A decade of the modified Atkins diet (2003-2013): Results, insights, and future directions

•The modified Atkins diet is an “alternative” diet used since 2003.•It allows for less fat and more protein than the ketogenic diet, with no hospital admission.•Outcomes appear similar to the ketogenic diet.•It is being increasingly used for adults with refractory epilepsy.

The modified Atkins diet has been used since 2003 for the treatment of children and adults with refractory epilepsy. This “alternative” ketogenic diet is started in clinic, without fasting, hospitalization, and restriction of protein, calories, or fluid intake. Now after 10 years of continued use, approximately 400 patients have been reported in over 30 studies of the modified Atkins diet as treatment for intractable seizures, with results demonstrating similar efficacy to the ketogenic diet and improved tolerability. The modified Atkins diet is being increasingly used in the adult population. Clinical trials have provided insight into the mechanisms of action of dietary therapies overall. This review will discuss the past decade of experience with the modified Atkins diet as well as predictions for its role in the treatment of epilepsy a decade from now.