What is the modified Atkins ketogenic diet therapy?
The modified Atkins ketogenic diet therapy is a form of dietary therapy for epilepsy.
As its name suggests, this diet is a modification of the Atkins diet for weight loss. Children starting this treatment will eat no more than 10 grams (g) of carbohydrates per day. Some children may be able to increase their daily carbohydrate intake, but this is done on an individual basis. Unlike the regular Atkins diet, fat is the main food group providing at least 65% of the calorie intake.
The modified Atkins ketogenic diet therapy was first described as a treatment for epilepsy in 2003. When strictly followed, it has been found to be as effective as the classic ketogenic diet.
What are the benefits of the modified Atkins ketogenic diet therapy?
The modified Atkins ketogenic diet therapy has been shown to reduce seizures in many children, sometimes by more than 90 per cent, although it does not work for every child.
Parents and/or children are taught about this diet therapy, which can be started at home. While there is no prescribed time to eat and food does not need to be weighed, it is still very strict and food choices are limited. Although research is still limited, children treated with the modified Atkins ketogenic diet therapy seem to have fewer long-term side effects than children who are on the classic ketogenic diet.
This diet therapy is usually recommended for teenagers or children who cannot follow a controlled schedule. This is a decision that is made by the ketogenic diet team in consultation with the family and child.
It may take several months before the full effect of this treatment is seen. If the modified Atkins ketogenic diet therapy is successful in controlling seizures, there is no maximum length of time that the treatment can be used. The length of time that a child’s seizures are managed with a ketogenic diet therapy is decided by the family, child and ketogenic diet therapy team.
Limitations and side effects of the modified Atkins diet
Side effects of the modified Atkins diet may include:
- constipation
- higher cholesterol levels
- kidney stones
- changes in blood chemistry
- micronutrient deficiencies
- weight loss
There may be other potential side effects for your child. Ask your child's doctor to explain all possible side effects. When children start this treatment, the child and parents are taught what signs and symptoms to look for and how to manage them.
Your child will also need to take specific vitamin and mineral supplements. Your child's doctor and dietitian can advise you on these.
Points to consider before trying the modified Atkins ketogenic diet therapy
- More foods are allowed than with the classic ketogenic diet, but the modified Atkins diet is still very restricted. The diet controls the type and quantity of food your child can eat. This therapy will not work unless it is followed carefully, and some children are unable or unwilling to follow it.
- The modified Atkins diet may have additional financial costs (i.e. cost of buying additional or different food, supplements and equipment) that are a barrier for some families.
- Meals and snacks can be time-consuming and tedious to prepare. This usually becomes easier as families adapt to the new routine.
- The diet might not work for some children, no matter how closely they follow the diet.
- This diet is not safe for children with certain metabolic disorders, such as fatty acid oxidation defects.
- Children must be followed closely by a doctor during treatment with the diet.
Starting the modified Atkins ketogenic diet therapy
Before starting the modified Atkins ketogenic diet therapy, your child will need to be seen in a ketogenic diet clinic for a full evaluation by the ketogenic diet therapy team members. Your child will need a physical examination, with measurement of their height and weight and several different blood and urine tests.
The team will also ask for a history your child’s diet, including:
- What they eat at home
- What they do and do not like to eat
- How much they eat
- Whether you see any problems feeding them the diet
- Whether your family has any cultural or religious food restrictions
Your child will usually start the modified Atkins ketogenic diet therapy as an outpatient. Your child does not need to be admitted to hospital, but it is important to stay in close contact with your child’s ketogenic diet therapy team.
Learning to use the modified Atkins ketogenic diet therapy
Your family will meet with a dietitian to learn how to count carbohydrates, read food labels, plan menus and identify high-fat foods. The dietitian will explain which vitamin and mineral supplements your child will need, and where to buy them.
They will also help you with strategies for dealing with problems you may encounter while your child is on the diet, including illness, hunger and high or low ketones.
A nurse will teach you on how to measure your child’s urinary ketones, and review how to manage possible medical complications.
Before starting the diet at home, it is a good idea to become comfortable with the concepts of the diet and buy enough food to follow the diet for a few days.
You will start by limiting your child’s carbohydrates to 10 g per day. As your child begins the diet, ketones will appear in the blood and urine. You will need to routinely test your child’s urinary ketones.
Some children experience temporary side effects while starting the diet, including sleepiness, dehydration or vomiting. Contact your child’s doctor if any of these happen. If these side effects are severe, your child may need to be admitted to hospital for a short time.
Using the Modified Atkins ketogenic diet therapy at home
Following the diet closely is very important to ensure your child has given it the best chance to work and to see if it can control your child's seizures. It may take several months to see the effects of the diet. If you find the diet too restrictive, speak to your dietitian and doctor to discuss ways to alter it to make it easier to use. Changes to the diet could mean changes to content, quantity, or scheduling.
Follow up appointments for the modified Atkins ketogenic diet therapy
Children treated with the modified Atkins ketogenic diet therapy require frequent monitoring by their health-care team. Children are seen by the ketogenic diet therapy team one month after starting the treatment and then every 3 to 6 months. Check-ups will include measurements of weight and height, review of urine and blood tests, discussion of your child’s seizures and side effects of the diet, and a medical examination.
Between appointments, you will need to keep track of your child's seizure activity, urinary ketone levels and body weight. Record this information in a diary or your phone so that you can bring it with you to your child’s next clinic appointment.
Some medications, including over-the-counter cough and cold medicines, and intravenous (IV) fluids have sugar (carbohydrates) in them. The dietitian will explain how to identify medications with carbohydrates and what to do. Tell all doctors and pharmacists involved with your child’s care that your child is on the Modified Atkins ketogenic diet therapy.
Discontinuing the modified Atkins ketogenic diet therapy
If the diet has kept seizures well under control for several years, your child may be slowly taken off the diet with guidance from your child's doctor and dietitian. Alternatively, if the diet is not working or you find it too restrictive, the diet may be slowly discontinued, or your child’s ketogenic diet therapy team may suggest switching to a different diet. If the diet continues to work well for your child’s seizures and your child has no negative side effects, the diet can be continued for longer. Some children will transition to adult health care with the ketogenic diet therapy.
The modified Atkins ketogenic diet therapy should not be stopped abruptly, as this may trigger seizures. It is usually slowly discontinued over several months. Your child's ketogenic diet therapy team will work with you to discontinue the diet.