In addition to the classic ketogenic diet, Dr. Kossoff described several other less restrictive dietary treatment options. The modified Atkins diet falls between a regular diet and a classic ketogenic diet, with high fat (about 65% vs. about 90% with the classic ketogenic diet) and low carbohydrates. Also with the modified Atkins diet, there is no need to fast, restrict calories or fluids, hospitalize the patient, or weigh food on a gram scale. Over a decade, 32 studies involving 400 patients treated with this approach, including 17 prospective studies, have provided evidence that the diet is effective, with almost a 50% responder rate and a 13% seizure-free rate, "remarkably similar to what we see with a classic ketogenic diet," he noted.
This is the dietary approach most likely to be used in adults, he added.
The Low Glycemic Index diet is also a high-fat, low-carbohydrate diet, but it primarily targets the type of carbohydrates in the diet, aiming for a glycemic index of less than 50. Interestingly, this diet does induce urinary ketosis but is effective, "suggesting that these diets may work by mechanisms we are not completely sure of, not necessarily ketosis," Dr. Kossoff said.
Dr. Kossoff declared that he had no relevant disclosures. He was the lead author of the International Ketogenic Diet Study Group’s recommendations on the ketogenic diet in children (Epilepsia 2009;50:304-17).