A modified version of a popular high-protein,
low-carbohydrate diet can significantly cut the
number of seizures in adults with epilepsy, a study led by
Johns Hopkins researchers suggests. The
Atkins-like diet, which has shown promise for seizure
control in children, may offer a new lifeline for
patients when drugs and other treatments fail or cause
For almost a century, doctors have prescribed an eating
plan called the ketogenic diet to treat
children with epilepsy. This diet often consists of a short
period of fasting, strictly limits fluids and
drastically restricts carbohydrates. It appears to limit or
even eliminate seizures, possibly by
generating the buildup of ketones, compounds the body
produces when it derives calories mostly from
fat. Some of the largest studies to scientifically test this
diet's efficacy took place at Johns Hopkins
in the mid-1990s, led by pediatric neurologists John Freeman
and Eileen Vining.
Why exactly the ketogenic diet works remains unknown,
and it is notoriously difficult to follow,
relying almost solely on fat and protein for calories.
Consequently, doctors typically recommend it only
for children, whose parents can strictly monitor their
eating habits. The ketogenic diet is almost
never prescribed to adults, who generally make their own
food choices and often have difficulty
complying with the diet's strict guidelines.
In 2002, Johns Hopkins researchers began testing a
modified version of the Atkins diet in
children with epilepsy. The modified diet shares the
high-fat focus of the ketogenic diet, prompting
the body to generate ketones. However, it allows more
carbohydrates and protein, doesn't limit fluids
and calories, and has no fasting period. When studies showed
that the new diet prevented or curtailed
seizures in children, the researchers began testing it for
efficacy and ease of use in adults.
Reporting on the results in the February issue of
Epilepsia, Eric H. Kossoff, an assistant
professor of neurology
at the School of Medicine, said 30 adults with epilepsy,
to 53 years, who had tried at least two anticonvulsant drugs
without success and had an average of 10
seizures per week, were placed on the modified Atkins diet.
All patients were seen for free in the
Johns Hopkins General Clinical Research Center.
The regimen restricted them to 15 grams of
carbohydrates a day.
"That's a few strawberries, some vegetables or a bit of
bread," Kossoff said. The diet offers
most of its calories from fat--eggs, meats, oils and heavy
cream — with as much protein and no-carb
beverages as patients want.
Each day, patients kept diaries of what they ate and
how many seizures they had. The
researchers evaluated how each patient was doing at one,
three and six months after starting the
Results showed that about half the patients had
experienced a 50 percent reduction in the
frequency of their seizures by the first clinic visit. About
a third of the patients halved the
frequency of seizures by three months. Side effects linked
with the diet, such as a rise in cholesterol
or triglycerides, were mild. A third of the patients dropped
out by the third month, unable to comply
with the restrictions.
Fourteen patients who stuck with the diet until the
six-month mark chose to continue, even
after the study ended — a testament to how effectively
the diet worked to treat their epilepsy,
Though the modified Atkins diet won't be a good fit for
all patients, Kossoff said, "it opens up
another therapeutic option for adults trying to decide
between medication, surgery and electrical
stimulation to treat intractable seizures." A second study
to examine the diet's effects on adults with
intractable seizures is under way.
Other researchers who contributed to the study are
Hannah Rowley and Eileen P.G. Vining, both
of Johns Hopkins, and Saurabh R. Sinha, of Sinai Hospital of