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Commentary It has now been a decade since the modified Atkins diet (MAD), a less restrictive, outpatient-initiated version of the ketogenic diet (KD), was first published in the medical literature (1). Although still inducing ketosis, the MAD does not restrict protein, calories, or fluids—solely measuring daily carbohydrates and encouraging high fat intake. In the ten years since its introduction, there have been 27 articles published, reporting 355 children and adults. Results to date suggest similar efficacy but fewer side effects in comparison to the KD. The scientific evidence behind the MAD is strong; however, until this article, there had not been any randomized and controlled trials to support its use. This is similar to the situation prior to 2008 for the classic KD, following which two studies, one blinded, were published (2, 3). The most widely publicized—a randomized and controlled study by Neal and colleagues from United Kingdom—tested the ketogenic diet (both the classic and the medium-chain triglyceride versions) versus 3 months of continued status quo anticonvulsants in children ages 2–16 years with refractory epilepsy (2). The randomization occurred following a 4-week baseline period for all children. As of the writing of this review, according to Google Scholar, this publication has been cited 205 times in the literature in just 5 years, demonstrating its impact. Perhaps seeking to replicate the fame and impact of this landmark study, Dr. Sharma and her colleagues from India utilized an essentially identical study design to evaluate the MAD in children ages 2–14 years with intractable epilepsy. There were some differences compared to the Neal study, primarily in regard to patient demographics: 78% were male, all from a single tertiary center, and a larger percentage (approximately half ) had the diagnosis of Lennox-Gastaut syndrome (2). The study was completed successfully with a lower dropout rate than the Neal study; in fact, with a remarkable 8% discontinuation rate with MAD (versus 15% in the Neal KD study arm) (2). The results certainly suggest both a similarity to the KD based on the Neal outcomes, as well as seizure improvement dramatically better than the control. The likelihood of > 50% seizure reduction at 3 months was 52% with the MAD versus 11.5% in the control group. Similarly, > 90% seizure reduction occurred in 30% versus 7.7%. This is similar, if not slightly better, than the Neal findings with the KD, in which they found 38% versus 6% (for > 50% seizure reduction) and 7% versus 0% (> 90% seizure reduction) (2). These studies can and should not be directly compared, and the high placebo rate in the current study is surprising, yet the results are intriguing. The MAD was very well-tolerated, with adverse effects primarily constipation, weight loss, and vomiting, as would be Use of the Modified Atkins Diet for Treatment of Refractory Childhood Epilepsy: A Randomized Controlled Trial.

Ghee Whiz! the Growing Evidence for the Benefits of the Modified Atkins Diet