Frequently Asked Questions about the Modified Atkins Diet for Seizures

Important Caution: Dietary therapy for seizures is a form of medical therapy that must be overseen by a trained medical professional. Do not undertake any type of ketogenic or Modified Atkins dietary therapy without proper medical supervision, particularly if you are taking anti-seizure medication. The articles and contents on this website are for informational purposes only. We cannot give medical advice and urge you to discuss with a neurologist the treatment options that are best for you. We cannot be held responsible if you fail to do so.

Why is dietary therapy used to treat epilepsy?
Patients who have difficult- to-treat seizures, or who have intolerable or even catastrophic reactions to medication, need non-pharmaceutical treatment options, such as dietary therapy.

There are very effective anti-seizure medications available, and most people are able to control their seizures by using them. However, there is no “magic pill” that works for everyone; it may take time to find a seizure medication and dosage that is right for you. Unfortunately some people are not able to find relief from seizures by taking medication, and fail numerous attempts.

About 30% of people are not able to control their seizures with medication. This is when Ketogenic and Modified Atkins diet therapy is most often used as a treatment option. Ketogenic and Modified Atkins dietary therapy have proven effective for patients who do not have success controlling their seizures with medication or with patients who find the side-effects of medication intolerable.

According to Dr. Eric Kossoff, of Johns Hopkins Hospital, “Despite a doubling of anticonvulsants available for the treatment of epilepsy over the past decade, there has been a growing recognition that if two or three drugs don’t work, the odds of finding a successful medicine for seizures is nearly zero. Many children, adolescents, and adults look for another answer.”

What is the Ketogenic diet?
The Ketogenic diet is a special high fat, low carbohydrate diet that is used by some people to control epileptic seizures. The diet’s name is derived from ketones, a substance formed when the body burns fat for energy, rather than glucose. It has been widely used since the 1920’s to control epilepsy, but fell into disuse for a period of time after the development of modern anti-seizure medication. A resurgence of scientific interest in the diet began in the 1990’s; since that time, numerous clinical studies have been conducted validating it as an effective treatment method, particularly when anti-epileptic medications fail. A less restrictive version of the traditional Ketogenic diet, the Modified Atkins diet, was developed in 2002.

What is the Modified Atkins diet?
The Modified Atkins diet is a variation of the traditional ketogenic diet, modeled on the Atkins weight loss diet. The diet has been modified to allow less carbohydrate than the weight loss version of the Atkins diet, and significantly more fat. It was studied by Dr. Eric Kossoff and colleagues at Johns Hopkins Hospital in 2002 and the first paper was published on the diet in 2003. Since then numerous international clinical studies have been conducted to verify the efficacy of the diet to control seizures. It is often prescribed for older children, teenagers and adults, or for those who wish for less restrictive food options than the traditional ketogenic diet allows. Foods can be eaten in restaurants and in social gatherings more easily, therefore the diet is usually more easily tolerated by adults and teenagers.

Both the traditional Ketogenic diet and the Modified Atkins diet are very high fat and very low carbohydrate. On the Modified Atkins diet, however, proteins are not as restricted, foods do not need to be weighed and measured as strictly as with the traditional Ketogenic diet, there is no calorie or fluid restriction, and no need to fast when beginning the diet. Patients can initiate the diet without hospital admittance through out-patient clinics, where they receive counseling from a trained dietician and are given instructions to follow at home. It has been suggested that the diet may be particularly useful in medical centers with limited nutritional resources or the inability to admit children regularly for traditional ketogenic diet initiation, since patients can be taught to use the diet with a minimum of supervision and guidance.

Is dietary therapy ever used as a first treatment method before anti-seizure medications are given?
The future of the Modified Atkins diet is being explored, and interest has been generated in the use of the diet as a first line therapy, particularly for some milder forms of epilepsy. It is now being used by small numbers of patients in this way, and as more physicians are trained in the method the use of it is expected to grow. However, because the diet is strict and takes commitment on the part of patients and families to follow, it is not routinely chosen as a first line therapy by most people. It is more commonly used when medication fails to adequately control seizures or when concerns arise over the side-effects of medication, or side effects prove impossible to manage.

Can dietary therapy be used while taking anti-seizure medication?
Stopping anti-seizure medication must only be done in counsel with your neurologist, usually by slowly reducing the medication over time. Many people start dietary therapy while still taking medication, and if improvement in seizure control is achieved, the neurologist may suggest a slow wean from medication. Some people can be completely weaned from medication and maintain seizure control; others use the diet in conjunction with medication in order to maintain control. Each person is different and changes in medication must be discussed with your doctor.

Are there any side effects to the Modified Atkins diet?
Some patients lose weight, but usually only those who were overweight to begin with. Most maintain adequate weight accounting for growth and age. Some children had an increase in blood cholesterol. Occasionally children have difficulty adjusting initially to the diet and feel ill or are reluctant to drink, though most adjust after a short period of time. There is an increased risk of kidney stones, so staying well hydrated is encouraged to prevent this from happening. For all of these reasons, the diet should be used with proper medical supervision.

How is the patient monitored over time while on the diet?
Blood tests to check cholesterol and lips levels, as well as urine monitoring, is usually conducted every 3 to 6 months. Attending physicians also periodically monitor the child’s height and weight. Parents are encouraged to keep seizure records to monitor the diet’s effect.

How long should someone remain on the Modified Atkins diet?
The answer to that question depends on seizure control. When someone becomes seizure free for two years on the diet, often attempts are made to slowly switch back to normal ways of eating. Many children with refractory epilepsy who found seizure control through the diet were later able to resume normal ways of eating, and have remained seizure and medication free since. A number of parents who successfully used the diet for their child have blogged about their experiences; others have started free online parental support groups and forums, where experienced members support newcomers who are learning about the diet. Such online support can be found at:

• Yahoo’s ‘Atkins Diet for Seizure Control Group’ http://health.groups.yahoo.com/group/atkins4seizures/
Matthew’s Friends Website http://www.matthewsfriends.org/

Sources cited:

1) The Modified Atkins Diet: A Valuable Treatment for Epilepsy in China; Kossoff, E.K, ; Healing Young Hearts Website; http://www.healingyounghearts.org/wordpress/?page_id=434

2) Ketogenic Diet; Epilepsy.com website; http://www.epilepsy.com/epilepsy/treatment_Ketogenic_diet

3) Atkins Diet FAQ’s; Matthew’s Friends website; http://site.matthewsfriends.org/

4) Modified Atkins Effectively Treats Childhood Seizures, Johns Hopkins Children’s Center website; http://www.hopkinschildrens.org/Modified-Atkins-Diet-Treats-Childhood-Seizures.aspx

2 Responses to Frequently Asked Questions about the Modified Atkins Diet for Seizures

  1. Nancy Sutton says:

    My son, 23, has been battling Epilepsy since he was 10. We have tried just about every medication and have only had minimal control. After his most recent video monitoring, his neurologist believes that David has Lennox-Gastaut Syndrome which is a rare & severe form of Epilepsy and LGS doesn’t respond to meds. His final med to try is Febatol. Is there any info/documentation that the MAD works with people with LGS?
    Desparate mother

    • admin says:

      Dear Nancy,

      My heart really goes you to you dear lady! And I understand your desperation. I would suggest you find a neurologist who is knowledgeable with ketogenic therapy and discuss your son’s case.

      Ketogenic diets are a suggested treatment for children who have difficult to treat epilepsy and according to studies, the diet may be helpful for Lennox-Gastaut Syndrome (LGS). Johns Hopkins Hospital conducted a double-blinded crossover study with 20 children with LGS who were having a minimum of 15 drop seizures per day, and the results were favorable according to the newly released book ‘Ketogenic Diets’ (Kossoff et al, 2011). The book also made mention that sometimes neurologists mistake LGS with Doose syndrome, until EEG patterns reveal otherwise. This can be significant, as Doose syndrome responds particularly well to ketogenic diet therapy and its variations, such as the Modified Atkins Diet.

      It seems if your son has failed numerous medications, dietary therapy may well be worth a try and discussing it with your neurologist would be a wise move. If your neurologist is not familiar with dietary therapy (and many have no experience with it and misunderstandings about it) they may discourage you from trying it on the grounds that it is “too hard” or “not as good as medication”. If that is the case, then I urge you to find a neurologist familiar with ketogenic diets. Discuss whether or not your child is a candidate for it with a trained professional familiar with the therapy. Gather all the information you can so you can make a wise choice. Knowledge is power!

      While dietary therapy takes a commitment of time, so many of us who have had children respond to the diet are thankful for the answers it has given us. Research has consistently proven dietary therapy is effective, and copies of published peer-reviewed clinical trials are available on-line. In fact, current thinking is that dietary therapy should be recommended after 2 medications fail, and in certain types of epilepsy it is now recommended as a first-line treatment before medication. Many parents wish they had tried it much earlier.

      If you are interested in reading a very inspiring story of a mother’s experience using the traditional ketogenic diet with a child who had very severe refractory epilepsy (Dravet syndrome) then I suggest you visit the Matthew’s Friends website and read Emma William’s account of her son Matthew’s story at: http://site.matthewsfriends.org/index.php?page=matthew-s-story

      I am wishing you all the best as you seek answers for your dear son.

      Sincerely,

      Jeanne Riether

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