Improving compliance in adults with epilepsy on a modified Atkins diet: A randomized trial

Tanya J.W. McDonald, Bobbie J. Henry-Barron, Elizabeth A. Felton, Erie G. Gutierrez, Joanne Barnett, Rebecca Fisher, Mon Yi Lwin, Amanda Jan, Diane Vizthum, Eric H. Kossoff, Mackenzie C. Cervenka

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Purpose: To determine whether use of a ketogenic formula during the first month of the modified Atkins diet (MAD) in adults with drug-resistant epilepsy (DRE) improves seizure reduction and compliance compared to MAD alone. Methods: Eighty adults (age ≥18 years) with DRE and ≥4 reliably quantifiable seizures/month were enrolled. All participants were trained to follow a 20 g/day net carbohydrate limit MAD. Patients were randomized to receive one 8-ounce (237 mL) tetrapak of KetoCal®, a 4:1 ketogenic ratio formula, daily in combination with MAD during the first month (treatment arm) or second month (control/cross-over arm). Patients recorded urine ketones, weight, and seizure frequency and followed up at 1 and 2 months. Results: By 1 month, 84% of patients achieved ketosis (median of 4–4.5 days). At 1 month, the treatment arm had a significantly higher ketogenic ratio and more patients with a ≥1:1 ketogenic ratio compared to the control arm. There was no difference in median seizure frequency, proportion of responders (≥50% seizure reduction), or median seizure reduction from baseline between groups. However, patients treated with KetoCal® during the first month were significantly more likely to continue MAD for 6 months or more. Conclusion: Although supplementing MAD with a ketogenic formula in the first month did not increase the likelihood of reducing seizures compared to MAD alone, significantly more adults remained on MAD long-term with this approach. This suggests a potential strategy for encouraging compliance with MAD in adults with DRE.

Original languageEnglish (US)
Pages (from-to)132-138
Number of pages7
StatePublished - Aug 2018


  • Drug-resistant
  • KetoCal
  • Ketogenic diet
  • Ketosis
  • Seizure

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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