{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T06:16:47Z","timestamp":1778134607283,"version":"3.51.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100001260","name":"National Organization for Rare Disorders","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001260","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:p>The ketogenic diet, a high-fat, low-carbohydrate diet, is an established treatment for patients with severe epilepsy. We have previously reported a moderate reduction in seizure frequency in drug-resistant epilepsy after treatment with a modified Atkins diet (MAD). In this study, we report the mean dietary intake, including micronutrients, in 56 adults, prospectively recorded at 4 and 12\u202fweeks. All reported values describe food intake alone, excluding vitamin and mineral supplements. To the best of our knowledge, this is the first report of micronutrient intake in adults on the MAD. The mean dietary intake of fat-soluble vitamins A, D, and E was higher, while the intake of several water-soluble vitamins, electrolytes, and minerals was lower compared with that of a population-based reference population consuming a habitual diet. This difference was most likely due, in line with expectations, to the high-fat, low-carbohydrate dietary content. Dietary intake of vitamin C and potassium in both men and women was 25\u201350% lower than that recommended by the Nordic Nutrition Recommendations 2023 (NNR 2023). Among women, vitamin D, folate, calcium, iodine, and selenium were also 25\u201350% lower than recommended, while iron at the 12-week follow-up was &amp;gt;50% lower. Furthermore, magnesium and zinc were lower than the recommended levels but less pronounced (&amp;lt;25%) in both men and women. Among women, riboflavin and vitamin B6 were &amp;lt;25% below the recommended levels, and among men, folate, calcium, and selenium were &amp;lt;25% below recommendations. The mean fiber intake of the study population (24\u202fg\/day) was in line with the reference population and almost in accordance with recommendations. When combining intake from diet and supplements, the mean intake of each nutrient was within the NNR 2023 recommendations. Our findings indicate that treatment with MAD resulted in lower dietary intakes of several water-soluble vitamins, electrolytes, and minerals compared with both a reference population and the NNR 2023 recommendations, highlighting the need for careful dietary monitoring, advice, and supplementation during MAD treatment.<\/jats:p>","DOI":"10.3389\/fnut.2026.1797011","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:45:04Z","timestamp":1778132704000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Micronutrient intake in adults with drug-resistant epilepsy treated with the modified Atkins diet needs monitoring"],"prefix":"10.3389","volume":"13","author":[{"given":"Ida","family":"Kjendbakke","sequence":"first","affiliation":[{"name":"National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaja Kristine","family":"Selmer","sequence":"additional","affiliation":[{"name":"National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital","place":["Oslo, Norway"]},{"name":"Department of Research and Innovation, Division of Clinical Neuroscience, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl Otto","family":"Nakken","sequence":"additional","affiliation":[{"name":"National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dag","family":"Hofoss","sequence":"additional","affiliation":[{"name":"National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Per Ole","family":"Iversen","sequence":"additional","affiliation":[{"name":"Department of Nutrition, University of Oslo","place":["Oslo, Norway"]},{"name":"Department of Haematology, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magnhild","family":"Kverneland","sequence":"additional","affiliation":[{"name":"National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital","place":["Oslo, Norway"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"CD001903","DOI":"10.1002\/14651858.CD001903.pub5","article-title":"Ketogenic diets for drug-resistant epilepsy","volume":"2020","author":"Martin-McGill","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"16","DOI":"10.3390\/ijerph191610429","article-title":"Ketogenic diet benefits to weight loss, glycemic control, and lipid profiles in overweight patients with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials","volume":"19","author":"Zhou","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"952","DOI":"10.1093\/nutrit\/nuab080","article-title":"Efficacy and tolerability of the ketogenic diet and its variations for preventing migraine in adolescents and adults: a systematic review","volume":"79","author":"Caminha","year":"2021","journal-title":"Nutr Rev"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s13195-021-00783-x","article-title":"Randomized crossover trial of a modified ketogenic diet in Alzheimer\u2019s disease","volume":"13","author":"Phillips","year":"2021","journal-title":"Alzheimer's Res Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1358578","DOI":"10.3389\/fpsyt.2024.1358578","article-title":"Sleep, mood disorders, and the ketogenic diet: potential therapeutic targets for bipolar disorder and schizophrenia","volume":"15","author":"Choi","year":"2024","journal-title":"Front Psychol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1306","DOI":"10.1002\/mds.27390","article-title":"Low-fat versus ketogenic diet in Parkinson\u2019s disease: a pilot randomized controlled trial","volume":"33","author":"Phillips","year":"2018","journal-title":"Mov Disord"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1038\/s41582-022-00651-8","article-title":"The metabolic basis of epilepsy","volume":"18","author":"Rho","year":"2022","journal-title":"Nat Rev Neurol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1111\/j.1365-277X.2011.01172.x","article-title":"The effect of the classical and medium-chain triglyceride ketogenic diet on vitamin and mineral levels","volume":"25","author":"Christodoulides","year":"2012","journal-title":"J Hum Nutr Diet"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"274","DOI":"10.1016\/j.clnesp.2025.07.023","article-title":"The nutritional adequacy of the ketogenic diet in paediatric epilepsy: detailed nutrient analysis and dietary recommendations","volume":"69","author":"Tsang","year":"2025","journal-title":"Clin Nutr ESPEN"},{"key":"ref10","doi-asserted-by":"crossref","DOI":"10.6027\/nord2023-003","volume-title":"Nordic Nutrition Recommendations 2023","author":"Blomhoff","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1111\/epi.14457","article-title":"Effect of modified Atkins diet in adults with drug-resistant focal epilepsy: a randomized clinical trial","volume":"59","author":"Kverneland","year":"2018","journal-title":"Epilepsia"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/1475-2891-9-37","article-title":"Evaluation of energy and dietary intake estimates from a food frequency questionnaire using independent energy expenditure measurement and weighed food records","volume":"9","author":"Carlsen","year":"2010","journal-title":"Nutr J"},{"key":"ref13","year":""},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2235","DOI":"10.1111\/epi.16364","article-title":"Pharmacokinetic interaction between modified Atkins diet and antiepileptic drugs in adults with drug-resistant epilepsy","volume":"60","author":"Kverneland","year":"2019","journal-title":"Epilepsia"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1002\/epi4.12225","article-title":"Optimal clinical management of children receiving dietary therapies for epilepsy: updated recommendations of the international ketogenic diet study group","volume":"3","author":"Kossoff","year":"2018","journal-title":"Epilepsia Open"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1212\/CPJ.0000000000001007","article-title":"International recommendations for the management of adults treated with ketogenic diet therapies","volume":"11","author":"Cervenka","year":"2021","journal-title":"Neurol Clin Pract"},{"key":"ref17","volume-title":"Norkost 4: Summary","author":"Myhre","year":"2024"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1186\/s12937-024-01066-5","article-title":"Nutritional quality and climate impact of Norwegian adults' diet classified according to the NOVA system","volume":"23","author":"Slaathaug","year":"2024","journal-title":"Nutr J"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"100155","DOI":"10.1016\/j.advnut.2023.100155","article-title":"Vitamin C","volume":"15","author":"Lykkesfeldt","year":"2024","journal-title":"Adv Nutr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1111\/dmcn.14393","article-title":"Potassium citrate and metabolic acidosis in children with epilepsy on the ketogenic diet: a prospective controlled study","volume":"62","author":"Bjurulf","year":"2019","journal-title":"Dev Med Child Neurol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"200384","DOI":"10.1016\/j.ijcrp.2025.200384","article-title":"Low carbohydrate high-fat diet in real life: a descriptive analysis of cardiovascular risk factors","volume":"25","author":"Hagstr\u00f6m","year":"2025","journal-title":"Int J Cardiol Cardiovasc Risk Prev"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1017\/S0029665121000550","article-title":"Sex differences in requirements for micronutrients across the lifecourse","volume":"80","author":"Prentice","year":"2021","journal-title":"Proc Nutr Soc"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1348456","DOI":"10.3389\/fnut.2024.1348456","article-title":"Assessing gender differences in food preferences and physical activity: a population-based survey","volume":"11","author":"Feraco","year":"2024","journal-title":"Front Nutr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2","DOI":"10.4045\/tidsskr.18.0319","article-title":"Is iodine intake adequate in Norway?","volume":"139","author":"Henjum","year":"2019","journal-title":"Tidsskr Nor Laegeforen"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1079\/PHN2003554","article-title":"The iodine content of Norwegian foods and diets","volume":"7","author":"Dahl","year":"2004","journal-title":"Public Health Nutr"},{"key":"ref26","volume-title":"Salt and the Salt Partnership","year":"2026"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1678","DOI":"10.3945\/ajcn.2008.26099","article-title":"Progressive bone mineral content loss in children with intractable epilepsy treated with the ketogenic diet","volume":"88","author":"Bergqvist","year":"2008","journal-title":"Am J Clin Nutr"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"880","DOI":"10.1111\/epi.17169","article-title":"Substantial early changes in bone and calcium metabolism among adult pharmacoresistant epilepsy patients on a modified Atkins diet","volume":"63","author":"Molteberg","year":"2022","journal-title":"Epilepsia"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"3491","DOI":"10.1007\/s10072-020-04573-5","article-title":"Management of antiepileptic drug-induced nutrition-related adverse effects","volume":"41","author":"Safahani","year":"2020","journal-title":"Neurol Sci"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"68","DOI":"10.29219\/fnr.v68.10692","article-title":"Evaluation of dietary quality in patients with functional gastrointestinal symptoms: a Norwegian single-Centre study","volume":"68","author":"Holm","year":"2024","journal-title":"Food Nutr Res"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1016\/j.jada.2010.05.011","article-title":"Dietary behavior assessment: historical and recent innovations","volume":"110","author":"Millen","year":"2010","journal-title":"J Am Diet Assoc"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e0317370","DOI":"10.1371\/journal.pone.0317370","article-title":"Relative validity and reproducibility of a short semi-quantitative food frequency questionnaire for Chinese athletes","volume":"20","author":"Xu","year":"2025","journal-title":"PLoS One"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1054\/clnu.2001.0460","article-title":"Use of a three-day estimated food record, a 72-hour recall and a food-frequency questionnaire for dietary assessment in a Mediterranean Spanish population","volume":"20","author":"Schr\u00f6der","year":"2001","journal-title":"Clin Nutr"}],"container-title":["Frontiers in Nutrition"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1797011\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:45:06Z","timestamp":1778132706000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnut.2026.1797011\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,7]]},"references-count":33,"alternative-id":["10.3389\/fnut.2026.1797011"],"URL":"https:\/\/doi.org\/10.3389\/fnut.2026.1797011","relation":{},"ISSN":["2296-861X"],"issn-type":[{"value":"2296-861X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,7]]},"article-number":"1797011"}}