cholesterol, growth slowing, acidosis, and kidney stones. Some evidence shows that adults with epilepsy may benefit from the diet and that a less strict regimen, such as a modified Atkins diet, is similarly effective. Around half of children and young people with epilepsy who have tried some form of this diet saw the number of seizures drop by at least half, and the effect persists after discontinuing the diet.

An elevated level of ketone bodies in the blood (a state called ketosis) eventually lowers the frequency of epileptic seizures.

However, if only a little carbohydrate remains in the diet, the liver converts fat into fatty acids and ketone bodies, the latter passing into the brain and replacing glucose as an energy source. Normally carbohydrates in food are converted into glucose, which is then transported around the body and is important in fueling brain function. The diet forces the body to burn fats rather than carbohydrates. The ketogenic diet is a high- fat, adequate- protein, low-carbohydrate mainstream dietary therapy that in medicine is used mainly to treat hard-to-control (refractory) epilepsy in children.

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