By SickKids staff

Learn about the benefits and limitations of the modified Atkins diet for childhood epilepsy, how it is started, and how to use it at home.

Key points

Children on the modified Atkins diet start with no more than 10 g of carbohydrate a day and slowly build up to 20-30 g. Fat provides 65 per cent of their calories.
The diet offers a wider variety of food than the classic ketogenic diet and often starts to work quickly, although it can take a few months to see the full effects.
Negative side effects include constipation, higher cholesterol and hunger, even if calories are not restricted.
The diet is very restrictive and needs to be followed carefully under the guidance of a dietitian and your child's doctor.
The modified Atkins diet 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 on this diet can eat no more than 10 g of carbohydrate per day at first. Some children may be able to increase to 20 g or 30 g of carbohydrate per day after a few months. Unlike the regular Atkins diet, fat is encouraged: about 65% of the calories in this diet should come from fat.

The modified Atkins diet was first described as a treatment for epilepsy in 2003.

Benefits of the modified Atkins diet

Although it does not work for every child, the modified Atkins diet has been shown to reduce seizures in many children, sometimes by more than 90 per cent. It is easier to follow than the traditional ketogenic diet and offers a wider range of food. Children can order food that is appropriate for the diet in restaurants and cafeterias. Although research is still limited, children on the modified Atkins diet seem to have fewer side effects than with the traditional ketogenic diet.

The modified Atkins diet is sometimes recommended for children with behavioural difficulties and for teens, if the child’s doctor and family feel the traditional ketogenic diet is not appropriate.

If it is going to work, the modified Atkins diet often starts to work quickly, although it can take several months to see the full effects. If the modified Atkins diet is successful in controlling seizures, it may be continued for several years under the guidance and monitoring of your child's doctor.

Limitations and side effects of the modified Atkins diet

Studies so far have found few side effects from the modified Atkins diet. Side effects may include constipation, higher cholesterol, including higher “bad” LDL cholesterol and changes in blood chemistry. Overweight patients may lose weight, which can sometimes be desirable. Some children feel hungry on the diet, even if calories are not restricted. Ask your child's doctor to explain all possible side effects, what you should watch for and what action you should take for each one.

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 diet

  • More foods are allowed than with the classic ketogenic diet, but the diet is still very restrictive, especially for a child. The diet controls the type of food and the quantity of food.
  • The diet will not work unless it is followed carefully, and some children are unable or unwilling to follow it.
  • It can be time-consuming and tedious to prepare. This usually gets easier as families adapt to the new routine.
  • It might not work for some children, no matter how closely they follow the diet.
  • It 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 diet

Before starting the modified Atkins diet, your child will need a full evaluation. This will include a physical examination, with measurement of their height and weight and a number of blood and urine tests. The team will also ask for a diet history for your child, 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 and whether your family has any cultural or religious food restrictions.

The modified Atkins diet is usually started on an outpatient basis. Your child does not need to be admitted to hospital, but it is important to stay in close contact with your child’s doctor.

Your family will meet with a dietitian to learn how to count carbohydrates, read food labels, plan menus and identify high-fat foods. They 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 train you on how to measure your child’s urinary ketones and how to keep track of their body weight and seizure activity. The team will discuss side effects to watch for.

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 be asked to start by limiting your child’s carbohydrates to 10 g per day, or 15 g per day for teens. 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 diet at home

Sticking closely to the diet is very important to ensure your child has given it a proper try 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.

Unlike the classic and MCT diets, other family members can also follow the modified Atkins diet after they have discussed this with their doctor. This may help children feel less isolated and may help them follow the diet more easily.

Children on the modified Atkins diet require frequent monitoring, usually every month for the first few months and then usually every three to six months. Check-ups will include measurements of weight and height, as well as urine and blood tests.

Between appointments, you will need to keep track of your child's seizure activity, urinary ketone levels and body weight.

Some medications, including over-the-counter cough and cold medicines and IV fluids, have sugar (carbohydrates) in them. The dietitian will explain how to identify medications with carbohydrates and what to do. Whenever you take your child to the doctor, or get a new prescription, you need to inform them that your child is on the modified Atkins diet.

Discontinuing the modified Atkins diet

If the diet has kept seizures well under control for several years, it may be tapered off with guidance from your child's doctor and dietitian. Alternatively, if it is not working, the diet may be tapered off or your child’s doctor may suggest switching to a different diet.

The modified Atkins diet should not be stopped abruptly, as this may trigger seizures. It is usually tapered slowly, by increasing the amount of carbohydrate by about 10 g every three to four days. Your child's dietitian and doctor will work with you to discontinue the diet.

Last updated: February 4th 2010