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Background Gliomas are the most dreaded primary brain tumour because of their dismal cure rates. Ketogenic-type diets (KDS) are high-fat, low-protein, and low-carbohydrate diets; the modified Atkins diet (MAD) is a less-stringent version of a KD that still generates serum ketones in patients. The purpose of the present study was to retrospectively examine the feasibility of attaining ketosis and the safety of the mad in patients undergoing radiation and chemotherapy treatment for glioma. The rate of pseudoprogression (PSP) after treatment was also assessed as a marker of radiation sensitization. To our knowledge, this dataset is the largest published relating to patients with glioma undergoing KD during radiation and chemotherapy. Methods We retrospectively studied 29 patients with grades ii–iv astrocytoma following the MAD during standard radiation and chemotherapy. Feasibility of attaining ketosis was assessed though levels of beta hydroxybutyrate in blood. Pre- and post-radiation magnetic resonance images were evaluated for PSP by a neuroradiologist blinded to patient data. Results In the 29 patients who started the MAD during radiation, ketosis was achieved in all 29 (100%). No serious adverse events occurred secondary to the MAD. Of those 29 patients, 19 had glioblastoma multiforme. Of the latter 19 patients, 11 (58%) showed PSP after mad and radiation and temozolomide therapy. Conclusions A modified Atkins diet is feasible and safe for glioma patients during radiation and chemotherapy treatment. The MAD and resulting ketosis could play a role as a radiation sensitizer. [ABSTRACT FROM AUTHOR]