BOSTON—The Atkins diet has recently risen from medical scorn to a level of more widespread acceptance in the medical establishment. Indeed, it has come so far that researchers from Johns Hopkins Medical Institutions in Baltimore have preliminary information about its use as a potentially more tolerable substitute for the ketogenic diet as anticonvulsant therapy for patients with intractable epilepsy.

“The Atkins diet can induce a ketotic state similar to the ketogenic diet and may be similarly beneficial for patients with epilepsy and perhaps more tolerable,” said Eric H. Kossoff, MD. The two diets share low-carbohydrate, high-fat intake designs based on similar foods; both produce ketosis, and both can be used long term. However, the Atkins diet is also a high-protein diet with no caloric restrictions and an allowance of more carbohydrates; additionally, there is no weighing or measuring of foods in the Atkins diet and no admission fast is required. “It’s relatively easy to start,” said Dr. Kossoff.

EATING YOUR WAY TO SEIZURE REDUCTION?

Dr. Kossoff, Assistant Professor of Pediatrics and Neurology, and colleagues reported the results of a six-patient case series at the 2003 Annual Meeting of the American Epilepsy Society. The patients (three males) were initiated on the Atkins diet for the treatment of intractable focal and multifocal epilepsy. The patients were between ages 7 and 52; none were surgical candidates, and all had previously failed anticonvulsant therapy with two or more medications (range, two to 18). The investigators determined urinary ketosis and monitored patients’ weight over a two-year period; in patients on the Atkins diet for two months or longer, serum lipid profiles and urine calcium and creatinine levels were measured.

“Half of our patients had a 90% to 100% seizure reduction, generally correlated with large ketosis,” Dr. Kossoff reported. One patient, a 7-year-old female who had multiple seizure types 70 to 80 times per day and had failed eight anticonvulsants, experienced a complete stoppage of seizures during a three-day period on the Atkins diet, accompanied by large ketones. The child remained seizure-free and her dosages of zonisamide and phenytoin were tapered; she is still on the Atkins diet, the researchers noted.

The second patient, a 10-year-old male presenting with absence and generalized tonic-clonic seizures and significant behavioral problems and who had failed two anticonvulsants, had achieved seizure freedom and improved behavior for more than two years while on a 3:1 ketogenic diet. However, one year after discontinuation of the ketogenic diet, seizures and behavioral problems returned, Dr. Kossoff said. The Atkins diet was initiated successfully; the patient had large ketones and controlled behavior when his carbohydrate intake was less than 20 g/day. The patient remains on the Atkins diet, seizure-free, and is not taking any anticonvulsants.

The third successful case was an 18-year-old female with complex partial seizures two to eight times per week who had failed five anticonvulsants. The Atkins diet was initiated and her seizures decreased to two to four simple partial seizures per month, clustered around menses, Dr. Kossoff said. Her ketones were consistently large; topiramate was tapered and discontinued, and carbamazepine was lowered to 800 mg/day. Her weight was reduced from 158 lb to 117 lb during a one-year period. She is not currently on the Atkins diet.

The three patients who failed were two males (ages 42 and 52) and a 12-year-old female. The female patient experienced a modest (20%) seizure reduction; the two men experienced no reduction in seizure frequency. All three of these patients had less consistent—or no—ketosis, Dr. Kossoff noted.

BACK TO THE FUTURE

The Atkins diet “was well tolerated by all patients,” Dr. Kossoff said. “Based on these preliminary results, a prospective study is under way at our institution. We feel strongly that this should be studied in more detail before any further recommendations can be made. This should also be done under strict medical and nutritional supervision,” he added. The study involves children (ages 3 to 18) with seizures three or more times per week, failure of two or more anticonvulsants, and no prior exposure to the ketogenic diet.

This work is highly preliminary, but Dr. Kossoff speculated on the possible role of the Atkins diet for epilepsy in the future. It might serve as “a test of potential ketogenic diet compliance and efficacy,” he said, or it might be useful “in patients with behavioral problems who might find the ketogenic diet too restrictive.” Additionally, the Atkins diet could also play a role in communities without a ketogenic diet program, he said; the possibilities of its efficacy in an adult epilepsy population also remain to be investigated.

NR

—C. Justin Romano

Suggested Reading
Atkins RC. Dr. Atkins’ New Diet Revolution. 3rd edition. New York: M Evans & Co; 2002.
Kossoff EH, Krauss GL, McGrogan JR, Freeman JM. Efficacy of the Atkins diet as therapy for intractable epilepsy. Neurology. 2003;61:1789-1791.

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