Unraveling the nutritional challenges in epilepsy: Risks, deficiencies, and management strategies: A systematic review

Table 7 Showcases the main characteristics of the three primary types of ketogenic diets

Aspect	Classic ketogenic diet	Modified Atkins diet	Medium-chain triglyceride ketogenic diet
Macronutrient ratio	High fat (about 3:1 or 4:1, Fat: Protein + Carbs)	High fat, low carb	High fat, low carb, focused on Medium-Chain Triglyceride
Carbohydrate intake	Extremely low (5%-10% of total daily calories), typically 20-50 g per day	Restricted, liberalized compared to classic, can range from 20-100 g per day	Low, but slightly higher than classic, with a focus on low-glycemic carbs
Protein intake	Moderate (15%-20% of total daily calories), typically 1 g/kg of body weight	Moderate to liberal, like classic ketogenic diet	Moderate: Can be slightly higher than classic ketogenic diet, especially for adults
Fat sources	Emphasizes long-chain triglycerides, from animal and plant sources	Focuses on a variety of fat sources with a mix of long-chain triglycerides and medium-chain triglycerides, with medium-chain triglycerides oil often incorporated	Mainly medium-chain triglycerides
Dietary diversity	Restrictive, emphasizes specific food sources	More flexible in food choices	Limited by sources of medium-chain triglycerides
Implementation complexity	High, requires meticulous measurement and monitoring	Less complex but still requires tracking	Moderate complexity, easier to calculate medium-chain triglycerides
Adherence difficulty	Challenging due to strictness and limited food choices	Moderate, more flexible	Moderate, limited food options with medium-chain triglycerides
Efficacy in seizure control	Often high efficacy, especially in drug-resistant epilepsy, especially in children	Varied may be effective for some, easier to follow for some individuals, and allows for more variety in food choices	Effective for some, especially in certain epilepsies, as it can promote faster ketosis due to medium-chain triglycerides, potentially reducing side effects
Potential drawbacks	More restrictive, can be challenging to follow in the long term	It may not be as effective as classic ketogenic diet for some individuals	It can be more expensive due to the need for medium-chain triglycerides oil
Suitability	Best for children and adults who haven't responded well to medications	It is a good option for individuals who struggle with the strictness of classic ketogenic diet	It can be suitable for both children and adults, depending on individual needs and preferences
Indications	Drug-resistant epilepsy, certain epilepsy syndromes	Epilepsy management	Epilepsy, neurological conditions, fat malabsorption