Until recently, the popular low-carbohydrate, high-fat Atkins diet was considered by the healthcare profession to be no more than a diet fad with possible negative health outcomes including heart disease. However,the medical community may be revising its orginal stance as new research shows that the Atkins diet may potentially be another medical treatment option in preventing seizures in children and possibly adults with intractable epilepsy.

According to Eric Kossoff, M.D., Assistant Professor of Pediatrics and Neurology, Johns Hopkins Children’s Center, who has pioneered the study of the Atkins diet as a treatment option for epilepsy, “The Atkins diet can induce a ketotic state similar to the ketogenic diet and may be similarly beneficial for patients with epilepsy and perhaps more tolerable. The two diets share low-carbohydrate, high-fat intake designs based on similar foods; both produce ketosis, and both can be used long term.” However Kossoff points out that, “Contrary to the ketogenic diet, the Atkins diet has no caloric restrictions, and an allowance of more carbohydrates. Also, there is no measuring and weighing of foods and no admission fast is required.”

What is the Ketogenic Diet?

The typical ketogenic diet that is prescribed to children with difficult-to-control seizures provides 3 to 4 grams of fat for every 1 gram of carbohydrate and protein. The dietician recommends a daily diet that contains 75 to 100 calories for every kilogram (2.2 pounds) of body weight and 1-2 grams of protein for every kilogram of body weight. The kinds of foods that provide fat for the ketogenic diet are butter, cream, mayonnaise, and peanut butter. Because the amount of carbohydrate and protein in the diet have to be restricted, it is very important that the meals be prepared and measured in advance carefully. Typically the diet is started in the hospital. The child usually begins by fasting (except for water) under close medical supervision for 48 hours, followed by a gradual introduction of the diet over three subsequent days.

What is Ketosis?

When your body is producing ketones, and using them for fuel, this is called “ketosis”.

Ketones are a normal and efficient source of fuel and energy for the human body. They are produced by the liver from fatty acids, which result from the breakdown of body fat in response to the absence of glucose/sugar. In the ketogenic diet as well as the Atkins diet, the tiny amounts of glucose required for normal functioning can be met by consuming a minimum amount of carbohydrates-or can be manufactured in the liver from fat. It is unknown why or even if ketosis is the crucial factor in seizure reduction from the ketogenic diet, but it appears to be at least somewhat correlated to the diet’s effect

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Recent Research

In a study conducted by Kossoff et al. in 2003, six patients, aged 7 to 52 years, were started on the Atkins diet for the treatment of intractable focal and multifocal epilepsy. Seizures in all the patients had previously failed to improve with two or more seizure medications. After starting the Atkins diet, five patients maintained moderate to large levels of ketosis for periods of 6 weeks to 24 months; three patients had seizure reduction and were able to reduce antiepileptic medications. Based on these preliminary results, Kossoff and his colleagues at Johns Hopkins designed a prospective, open-label trial of a modified Atkins diet for children aged 3-18.

Although Kossoff’s work is highly preliminary, he believes that the Atkins diet might also serve as a test of potential ketogenic diet compliance and efficacy and might be useful in patients with behavioral problems who find the ketogenic diet too restrictive. In addition, Kossoff said, “The Atkins diet could also play a role in communities without a formal ketogenic diet program.” He also believes that the Atkins diet should only be implemented under strict medical and nutritional supervision. “The Atkins diet is still under investigation. Even if further studies show that it is effective and safe, it should be only be implemented under strict medical and nutritional supervision with both a registered dietician and neurologist,” said Kossoff.”

Future Research

Kossoff has recently completed enrollment for the pediatric study. In order to qualify for the study, patients were required to meet certain inclusion criterion such as 3 seizures per week and seizures that failed to improve with two or more seizure medications. Currently, a total of 20 patients are enrolled in the study. Kossoff speculates results will be available in June 2005. In addition, Kossoff is now accepting patients, aged 18 and older for a study examining the effectiveness of the Atkins diet in adults with intractable epilepsy. Anyone interested in learning more about the study should contact Dr. Eric Kossoff at:ekossoff@jhmi.edu or at (410)614-6054.

Suggested Reading

Atkins RC.Dr. Atkins’ New Diet Revolution. 3rd edition. New York: M Evans & Co; 2002.

Kossoff EH, Krauss GL, Mc Grogan JR, Freeman JM. Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology. 2003; 61:1789-1791.