The new or Modified Atkins Diet (MAD) is an altered version of the original Atkins diet-- a ketogenic, weight loss eating plan with a very low carbohydrate content.

The modified diet was developed at Johns Hopkins Hospital to provide an alternative to Atkins and offer a less restrictive diet, where unlimited amounts of protein can be eaten and the consumption of fats is more strongly encouraged.

The MAD is one of three alternative diets used to treat seizures in people with epilepsy, the other two being the MCT (medium chain triglyceride) diet and LGIT (low glycemic index treatment).MAD is primarily used when patients who have seizures on a daily basis are not fully responsive to medication.

The diet plan consists of a 1:1 ratio of fat to carbohydrates and protein. High-fat foods such as butter, dense cream and vegetables are included in the diet, along with protein-rich foods such as fish, chicken and red meat. All sweet foods such as biscuits and cakes are completely eliminated. Foods rich in carbohydrates such as pasta, potatoes, bread and cereals are eliminated during the first month, but then gradually introduced later.

Studies have shown that the efficacy of the diet is similar to the original Atkins diet. Studies of children who have stayed on MAD for long periods show a 50% decrease in the number of seizures they experience and some are able to reduce their use of medication. Some children with specific epilepsy syndromes benefit from even greater rates of seizure reduction.

Some further advantages and disadvantages of the diet are listed below.

Positives

• There is no need to restrict fluid or calorie intake
• Although fats are encouraged, they do not need to be weighed and measured and recipes do not need to be precise
• Proteins are not restricted; usually, around 35% of the calories come from protein
• The diet can be started outside of hospital
• There is no need to fast before starting the diet
• The diet can lead to weight loss, which is positive for people who were overweight before starting the diet
• Unlike the ketogenic classic Atkins diet, it is unusual to develop kidney stones
• In world regions with limited resources, MAD may be easier and less time consuming to adhere to than classic Atkins

Negatives

• Some patients find their cholesterol level increases
• The ketosis (increased ketone level in bodily tissues) can make people feel ill and deter them from eating or drinking
• The diet does not contain sufficient minerals and vitamins, so supplementation is required to prevent nutritional deficiency.
• The most common adverse side effect is constipation. P eople on the diet need to consume high-fiber vegetables to prevent this and also drink plenty of water

Once a patient has been free of seizures for around two years, the diet may sometimes be stopped, but it is usually continued. However, if no improvements are seen with the diet, it should be stopped in any case.