In drug-resistant epilepsy, also called intractable epilepsy, seizures continue despite anti-seizure medications or other epilepsy treatment options. Along with other recommended treatments, some people may explore dietary therapies such as the modified Atkins diet.

MyEpilepsyTeam members have asked each other about the diet and shared their experiences. “If you’ve used the modified Atkins diet, did it help?” one member asked. “Is it hard to follow? What foods are 100 percent out?”

Here’s how the diet works, how it differs from the classic ketogenic diet, and what research says about its effectiveness for drug-resistant epilepsy.

Modified Atkins Diet vs. Keto Diet

The classic ketogenic diet was developed as a treatment for epilepsy and uses specific ratios of fat, carbohydrates, and protein. It works by promoting ketosis. However, this strict diet can be hard for some people to follow.

“Keto diet was too hard because of ‘keto flu’ symptoms,” said one MyEpilepsyTeam member, who described the symptoms as “feeling anxious, lethargic, and angry.” They said they planned to try the modified Atkins diet.

Some families noticed that even after they stopped weighing and measuring foods as strictly, their children maintained ketosis and continued to have better seizure control. These observations helped lead to the development of the modified Atkins diet as a less restrictive dietary therapy for people with drug-resistant epilepsy.

“Keto diet was too hard because of ‘keto flu’ symptoms.”

— A MyEpilepsyTeam member

Some main differences between the modified Atkins diet and the classic ketogenic diet include:

• High-fat foods are encouraged, but portions don’t have to be weighed or measured.
• There are no fluid or total calorie restrictions.
• Protein is not restricted, whereas the classic ketogenic diet controls the ratio of fat to protein and carbohydrates.

In general, the modified Atkins diet may be easier to start and stick with than the strict classic ketogenic diet. The modified version’s flexibility can also make eating out easier.

How Effective Is the Modified Atkins Diet for Epilepsy?

Although researchers don’t fully understand why the modified Atkins diet may help control seizures, ketosis is thought to play an important role. Studies have found that some people following the diet have a 50 percent or greater reduction in seizures.

“Absence seizures are gone. Focal seizures once a month. No longer overweight. Life is good!”

— A MyEpilepsyTeam member

Results from low-carb diets vary from person to person. When asked whether the modified Atkins diet helped them, one member replied: “Yes, it does! Absence seizures are gone. Focal seizures once a month. No longer overweight. Life is good! And I was weaned off one pill! Hopefully another next visit.”

However, another member reported mixed results: “Seizure-wise, I’m not seeing a huge improvement like I was hoping,” they said. “I get several days with no symptoms, and then back-to-back seizures. I was just expecting a bigger improvement. I’m being optimistic, hoping I will see better improvement with more time.”

Modified Atkins for Epilepsy: What To Expect

Talk with your neurologist, and consider consulting a registered dietitian before starting the modified Atkins diet. Your healthcare team can help make sure this eating style is appropriate for you.

Your healthcare team may recommend baseline lab tests and prescribe urine ketone test strips to track your ketone levels. They may recommend checking your levels once or twice a week while following the diet.

Adjustment Period

As your body adapts to using fat instead of carbohydrates for fuel, you may feel ill at times. Working with your healthcare team, easing into the diet one step at a time, and making sure you get enough fluids can help.

Digestive Problems

Gastrointestinal symptoms such as constipation, vomiting, and nausea are among the possible side effects of the modified Atkins diet.

More serious complications of very low-carbohydrate diets are less common and may include:

• Gallstones
• Kidney stones
• Pancreatitis
• Liver problems

It’s important to work with your primary physician, neurologist, and a registered dietitian to identify any concerns early on.

Weight Loss

Weight loss can occur while following the modified Atkins diet. The high fat content may decrease appetite and lead to consuming fewer calories. If weight loss becomes excessive, a dietitian can adjust your meal plan and monitor your weight.

Nutrient Deficiencies

Because the modified Atkins diet limits many carbohydrate-rich foods, following it long term may raise the risk of certain nutritional deficiencies. For example, it may be harder to get enough fiber because many high-fiber foods — including whole grain breads, beans, lentils, fruits, and some vegetables — contain carbohydrates.

“Seizure-wise, I’m not seeing a huge improvement like I was hoping. I get several days with no symptoms, and then back-to-back seizures.”

— A MyEpilepsyTeam member

The diet may also affect levels of nutrients such as calcium, vitamin D, and carnitine, which play a role in bone health, muscle function, and energy production. Your healthcare provider may recommend vitamin or mineral supplements while you’re following the diet.

Foods To Eat and Avoid on the Modified Atkins Diet

Rather than tracking calorie intake, the modified Atkins diet focuses on foods that are high in fat, moderate in protein, and very low in carbohydrates to help maintain ketosis.

Carbohydrates are typically limited to about 20 grams of net carbs. Net carbs are calculated by subtracting grams of fiber from total grams of carbohydrates. The diet generally has a ratio of about 1.5 grams of fat for every 1 gram of combined protein and carbohydrate.

Foods To Eat

High-fat foods make up much of the modified Atkins diet. Examples include eggs, fatty fish, meats, olives, cheese, nuts, and avocado. Oils, butter, mayonnaise, and heavy cream may also be included.

Low-carbohydrate vegetables include:

• Asparagus
• Mushrooms
• Cauliflower
• Zucchini
• Spinach and other greens, such as collard, mustard, and dandelion greens

Low-carbohydrate fruits (less than 15 grams of carbohydrates per serving) include:

• Berries, such as strawberries, blackberries, and blueberries
• Citrus fruits, such as oranges, grapefruit, and clementines
• Nectarines
• Kiwifruit
• Cherries

Foods To Avoid

When following the modified Atkins diet, you’ll need to limit or avoid high-carbohydrate foods and starchy vegetables. Some fruits may also need to be limited because their natural sugars add to your daily carbohydrate intake.

Dairy foods such as cottage cheese can provide protein and fat with minimal carbohydrate. Many processed foods contain added sugars, so check ingredient lists for sweeteners such as sucrose, dextrose, and syrups. You can use the nutrition facts label to calculate net carbs.

Grains and starches to limit or avoid include:

• Pasta
• Rice
• Cereal
• Bagels
• Crackers
• Chips
• Potatoes
• Peas
• Corn

Foods and drinks that are often high in sugar include:

• Candy, including chocolate, gum, and lollipops
• Sauces and dressings, such as ketchup, barbecue sauce, and some salad dressings
• Cookies and cakes
• Sweet drinks, such as juice, soda, flavored milk

You may be able to find versions of some foods, such as condiments, with little or no added sugar. Be sure to check food labels when shopping.