(Taken From
www.epilepsy.com -
Link to Title)
By Eric Kossoff, MD
This month’s segment of Ketogenic Diet News and
Research highlights two recent articles which
significantly add to the growing knowledge about the
relatively new, modified Atkins diet. Although the use
of this diet started at Johns Hopkins, it has increased
in use around the world. Benefits of this diet include
an absence of protein, fluid, or calorie restriction, as
well as an outpatient, non-fasting initiation. The major
drawback in 2007 is a lack of published evidence…but
this appears to be changing rapidly.
In the January issue of Epilepsia, Drs. Kang
and Kim and their group from Seoul, South Korea reported
their experience using the modified Atkins diet in 14
children at Sanggye Paik Hospital. After six months on
the diet, half remained on the diet and 36% were at
least 50% improved. Although this improvement was only
about half of what the previous Epilepsia paper
from February 2006 reported in children, overall this
diet both created a ketotic state and was very
well-tolerated. Interestingly, this study found that
levels of both blood and urine ketosis did fluctuate
more in those with less seizure control.
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| Modified Atkins diet food from South
Korea (reproduced with permission from Dr. Kim
and Epilepsia) |
In an upcoming issue of Epilepsy & Behavior, our
group reported the second pediatric study of the
modified Atkins diet from Johns Hopkins. In this study,
we randomized 20 children to start the diet at either 10
grams per day of carbohydrates or 20 grams per day, with
a crossover to the opposite carbohydrate limit after
three months. We had noticed that in our first study one
year earlier, many children were not only able to
tolerate increased carbohydrates after several months,
but despite occasional resultant drops in ketosis,
seizures were not worsened by doing this. We predicted
the starting carbohydrate limit would be of no
importance, other than easier to follow at 20 grams per
day.
Surprisingly, we were only partially right: the
carbohydrate limit does seem to matter the first three
months…but not after! Sixty percent of those who started
at 10 grams per day were >50% improved at three months,
compared to only 10% who started at 20 grams per day.
The reasons for this aren’t clear – ketosis was about
the same between groups. We were correct regarding the
time from 3-6 months on the diet: 20 grams per day was
certainly easier, and after three months a change either
up or down in carbohydrates did not change seizure
frequency.
Children in this study had a statistical rise in both
total and LDL cholesterol, unlike the first study. By
using detailed, 3-day food records, we also confirmed
our suspicions that the modified Atkins diet is close to
a 1:1 ratio (fat: carbohydrate and protein), and (at
least in children) is not calorie restricted.
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Ketogenic diet
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Modified Atkins diet |
Standard, “normal” diet |
What do these two studies teach us about the modified
Atkins diet? For one, with now 58 total children
published in the literature, 34 (59%) have had a >50%
reduction of seizures at 6 months. This is remarkably
similar to the ketogenic diet. Secondly, although this
diet is less strict than the ketogenic diet, there may
be some value to starting at a more restrictive 10 grams
of carbohydrates per day…but then planning to increase
to 20 grams per day over time. Lastly, these studies
continue to question ketogenic diet traditions that high
ketosis, restricted calories, and fasting are necessary
for seizure improvement. Stay tuned for more studies
over the next few years!
Submitted: 4/02/07
Reviewed by Steven C. Schachter, MD
