What is the modified Atkins Diet?
The modified Atkins diet is a modification of the traditional ketogenic diet that had been used for several years by families mostly who had been using the ketogenic diet for many years and eventually stopped weighing and measuring foods. They had noticed ketones still remained high and seizures under control. It was first formally studied in children and adults who had never tried the ketogenic diet at Johns Hopkins Hospital by Dr. Eric Kossoff and colleagues in 2002, with the first paper published in 2003. A larger series of 20 children was published in December 2005.

How is it different from the ketogenic diet?
Although the foods are very similar, there are key differences between the modified Atkins diet and the ketogenic diet. First, with the Atkins diet there is no fluid or calorie restriction. Also, although fats are strongly encouraged, there are no restrictions on proteins. In addition, foods are not weighed and measured, but carbohydrate counts are monitored by patients and parents. It is started outside of the hospital, without a fast, as well. Lastly, foods can be eaten more freely in restaurants and outside the home, and families (and neurologists!) can do it as well. The diet is a "modified" Atkins diet as it allows for less carbohydrates than traditional Atkins (10-20g/day) and more strongly encourages fat intake. Please remember that no diet should be done without a neurologist and dietitian involved.

Who will it help?
At this time, research is underway to help answer this question. Preliminary results in a small number of patients suggests that the modified Atkins diet may help some children with intractable seizures.

What is it like?
Lots of high fat foods such as bacon, eggs, mayonnaise, butter,hamburger, heavy whipping, and oils are encouraged. Fluids such as Fruit2O and other flavored waters are favorites of patients. Unlike the ketogenic diet, however, children eat more foods and can cheat with some breads and cake products, as long as the total carbohydrates per day remain below the set amount prescribed by the neurologist. It's still not easy though and most families need help and support. A website by families involved in Dr. Kossoff's first study is at www.atkinsforseizures.com

What happens first?
You should talk with your neurologist and dietitian about how to start the diet and if it's the right decision. Once you do, lab work is usually obtained, and ketone strips are prescribed. Carbohydrates are limited and the foods change overnight (hard to transition).

Does it work?
In early studies so far, yes. About 2/3 had a 50% reduction in seizures after 6 months. Many were able to reduce medications.

Are there any side effects?
Some children and adults lose weight, although for the majority they were overweight to start and it's a good thing! Some children have had increases in cholesterol. Occasionally, the change to this diet and the resultant ketosis can make children feel ill and not want to drink. There is also a risk of kidney stones. For all these reasons, the modified Atkins diet should not be done without physician supervision.

How is the patient monitored over time?
A dietitian should keep track of weight and height periodically, as well as calorie intake in case there is a problem. Dr. Kossoff recommends blood and urine monitoring every three months, and checking urine ketones once or twice a week while on the diet.

Can the diet ever be stopped?
Yes, if a child is seizure-free for a period of time, the diet can sometimes be stopped successfully. Similarly to the ketogenic diet, if it's not helpful, it should be stopped, too.

For more information go to:

• www.hopkinsneuro.org/epilepsy
• www.atkinsforseizures.com

Topic Editor: Steven C. Schachter, M.D.
Last Reviewed:3/15/06