The Modified Atkins Diet: What is it, How does it compare to the classical medical ketogenic diet and when is it used?

The Modified Atkins Diet (MAD) is a less-restrictive variation of the Classical Medical Ketogenic Diet. Although it may not have quite the same success rates seen with the Classical Ketogenic Diet, MAD can be very helpful in managing seizures for some individuals. MAD is still a high fat/low carbohydrate diet but has some key differences from the classical diet.

Differences Between the Modified Atkins Diet and the Classical Ketogenic Diet:

• Protein is not restricted
  The Classical Ketogenic Diet is designed to provide “adequate protein”, meaning that patients eat enough to sustain their body mass, but no extra. The Modified Atkins Diet does not restrict the amount of protein in the diet.
• No gram scale required
  While the Classical Ketogenic Diet requires that foods be weighed on a gram scale, foods are measured using household measurements (like cups, tablespoons, etc.) on the Modified Atkins Diet.
• Not designed according to the ketogenic ratio–
  As you may recall from our previous post on the ketogenic ratio, the Classical Ketogenic Diet is designed according to a ratio, usually 4:1 or 3:1 (grams of fat: carbohydrate + protein). The Modified Atkins Diet is not designed according to a ratio, but is simply based on limiting carbohydrates, usually to 10-20 grams/day. However, if you were to calculate the ketogenic ratio of a typical MAD, it would come out to about a 1:1 ratio.
• Outpatient initiation
  While hospital admission is usually required when starting the Classical Ketogenic Diet, the Modified Atkins Diet is usually initiated in an outpatient setting.

Similarities Between the Modified Atkins Diet and the Classical Ketogenic Diet:

• Carbohydrates are restricted-
  Like the Classical Ketogenic Diet, carbohydrates are restricted on the Modified Atkins Diet, usually to 10-20 grams/day. Hidden sources of carbohydrate must still be monitored to ensure that patients are not consuming more than the recommended amount. Label reading is a must for all OTC products as well. See the previous post on sources of hidden carbohydrates.
• Fat consumption is encouraged-
  Fat consumption is encouraged on the Modified Atkins Diet. It can be difficult for patients on the MAD to get enough fat to remain in ketosis, so sometimes dietitians will recommend supplementing with KetoCal to boost daily fat intake.  A 2010 study found that consuming one serving of KetoCal® daily may help to improve the efficacy of the Modified Atkins Diet.
• Supplements are usually required-
  Although the Modified Atkins Diet is less restrictive than the Classical Ketogenic Diet, nutritional supplements are usually still required to ensure your child is meeting 100% of nutrition needs. Work with your dietitian to determine what, if any, supplements are necessary. All versions of the ketogenic diet can be deficient in vitamins and minerals, including Vitamin D, B vitamins and calcium, to name a few. This is one of many reasons why it is so important to only use the ketogenic diet and MAD under close medical supervision.

When is the Modified Atkins Diet Used?

The Modified Atkins Diet may be used to extend the use of dietary management of seizures to patients who are not candidates for the Classical Ketogenic Diet. Below are some examples of situations where the MAD might be used:

• As a stepping stone to the Classical Ketogenic Diet –
  Families might use the Modified Atkins Diet in preparation for starting the traditional diet or as a trial to see if dietary management is likely to be helpful.
• As a transition from the Classical Ketogenic Diet –
  Some patients may follow the Modified Atkins Diet when transitioning off of the Classical Ketogenic Diet. Some health care providers and families prefer to wean gradually from the Classical Ketogenic Diet, so they may switch to a MAD before coming off the ketogenic diet completely.
• Families with limited time and resources –
  Some families may not be able to commit to the requirements of initiating and managing the Classical Ketogenic Diet, so the outpatient initiation and less restrictive nature of the Modified Atkins Diet may be more appropriate.
• Older children, teenagers, and adults –
  Older children, teenagers, and adults may have trouble complying with the Classical Ketogenic Diet, so the Modified Atkins Diet may be easier for them to maintain. Also, because these patients have larger body masses, they may have trouble meeting their protein needs on the Classical Ketogenic Diet.

These are just some examples of when the Modified Atkins Diet (MAD) might be used. If you are considering dietary management of epilepsy, you will work with your doctor and dietitian to determine whether the Classical Ketogenic Diet, Modified Atkins Diet, or another variation works best for you and your family.

-Ellen

KetoCal® is a medical food for the dietary management of intractable epilepsy and is intended for use under medical supervision. Talk to your healthcare provider to determine if KetoCal is right for you. 

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