Ketogenic diet: variations on a classic (including the Atkins diet)

Ketogenic diets pie

Ketogenic diets pie (Photo credit: Wikipedia)

The ketogenic diet is a high fat, low-carbohydrate and adequate protein diet, which was originally developed to treat epileptic individuals (see my previous posts about the use of the diet for epilepsy and the mechanisms of action of the diet). The diet produces remarkable  results on subjects suffering from intractable seizures but also revealed quite useful for a variety of other conditions, such as narcolepsy and autism and shows promises for the treatment of Alzheimer’s disease, Parkinson, Amyotrophic Lateral Sclerosis, Multiple Sclerosis, migraine headache, depression and type-2 diabetes (see my post on the use of ketogenic diet beyond epilepsy).

However, the ketogenic diet has been described as too strict and unpalatable, leading some patients to drop from the treatment. For this reason, variations of the diet have been considered to treat epilepsy. Positive results with modified versions of the Ketogenic diet have been reported for epilepsy, daily headaches, narcolepsy and weight loss.

Classic Ketogenic Diet

The classic ketogenic diet typically incorporates 3 or 4 times more fat than carbohydrates and proteins combined. Carbohydrates are limited to 5-10 g a day. Sources of fat are generally long-chain triglycerides or LCT (most oils commonly consumed are LCT). Food and drinks need to be carefully weighted and measured. Water intake used to be restricted but new guidelines suggest that not restricting water intake can solve problems related to the formation of kidney stones.

Example of recipe on the classic ketogenic diet: (from The Charlie Foundation)

Chicken & Cabbage Soup, 397 Calories, 7.35g Protein, 2.5g Carbohydrate

100g chicken broth
30g raw green cabbage, shredded
5g raw onion, diced small
1g raw garlic, diced fine
20g cooked chicken breast, diced
15g butter
15g olive oil
15g mayonnaise
salt & white pepper

Add the butter and olive oil to a small pot.  Over medium low heat, melt the butter.  Add the cabbage, onions and garlic to the butter and oil.  Sautee until the vegetables begin to soften. Add the broth and chicken to the vegetables.  Cover and let the soup simmer over low heat until the vegetables are very soft. Remove the pot from the heat and add the mayonnaise.Use an immersion blender to puree the soup. Use an immersion blender to puree the soup.

Medium-Chain Triglyceride diet (MCT)

The Medium-chain triglyceride (MCT) diet was developed in the 70′ as a way to make the ketogenic diet easier to follow.  Medium-chain triglyceride produce more ketones per gram than long-chain triglycerides and therefore are required in lesser amount than LCT to achieve efficient ketogenesis. This property allows for more flexibility with proteins and carbohydrates. Rich sources of MCTs include palm kernel oil, coconut oil and camphor tree drupes. Since MCT oil does not supply essential fatty acids (essential fats are long or very long chain), other fat sources must be included in the diet.

Example of recipe on the MCT diet: (from Matthews Friends)

Garlic Chicken

Roast potatoes
MCT Oil, butter and mayonnaise
Broccoli , cauliflower and mushrooms
Pinch of Garlic and black pepper

Fry the chicken in garlic and butter until browned. Make a sauce with MCT Oil and black pepper and mushrooms. Serve with roast potatoes , broccoli and cauliflower.

Modified Atkins (MA) diet

A modified version of the Atkins diet was used with success to treat epilepsy. The modified Atkins (MA) diet allows a higher level of carbohydrates than the classic ketogenic diet but less than the classic Atkins diet. On the Modified Atkins diet, individuals may eat between 10 to 20g of carbohydrates a day and protein sources are not restricted. The total amount of calories is not restricted either, making the diet easier to administer.

Example of recipe on the Modified Atkins Diet: (from Atkins for seizures)

Low Carb Broccoli Cheese Casserole

3 cups fresh chopped broccoli, lightly steamed until crisp/tender
1 1/2 cups shredded mild Cheddar cheese
1 egg, beaten
1/4 cup cream
1/4 cup mayonnaise
2 tablespoons prepared horseradish
Cooked bacon bits

Whisk together the egg, cream, mayo and horseradish. Add the broccoli and mix, then add the cheese and mix. Top with bacon bits. Cook covered at 350 for 30 minutes, then remove the top and cook another 15 minutes. Remove from oven, put the casserole top back on and let sit for 10 minutes before serving.

Low Glycemic Index Therapy (LGIT) diet

The low glycemic index therapy (LGIT) was reported as a more liberal way to control epilepsy in 2005. The diet allows for the consumption of 40 to 60 g/d of carbohydrates a day, however, those carbohydrates are selected so that they do not produce large fluctuations in blood glucose levels (glycemic index, <50 – see this website to calculate the glycemic index of common foods). The fact that the LGIT diet is efficient at preventing seizures in epileptic patients while it is not producing measurable amounts of ketones suggested that other mechanisms besides the anti convulsant action of ketones were involved in the success of low-carbohydrate diets.

Example of recipe on the Low Glycemic Index Therapy Diet: (from Spark Recipes)

3 lbs raw boneless, skinless chicken breast, cut in large chunks
2 cups fresh mushrooms, sliced
1 (8 oz) bottle Ken’s Steak House Creamy Caesar Dressing (or other creamy Caesar dressing)
4 ounces Neufchatel cheese (low-fat cream cheese)
1 can (10.75 oz) cream of chicken soup
8 oz part skim mozzarella cheese, shredded

Pour bottle of Caesar dressing into crock pot. Add chicken breast chunks and mushrooms, stir to coat, cover. Cook on high for about 4 1/2 hours. In bowl, mix together cream of chicken soup and softened cream cheese. Stir soup/cream cheese mixture into chicken in crock pot gently. Add mozzarella cheese, stir gently. Cook another 1/2 hour until cheese is melted and mixture is hot.

Considering that variations of the ketogenic diet have shown results comparable to the classic ketogenic diet, it seems logical to suggest that variations of the ketogenic diet, which are more palatable and less difficult to administer, might be useful for conditions that showed promising results with the classic ketogenic diet. According to this logic, I chose to follow a vegan version of the Low-Glycemic Index diet to fight my migraines. As I already reported in a previous post, I am now migraine and medication free, after more than 20 years of poorly controlled headaches and migraines. I am almost in disbelief, but definitely relieved (and slightly mad I didn’t try this earlier).

References used in this article:

Sucheta M. Joshi, S.M., Singh, R.K., Shellhaas, R.A., Advanced Treatments for Childhood Epilepsy Beyond Antiseizure Medications. JAMA Pediatr. 2013;167(1):76-83. doi:10.1001/jamapediatrics.2013.424.

Tonekaboni SH, Mostaghimi P, Mirmiran P, Abbaskhanian A, Abdollah Gorji F, Ghofrani M, Azizi F., Efficacy of the Atkins diet as therapy for intractable epilepsy in children.Arch Iran Med. 2010 Nov;13(6):492-7. 

Levy RG, Cooper PN, Giri P., Ketogenic diet and other dietary treatments for epilepsy. Cochrane Database Syst Rev. 2012 Mar 14;3:CD001903. 

Kossoff EH, Turner Z, Bluml RM, Pyzik PL, Vining EP., A randomized, crossover comparison of daily carbohydrate limits using the modified Atkins diet.Epilepsy Behav. 2007 May;10(3):432-6. Epub 2007 Feb 26.

Miranda MJ, Turner Z, Magrath G., Alternative diets to the classical ketogenic diet–can we be more liberal? Epilepsy Res. 2012 Jul;100(3):278-85.


Copyright (see copyright page): © “Food, Science and Health” ( by Barbara Cerf-Allen, 2013 All Rights Reserved

Disclaimer: I am not advocating any of the above mentioned diets, nor am I making any claim about their usefulness for your specific condition. I am not a medical doctor and I am not giving medical advice. This blog is about sharing scientific information and my personal anecdotal experience,

(Note: all images without explicit credit are my own. You are welcome to use them. Please just credit them to this website. Thank you!)

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