Modified Atkins Diet and Low Glycemic Index Treatment for Medication-Resistant Epilepsy: Current Trends in Ketogenic Diet

The ketogenic diets (KDs) have been used for the treatment of medication-resistant epilepsy since the 1920s. The classical KD is a highly restrictive diet with a 3:1-4:1 ketogenic ratio, calculated as the weight of fat divided by that of carbohydrates plus protein. Although the classical KD result in at least a 50% reduction in seizure frequency in approximately half of epileptic patients, some patients cannot tolerate the diet over a long period of time because of its restrictiveness. Consequently, the modified Atkins diet (MAD) and the low glycemic index treatment (LGIT) that are more liberal and less restrictive than the classical KD, were developed in the 1990-2000s [1,2]. Contrary to the classical KD, these diets can be provided without restriction of calories, protein and fluid intake, and calculation of ketogenic ratio is not necessary. Figure 1 shows the distribution of major nutrients in calories in each diet [1,2]. MAD and LGIT have a similar composition pattern and the percentage of fat is less than in KD. These new KDs weigh greater importance in having a stable blood glucose level than the production of ketone bodies.