The modified Atkins diet (MAD) has been effectively used in children and adults with drug-resistant epilepsy (DRE) for almost two decades [1–7], however long-term compliance remains a major challenge to successful implementation [8,9]. KetoCal® is a ready-to-drink 4:1 ratio (fat: carbohydrates and protein in grams) nutritionally complete liquid formula that can be used as a meal substitute or supplement. A 2011 prospective study of 30 children with intractable epilepsy treated with MAD in combination with daily KetoCal® (powder mixed with water or used as a baking mix) found that children tolerated KetoCal® and that there was a >50% seizure reduction in 80% of participants after 1 month [10], which is on average over 30% greater than rates reported previously for MAD alone in pediatric populations [11–14].
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