A study published today in Epilepsy Research found that combining CBD with ketogenic diet therapy can reduce seizures in patients with pharmacoresistant epilepsy, particularly when the diet is added after CBD treatment has already begun.
Researchers from The Johns Hopkins University School of Medicine conducted a retrospective chart review of 58 people with epilepsy who received both CBD and ketogenic diet therapy between 2018 and 2025. Participants had a median age of 2 when combination therapy began, with ages ranging from infancy to 60 years old.
Of the participants, 76% received prescription CBD, sold as Epidiolex, while 24% used artisanal CBD. In addition, 60% were on the classic ketogenic diet, and 57% had started CBD before beginning ketogenic diet therapy.
At one month, 40% of participants had a seizure reduction of more than 50%. At three months, 28% saw seizure reductions above that threshold. Researchers found that seizure reductions were greater when CBD was started before ketogenic diet therapy rather than after.
The average duration of combination therapy was 17.4 months. Overall, 87% of participants reported moderate to large urinary ketosis, and among those who added CBD to ketogenic diet therapy, eight of 13 had no change in ketosis.
Liver function increases were reported in five participants with documented testing before and during combination therapy, though researchers said most were minor.
The study concludes by saying “Overall, the results of this study show similar efficacy of the combination therapy in treating epilepsy compared to either CBD or KDT alone, but suggests it is worth considering as an additive option, especially when KDT is added to CBD.”
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