Ketogenic diet (KD) is used worldwide in the treatment of medically refractory epilepsy. Since the introduction of KD in the early 1900s, new approaches such as medium-chain triglyceride ketogenic diet, modified Atkins diet and low glycaemic index treatment have been suggested as alternative treatments. Several studies have documented significant seizure reduction from all four diets. The aim of this article is to give an overview of the effect of dietary treatment and to discuss advantages in initiating dietary treatment as an early treatment instead of as a last option.