Research shows that 41% of medications sold in the Netherlands are safe to use with ketogenic diet therapy for epilepsy, according to a 2026 systematic classification study. Researchers analyzed 28,721 medications and created the first comprehensive “Ketoproof” labeling system that identifies which pharmaceutical ingredients interfere with ketosis. This breakthrough tool helps doctors and pharmacists safely prescribe medications without disrupting the diet’s seizure-reducing effects, addressing a major gap in previous prescribing guidance.
A new study from the Netherlands created the first-ever systematic guide to help doctors and pharmacists identify which medications are safe for children following a ketogenic diet for epilepsy treatment. Researchers analyzed over 28,000 medications and classified their ingredients based on whether they could interfere with the diet’s strict carbohydrate restrictions. They found that about 41% of medications are compatible with ketogenic therapy. According to Gram Research analysis, this breakthrough classification system—called “Ketoproof”—provides healthcare professionals with a transparent, evidence-based tool to safely prescribe medications without disrupting the diet’s therapeutic effects.
Key Statistics
A 2026 cross-sectional analysis of 28,721 medications in the Netherlands found that 41% (11,781 medications) were classified as Ketoproof and safe for patients following ketogenic diet therapy for epilepsy.
Researchers identified 1,047 pharmaceutical excipients in Dutch medications and successfully classified 74% of them (778 excipients), with 56% labeled as Ketoproof and 18% as non-Ketoproof, according to the 2026 study.
The study revealed that 26% of pharmaceutical excipients (269 ingredients) could not be classified due to insufficient scientific data about their effects on ketosis, highlighting gaps in pharmaceutical transparency.
Among the 778 successfully classified excipients in the 2026 Netherlands analysis, polyols, sugar alcohols, organic acids, and coloring agents required expert consensus review due to their uncertain effects on ketogenic therapy.
The Quick Take
- What they studied: Whether medications contain hidden ingredients that could interfere with a ketogenic diet used to treat epilepsy in children
- Who participated: Researchers analyzed all 28,721 medications sold in the Netherlands and classified 1,047 different pharmaceutical ingredients (called excipients) used in those medications
- Key finding: About 41% of medications available in the Netherlands are safe to use with ketogenic diet therapy without disrupting the diet’s effectiveness
- What it means for you: If your child takes medication for epilepsy while on a ketogenic diet, doctors and pharmacists now have a reliable tool to check if those medications will interfere with the treatment. This reduces guesswork and helps ensure the diet works as intended. However, always consult your healthcare team before making any medication changes.
The Research Details
Researchers conducted a systematic review of all medications available in the Netherlands between June 2023 and March 2024. They extracted information about every ingredient in these medications from a national pharmaceutical database called G-Standaard. Each ingredient was then carefully evaluated based on its chemical structure, how the body processes it, and how it’s administered (pill, liquid, injection, etc.).
The team created a decision-making flowchart to classify each ingredient as either “Ketoproof” (safe for ketogenic diet) or “non-Ketoproof” (potentially problematic). Some ingredients required expert discussion because their effects on ketosis weren’t immediately clear—particularly sweeteners, acids, and coloring agents. Finally, they labeled all 28,721 medications based on their ingredient profiles and integrated the results into a web-based tool called KetoMed for healthcare professionals to use.
This approach is important because it provides the first transparent, standardized system for evaluating medication safety in ketogenic diet therapy. Previously, doctors had to rely on incomplete information or regional databases that weren’t comprehensive.
Ketogenic diet therapy is an established, evidence-based treatment for epilepsy that doesn’t respond to standard medications. The diet works by forcing the body into a state called ketosis, where it burns fat instead of carbohydrates. This metabolic shift reduces seizures in many children. However, many medications contain hidden carbohydrates or other ingredients that can disrupt ketosis and reduce the diet’s effectiveness. Without a systematic way to identify these problematic ingredients, pharmacists and doctors had to make inconsistent decisions, sometimes unknowingly prescribing medications that undermined the therapy.
This study is reliable because it used a national pharmaceutical database that includes all medications legally sold in the Netherlands, ensuring comprehensive coverage. The researchers used a transparent, reproducible classification system that other countries can adopt. They involved expert consensus for uncertain cases, adding credibility to borderline decisions. The study was published in a peer-reviewed journal focused on clinical pharmacy. However, the analysis is specific to the Netherlands, so medication availability and formulations may differ in other countries. Additionally, 26% of excipients couldn’t be classified due to insufficient data, indicating some limitations in available information.
What the Results Show
Researchers identified 1,047 different pharmaceutical ingredients used in medications sold in the Netherlands. Of these, 778 (74%) were successfully classified: 590 (56%) were labeled as Ketoproof (safe for ketogenic diet), and 188 (18%) were labeled as non-Ketoproof (potentially problematic). The remaining 269 ingredients (26%) couldn’t be classified because there wasn’t enough scientific information available about their effects on ketosis.
When they applied this classification to all 28,721 medications available in the Netherlands, they found that 11,781 medications (41%) could be labeled as Ketoproof. This means that less than half of available medications are guaranteed safe for patients strictly following a ketogenic diet. The other 59% either contain problematic ingredients or have uncertain status.
Ingredients that required the most careful expert review included polyols and sugar alcohols (sweeteners), organic acids, and coloring and flavoring agents. These ingredients aren’t necessarily harmful, but their effects on ketosis needed individual assessment based on the specific compound and how much is in each medication.
The researchers integrated all this information into KetoMed, a web-based tool that healthcare professionals can use to quickly check whether a specific medication is compatible with ketogenic diet therapy. This tool is designed to support safer prescribing decisions and reduce the inconsistency that previously existed when doctors had to evaluate medications individually.
The study revealed significant gaps in pharmaceutical transparency. Many medications don’t clearly list all their ingredients on standard labels, making it difficult for healthcare professionals to assess compatibility with ketogenic therapy. The research also showed that excipient content varies by country and manufacturer, meaning a medication labeled as Ketoproof in the Netherlands might have different ingredients elsewhere. The classification system identified that administration route matters—liquid medications often contain more problematic sweeteners than solid tablets, for example.
This is the first systematic, comprehensive classification of pharmaceutical excipients specifically for ketogenic diet therapy. While some regional databases and clinical guidelines existed before, they were incomplete and inconsistent. Previous approaches relied on individual case reports or limited lists rather than a transparent, reproducible framework. This study represents a significant advancement because it provides the first evidence-based, standardized system that can be adopted internationally and integrated into clinical decision-support systems used by hospitals and pharmacies.
The study is limited to medications available in the Netherlands, so results may not directly apply to other countries where different medications are sold or formulations differ. About 26% of excipients couldn’t be classified due to insufficient scientific data, meaning some medications have uncertain status. The research is a snapshot from June 2023 to March 2024, so new medications introduced after this period aren’t included. Additionally, the study doesn’t evaluate how much of a problematic ingredient is in each medication—sometimes small amounts might not significantly disrupt ketosis, but the classification system doesn’t account for dose-dependent effects. Finally, while the KetoMed tool is designed to support healthcare professionals, the study doesn’t yet demonstrate whether using this tool actually improves patient outcomes or medication safety in real-world clinical practice.
The Bottom Line
If your child is on ketogenic diet therapy for epilepsy, work with your pharmacist and neurologist to review all medications using the new Ketoproof classification system or KetoMed tool. Don’t stop or change any medications without professional guidance. For medications labeled as non-Ketoproof, discuss alternatives with your healthcare team—sometimes switching to a different formulation or medication can resolve compatibility issues. This evidence-based approach (strong confidence) is more reliable than previous informal methods. For medications with uncertain status, your healthcare team may need to monitor ketone levels more closely or consider alternatives.
This research is most relevant for children with refractory epilepsy (seizures that don’t respond to standard medications) who are considering or currently following ketogenic diet therapy. Parents, neurologists, epilepsy specialists, and pharmacists should all be aware of this classification system. Healthcare systems and regulatory agencies should consider adopting this framework to standardize medication safety evaluation. This is less relevant for people following ketogenic diets for weight loss or other reasons, though the information could still apply if they take medications.
If a medication change is made based on Ketoproof classification, improvements in seizure control typically appear within 2-4 weeks as ketosis is re-established. However, some children may take 4-8 weeks to show full benefit. Conversely, if a problematic medication was unknowingly disrupting ketosis, removing it might improve seizure control within days to weeks. Individual responses vary significantly, so work closely with your healthcare team to monitor progress.
Frequently Asked Questions
Can my child take regular medications while on a ketogenic diet for epilepsy?
Many medications are safe, but about 59% contain ingredients that might interfere with ketosis. Use the new Ketoproof classification system or ask your pharmacist to check each medication. Work with your healthcare team to find compatible alternatives when needed.
What ingredients in medications disrupt ketogenic diet therapy?
Common problematic ingredients include sugar-based sweeteners, certain sugar alcohols, and some coloring agents. Liquid medications often contain more problematic sweeteners than tablets. Your pharmacist can identify specific ingredients in your child’s medications using the Ketoproof classification system.
How do I know if a medication is safe for ketogenic diet?
Ask your pharmacist to check the medication using the KetoMed tool or Ketoproof classification system, a new evidence-based resource created in 2026. If a medication is labeled non-Ketoproof, discuss alternative formulations or different medications with your doctor.
Will changing medications affect my child’s seizure control?
If a medication was disrupting ketosis, removing it might improve seizure control within days to weeks. If switching to a Ketoproof alternative, improvements typically appear within 2-4 weeks as ketosis re-establishes. Monitor seizure patterns closely and work with your neurologist.
Is the Ketoproof system available in my country?
The system was developed for Netherlands medications, but researchers recommend international adoption. Check with your healthcare system or pharmacist about similar resources in your country, or discuss using the framework with your medical team.
Want to Apply This Research?
- Log each medication your child takes daily along with its Ketoproof status (using the KetoMed tool or your pharmacist’s assessment). Track seizure frequency, duration, and severity alongside medication changes. Also record ketone levels if you’re monitoring them at home, as this objective measure helps correlate medication compatibility with therapeutic effectiveness.
- Before filling any new prescription or refill, use the KetoMed tool or ask your pharmacist to verify the medication’s Ketoproof status. If a medication is non-Ketoproof, discuss alternatives with your doctor before starting it. Set a reminder to review all current medications with your pharmacist quarterly to catch any formulation changes that might affect Ketoproof status.
- Maintain a medication log that includes the drug name, dosage, frequency, Ketoproof classification, and any changes made. Track seizure patterns monthly to identify correlations between medication adjustments and seizure control. Schedule quarterly reviews with your pharmacist to ensure all medications remain compatible with the ketogenic diet as formulations and your child’s regimen evolve.
This article summarizes research findings and is not medical advice. Ketogenic diet therapy should only be undertaken under close medical supervision by a qualified neurologist or epilepsy specialist. Do not start, stop, or change any medications without consulting your healthcare provider. The Ketoproof classification system is a tool to support clinical decision-making, not a replacement for professional medical judgment. Individual responses to medications and dietary interventions vary significantly. Always work with your healthcare team to monitor your child’s seizure control, ketone levels, and overall health while on ketogenic diet therapy.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.