The Modified Atkins Diet (MAD) offers a less restrictive alternative to the classic ketogenic diet, providing a more flexible approach to managing conditions like epilepsy and supporting weight loss. This article delves into the principles of the MAD, its applications, guidelines for getting started, and some recipe ideas to help you incorporate it into your lifestyle.
Disclaimer: Before using, please refer to our Recipe Disclaimer. The ketogenic diet is a high-fat diet that can be used as part of the treatment plan for children who suffer from seizures. The diet should not be started without supervision and guidance from your child’s medical team. These recipes are designed to be used by patients who are followed by Children’s Hospital of Philadelphia’s Division of Neurology Dietary Treatment Program. Atkins is here to support you on your weight loss journey. Individual results may vary. Weight loss is influenced by exercise, lifestyle, dietary pattern, and calories consumed. Should you have any health care-related questions, please call or see your physician or other health care provider. Consult your physician or health care provider before beginning the Atkins Diet as you would any other weight loss or weight maintenance program. The weight loss phases of the Atkins Diet should not be used by persons on dialysis.
What is the Modified Atkins Diet (MAD)?
The modified Atkins diet (often abbreviated in the literature as “MAD”) is a change to the traditional “classic” ketogenic diet to make it less restrictive. Compared to the traditional ketogenic diet, MAD is less restrictive. The food is measured with household measurements like tablespoons, cups, or servings rather than on a food scale. Carbohydrates are limited to about 20 g net carbs a day (net = total carbs - fiber). There is no fluid restriction or limitation. Foods can be eaten in restaurants and outside the home.
Its history goes back to the early 2000s. Some families who had used the ketogenic diet for many years eventually stopped weighing and measuring foods. They had noticed that ketones still remained high and seizures stayed under control. It was first formally studied in children and adults who had never tried the ketogenic diet at Johns Hopkins Hospital by Dr. Eric Kossoff and colleagues in 2002. The first paper on this diet was published in 2003. This diet is now over 14 years old with greater than 500 patients published to date.
While the classic ketogenic diet requires precise measurements and a strict ratio of fat to carbohydrates and protein, the MAD simplifies this by focusing on limiting net carbohydrate intake. The classic ketogenic diet is the strictest form of diet therapy and involves 70 to 90 percent of your child’s calories being provided by fat (compared to the 25 to 40 percent that is usually recommended for children). The amount of fat is determined by the ketogenic ratio, which is the ratio of grams of fat to grams of carbohydrate plus protein. The modified Atkins diet is more flexible than the classic ketogenic diet and may be easier to incorporate into normal life.
Read also: Modified Keto Diet: Is It Right for You?
Applications of the Modified Atkins Diet
MAD is mostly used for patients who still have frequent seizures despite anti-seizure medications. Most of the time, the brain uses carbs for energy. The MAD forces the body to use fat to make ketones for energy instead. It can take a few weeks to months to see just how the MAD will affect seizures. If the MAD is helping seizures, your child will likely stay on the diet for 2 to 3 years.
The MAD is not a good fit for everyone. The MAD can be a big lifestyle change. You will meet with a dietitian in clinic to learn about the diet. Often, the diet is started with your child’s current medicines. If you use liquid or chewable forms, those may need to change to a form with less carbs. Some people may get high cholesterol when they start the MAD. This should get better over time and will go back to normal after they stop the diet. The diet may increase acid in the body. This is called acidosis. Routine visits to the Neurology Clinic are needed every 3 to 6 months. At each visit, the dietitian will look at growth and nutrition. Blood work will be done to see how your child is doing with the diet.
Getting Started with the Modified Atkins Diet
Making dietary changes of any kind can be challenging. However, due to the strict requirements of the Modified Atkins Diet, this challenge may seem overwhelming. Therefore, the best way to approach this diet is to reach the goal of 20 grams of carbohydrate per day little by little.
Step One: Identify High-Carb Foods to Limit
All fruits have carbohydrate however they vary in the amount. All vegetables have carbohydrate however some have more than others. All dairy products will have carbohydrate. Cookies, candy, chocolate, gum, etc. Gum, salad dressings, sauces, condiments (ketchup, barbeque sauce) have carbohydrate.
Step Two: Eliminate Sweets and High Carbohydrate Condiments
Sweet and sugary foods are very high in carbohydrate. Though it may be difficult to eliminate these items, it is essential to move forward with the diet. It may be helpful to try and substitute some of these sweets.
Read also: Understanding "Healthy" Food Labeling
Example Substitutions:
- Instead of chocolate milk, try one tablespoon of unsweetened cocoa powder (~3 grams carbohydrate) and mix with heavy cream. This can also be heated to make hot chocolate.
- Make a popsicle with diet soda (diet root beer or orange soda) and heavy cream. Use an ice cube tray (or small cups) to make these treats. Fill up half with diet soda and half heavy cream. Place in freezer and let sit for a frozen treat.
Important Considerations
This diet must be closely monitored by a physician and Registered Dietician. You should not try this diet on your own! This is meant to be informative only.
We have a team approach to treat epilepsy in the GW diet clinic. Once you start the diet, blood and urine will be monitored every 3 months. Once the team determines the MAD diet is right for you, the dietitian will review your diet history and provide a personalized diet “prescription”.
Modified Atkins Diet Recipes
Here are a few recipe ideas to get you started with the Modified Atkins Diet:
Chicken Cutlets with Sun-Dried Tomato Cream Sauce
This recipe provides a delicious and satisfying meal that is low in carbohydrates and high in healthy fats.
Ingredients:
- 1 1/2 pounds raw skinless, boneless chicken breast
- 1/4 teaspoon ground black pepper
- 1/4 teaspoon salt
- 2 tablespoons olive oil
- 1 1/2 teaspoons minced or pressed fresh garlic
- 1 cup low sodium chicken broth
- 1/3 cup heavy whipping cream
- 2 ounces cream cheese
- 1/2 cup (50g) grated parmesan cheese
- 1/3 cup drained, oil packed sun-dried tomatoes, chopped
- 1 teaspoon Italian seasoning blend
- 1/4 teaspoon crushed red chili pepper flakes
- 3 tablespoons chopped fresh basil leaves
Directions:
- Slice each chicken breast horizontally into two even cutlets. Season each side with salt and pepper.
- In a large non-stick skillet, warm olive oil over medium-high heat. Add chicken cutlets, cooking until each side is browned and chicken is almost cooked through, about 4 minutes per side. Remove chicken to a plate and cover with foil.
- Add minced or pressed garlic to the skillet, reduce heat to medium low, and sauté until fragrant, about 30 seconds. Add broth and scrape the bottom of the pan to get up any bits stuck to the bottom.
- Add heavy cream and cream cheese, stirring until cream cheese is melted and sauce comes to a simmer, about 4 minutes. Add parmesan cheese and continue to stir until cheese is fully melted, another 2 minutes.
- Stir in chopped sun-dried tomatoes, Italian seasoning, and red pepper flakes.
- Add the chicken and any accumulated juices back to the skillet, cover and allow to simmer until the sauce is thickened and the chicken is fully cooked, 4-6 minutes more.
Cooking tip: Slicing chicken breasts into cutlets is very helpful for reducing the cooking time and keeping the chicken tender. There are some excellent online video tutorials to help you master the technique. The basic idea is to lay a breast flat on a cutting board. Use the hand you do not hold your knife with to hold the chicken breast flat. Take a sharp knife and starting at the thickest end of the chicken breast, slice the chicken in half horizontally, halving the thickness. Cooking time will depend on the thickness of your cutlets. Ours were about 1-inch thick at their thickest, which is what the cooking times are based on.
Read also: Is Modified Wheat Starch Keto-Friendly?
Dessert Recipes
- Apple Cobbler
- Avocado Brownies
- Birthday Cupcake
- Blueberry Yogurt Bunnies
- Caramel Pecan Tarts
- Carrot Cake Cookies
- Cheesecake
- Chocolate Brownie
- Chocolate Chip Cookies - for helpful cooking tips, watch our video
- Chocolate Chunk Cookies
- Chocolate Nut Fudge
- Chocolate Peanut Butter Cups
- Chocolate Pudding
- Churros
- Cinnamon Graham KetoBar - for helpful cooking tips, watch our video
- Cinnamon Pecan Cookies
- Cinnamon Rolls
- Coconut and Peanut Butter Candies
- Creamy Jell-O®
- Creme Brulee
- Cupcakes with Chocolate Buttercream Frosting
- Festive Jell-O Cup
- Gummy Bears
- Iced Pumpkin Cake
- Ice Cream Cone
- Frozen Fruity Cream Cheese Treats - for helpful cooking tips, watch our video
- Fudge Brownie - for helpful cooking tips, watch our video
- Jell-O Parfait®
- Key Lime Pie
- Lemon Almond Cake - for helpful cooking tips, watch our video
- Marshmallows
- Marshmallow Cereal Treat
- Nut Bars
- Orange Creamsicle Ice Cream
- Peanut Butter Cookies
- Pumpkin Fudge Pops
- Pumpkin Pecan Cheesecake
- Raspberry Meringue - for helpful cooking tips, watch our video
- Snickerdoodle Cookie
- Strawberry Chocolate Ice Cream
- Strawberry Coconut Ice Cream
- Strawberry Shortcake
- Strawberry Sunflower Bar - for helpful cooking tips, watch our video
- Strawberry Valentines
- Sugar Cookies
- Vanilla Cream Cakes
- Vanilla Ice Cream
- Watermelon Sorbet
- Whoopie Pie
Modified Diet Recipes
The modified ketogenic diet (MKD) recipes should only be followed if specifically prescribed the MKD by your medical team.
- Birthday Cupcake
- Broccoli Cheddar Discs
- Cauliflower Parmesan Sticks
- Cheese Pizza
- Chicken Bites
- Chocolate Glazed Donuts
- Oatmeal & Raspberries - for helpful cooking tips, watch our video
- Waffles
Helpful Tips & Tricks for the Ketogenic Diet
Fat Hiding Tricks
- Combine weighed heavy cream and mayonnaise with weighed raw eggs, cook the mixture in a pan to form fluffy scrambled eggs.
- Add weighed canola oil to weighed yogurt; the oil will completely absorb and blend into the yogurt.
- Mix weighed room temperature butter into weighed creamy peanut butter. This not only helps hide fat, but also increases the volume of the spread.
- Add weighed canola oil into weighed liquid heavy cream. Use a milk frother (used to make cappuccinos) to emulsify the two together perfectly. Can be served as a drink!
Cooking Tips
- When weighing your ketogenic ingredients in one bowl, always start with the dry ingredients. Try to form small mounds of the dry ingredients while weighing to allow for easy removal if the weight goes over. The liquid ingredients (heavy cream, oil, etc.) should be weighed in a separate bowl individually. The reason for this is because if you weigh two liquids together and go over on the weight, you will not be able to safely remove the one liquid due to them mixing together.
- Always be sure to use nonstick cooking spray (any brand). Ketogenic foods tend to stick more than regular foods due to their high fat content. It’s important that no food residue is left behind on any cookware to avoid losing nutritional value.
- Dry seasonings can be used on the ketogenic diet as a “free” ingredient (single dry seasonings only, not pre-packaged mixes). In large quantities, fat tends to mask the natural flavors of foods that we know and love, therefore we encourage you to season the foods with dry seasonings to make them tasty and enjoyable. Especially salt!
- Ketogenic foods generally freeze very well, however the reheating process can be tricky. When reheating foods, the fats always tend to melt first, which is the main component for ketogenic foods. The best way to reheat keto foods is in the oven or on the stove top.
- When baking ketogenic foods, never fill molds all the way to the top (¾ full is ideal). During the baking process, the heat may make the fat separate from the recipe, creating a pool of fat on the top. If the recipe is filled all the way to the top, the melted fat will go over the edge and result in loss of nutritional value.