Saturday 3 May 2008

Use of the Atkins Diet in place of the traditional ketogenic epilepsy diet

Epilepsy has been in the news today with a new trial in the UK which showed that a ketogenic high-fat diet can significantly reduce the number of seizures. Although the mechanisms are not fully understood, the ketogenesis alters the metabolism of the brain in a way that can reduce the risk of seizures. The ketogenic diet was in use in epilepsy many years ago, but fell out of favour due to difficulty in keeping to the diet and concerns about the high fat content of the diet and cholesterol levels.

In the UK trial, the researchers called for the diet to be more widely available on the NHS. But why wait for what could be a very long time? The concerns about cholesterol levels have now been shown to be groundless. Moreover, researchers elsewhere have reported that less strict versions of the ketogenic diet, such as the Atkins Diet or a modified version of it, can be just as effective and may not need such close hospital supervision.

Epilepsy consultant Dr Eric Kossoff has been very active in this area of research, and has shown that the traditional ketogenic diet for epilepsy is needlessly restrictive. He uses a modified version of the Atkins Diet (10 g rather than 20 g of carbohydrates for the first few months). He has also found that epileptic kids don't need to start off with a fast, so no initial hospitalization is needed, and their carers can more or less just get the Atkins book and follow it (under the epilepsy consultant's supervision). This, together with the increased availability of low carbohydrate substitutes for making bread and other foods hitherto off-limits on the ketogenic epilepsy diet, should make life much easier for epileptics and those who cook for them.

I see that National Epilepsy Week 2008 is 18 - 25 May (in the UK). My contribution to the Week is to help raise awareness of the work of Dr Kossoff and colleagues. If you know of any epileptics for whom medications are not effective, I urge you to join me in bringing this information on epilepsy diets to their attention.

Here are summaries of Dr Kossoff's recent studies:

'A modified Atkins Diet is an effective and well-tolerated therapy for intractable pediatric epilepsy.'
Kossoff, E.H., McGrogan, J.R., Bluml, R.M., Pillas, D.J., Ruberstein, J.E., Vining, E.P., 'A modified Atkins Diet is an effective and well-tolerated therapy for intractable pediatric epilepsy', Epilepsia, 2006, 47(2):421-424.

'The ketogenic diet is effective for treating seizures in children with epilepsy. The Atkins Diet can also induce a ketotic state, but has fewer protein and caloric restrictions, and has been used safely by millions of people worldwide for weight reduction. ... This provides preliminary evidence that the Atkins Diet may have a role as therapy for patients with medically resistant epilepsy.'
Kossoff, E.H., Krauss, G.L., McGrogan, J.R., Freeman, J.M., 'Efficacy of the Atkins diet as therapy for intractable epilepsy', NEUROLOGY, 2003;61:1789-1791.

'The ketogenic diet is effective for treating seizures in children with epilepsy. The Atkins Diet can also induce a ketotic state, but has fewer protein and caloric restrictions, and has been used safely by millions of people worldwide for weight reduction. ... This provides preliminary evidence that the Atkins Diet may have a role as therapy for patients with medically resistant epilepsy.'
Kossoff, E.H., Krauss, G.L., McGrogan, J.R., Freeman, J.M., 'Efficacy of the Atkins diet as therapy for intractable epilepsy', NEUROLOGY, 2003;61:1789-1791.

'Only a decade ago the ketogenic diet was seen as a last resort; however, it has become more commonly used in academic centres throughout the world even early in the course of epilepsy. The Atkins diet is a recently used, less restrictive, therapy that also creates ketosis and can lower the number of seizures.'
Kossoff, E.H., 'More fat and fewer seizures: dietary therapies for epilepsy, THE LANCET Neurology, 2004, 3:415-20

Footnote:
The recipes in the Low Carb / Low GI Cookbook are particularly suitable for those following the Atkins Diet or a modified form of the Atkins Diet for seizures as they are extremely low in carbohydrates and fit well into the allowance of 10 to 20 grams of carbohydrate per day that are recommended for epileptics using the diet. Good results have also been obtained by starting the diet with a low level of carbs which is then increased after a period of time. The interactive features of the Low Carb / Low GI Cookbook are particularly useful as the carbohydrate values of individual ingredients are shown, and ingredients can be adjusted and carb counts automatically recalculated, according to the changing needs of the person using the diet. Recipes can also be added, and imported from other sources.

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