What is the modified Atkins Diet?

The modified Atkins diet is a change to the traditional ketogenic diet. Some families who had used the ketogenic diet for many years eventually stopped weighing and measuring foods. They had noticed ketones still remained high and seizures stayed 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. The first paper on this diet was published in 2003. A larger series of 20 children was published in December 2005. This diet is now over 10 years old with greater than 400 patients published today.

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, to - there is no fluid or calorie restriction.
  • Although fats are strongly encouraged, there are no restrictions on proteins.
  • Foods are not weighed and measured, but carbohydrate counts are monitored by patients and parents.
  • It is started outside of the hospital and the person does not need to fast before starting the diet.
  • 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 the traditional Atkins diet (10 to 20 g/day) and more strongly encourages fat intake.
  • Please remember that no diet should be tried without a neurologist involved.

Who will it help?

It seems to help similar numbers of patients as the ketogenic diet (50% with greater than 50% seizure reduction, including 15% seizure-free). It works for men and women equally and is being studied actively in adults. Like the ketogenic diet, it is mostly used for patients with daily seizures who have not responded to medications.

What is it like?

  • Lots of high fat foods such as bacon, eggs, mayonnaise, butter, hamburger, heavy whipping cream, and oils are encouraged.
  • Certain fruits, vegetables, nuts, avocados, and cheeses are used.
  • Fluids such as Fruit2O and other flavored waters are favorites of patients.
  • Unlike the ketogenic diet, however, patients eat more foods and can cheat with some breads and cake products, as long as the total carbohydrates each day remain below the set amount prescribed by the neurologist.
  • It's still not easy though, and most families need help and support.

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 (making it hard to transition).
  • Medications are usually left unchanged (and most patients on the modified Atkins diet are also still on some medications).

Does it work?

In studies so far, yes. About half 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. This can be a good thing though for those who were overweight in the beginning.
  • 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.
  • 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. We recommend dietitian involvement either from the beginning (ideally) or after 3 months if the diet seems to be working to help keep the patient on it.
  • Dr. Kossoff recommends blood and urine monitoring every 3 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 (e.g., 2 years), the diet can sometimes be stopped successfully. Similarly to the ketogenic diet, if it's not helpful, it should be stopped, too.

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Authored by: Steven C. Schachter, MD | Joseph I. Sirven, MD
Reviewed by: Eric Kossoff, MD on 6/2014
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