Patients who are on the diet for shorter periods generally have fewer side effects. However, Dr. Kossoff noted that some of his patients have been on the diet for more than 20 years. “These children who then become adults can do quite well,” he said.
Modified Atkins Diet and Low Glycemic Index Treatment
The modified Atkins diet and the low glycemic index treatment are two less-restricted alternatives to the classic ketogenic diet. The modified Atkins diet was created in 2003 at the Johns Hopkins Hospital, with the goal of creating a treatment in between a regular diet and the classic ketogenic diet, according to Dr. Kossoff. “It still is high-fat, low-carbohydrate,” he said. “But the ketogenic diet has 90% fat, whereas the modified Atkins diet is about 65% fat—still low-carbohydrate, but it allows more protein. And this is done as an outpatient approach, usually started in the clinic.”
A total of 32 studies on the modified Atkins diet have shown “good evidence for efficacy,” said Dr. Kossoff. The studies included approximately 400 patients and had a 48% responder rate and a 13% seizure-free rate, which are “remarkably similar to what we see with the classic ketogenic diet,” he commented. “We believe the modified Atkins diet is a good option. It’s a less restrictive option for some families who want to try something that is perhaps a little bit different than the classic ketogenic diet.”
The low glycemic index treatment, an alternative to the ketogenic diet developed by Elizabeth Thiele, MD, PhD, and colleagues, is a similar limited carbohydrate diet. It focuses on specific carbohydrates that have a low glycemic index—“perhaps berries or different kinds of bread versus high glycemic fruits like tropical fruits or white bread,” noted Dr. Kossoff. “What’s interesting about it on the mechanistic level is that if you look at how patients do on the low glycemic index treatment, they don’t maintain urinary ketosis, which suggests that these diets may work by mechanisms that we’re not completely sure of, perhaps by stabilizing blood glucose, and not necessarily by ketosis.”
Diets Becoming More Widely Used in Adults
Alternative diets such as the modified Atkins diet and low glycemic index treatment may have found their niche with adult patients, according to Dr. Kossoff. “There is growing evidence that dietary therapies for adults can be feasible and effective, especially when using these alternative diets,” he said. “We’ve seen a real increase in interest in this regard. Adult epilepsy diet centers are starting to emerge…. In most of these situations, we will use the modified Atkins diet. However, if it is an adult with a gastrostomy tube or in many cases if they are in an ICU, and in cases of status epilepticus, there has been some early evidence that using the ketogenic diet as a formula can be helpful in aborting the status epilepticus. Those are the situations in which we’ve used the classic ketogenic diet for adults, but generally, otherwise, we will use the modified Atkins diet. And again, many of the adults that we’re seeing have nonlesional epilepsies.
“We’ve come a long way in making the diets easier, safer, and more palatable,” Dr. Kossoff commented. “That’s really opened up many different options for patients who didn’t have diets given to them as an option before.”
—Colby Stong