PDF Reader Android

PDF Reader is a viewer for PDF-Files on ANDROID mobiles.

Comparison of e-book readers

An e-book reader is a portable electronic device that is designed primarily for the purpose of reading digital books and periodicals.

E-book readers are similar in form to a tablet computer. A tablet computer typically has a faster screen capable of higher refresh rates which makes them more suitable for interaction. The main advantages of e-book readers are better readability of their screens especially in bright sunlight and longer battery life. This is achieved by using electronic paper technology to display content to readers.

Any device that can display text on a screen can act as an e-book reader, but without the advantages of the e-paper technology.

Contents

Commercially available devices sold by maker or designer

Notes:

  • Library compatible – Can be used to borrow e-books from public libraries, i.e. the EPUB and/or PDF formats with digital-rights-management (DRM) protection are supported.
  • Listed by maker chronologically by year of release, newest first.
  • Only products listed that either the product itself or its company is notable, as shown by having a Wikipedia article (without notability notice).
  • When looking at two books read the back

Electronic-paper displays

Maker Model Intro year End year Orig MSRP Screen size (inch) Self-lit Screen type Weight Screen pixels Screen shades Touch screen[a] Wireless network Text-to-speech Integrated dictionary Directory organization Internal storage Card reader slot Replaceable battery Web browser Library compatible USB peripherals
Aluratek Libre Ebook Reader Pro 2009 ? $129.99 5 No ePaper 213 g (7.5 oz) 600 × 800 ? No No No No ? ? SDHC 32 GB ? No ? No
Amazon.com Kindle Paperwhite 3G 2012 ? $199 6 Yes eInk Pearl 221 g (7.8 oz) 758 × 1024 16 Yes 2-Point Multi-touch Wi-Fi,
3G CDMA,
3G GSM
No Yes Yes 2 GB
(1.25 GB)
No No Yes Yes (US only) No
Amazon.com Kindle Paperwhite Wi-Fi 2012 ? $139 6 Yes eInk Pearl 213 g (7.5 oz) 758 × 1024 16 Yes 2-Point Multi-touch Wi-Fi No Yes Yes 2 GB
(1.25 GB)
No No Yes Yes (US only) No
Amazon.com Kindle (4th generation) 2011 ? $109 6 No eInk Pearl 170 g (6.0 oz) 600 × 800 16 No Wi-Fi No Yes Yes 2 GB
(1.25 GB)
No No Yes Yes (US only) No
Amazon.com Kindle Touch 3G[1] 2011 2012 $189 6 No eInk Pearl 220 g (7.8 oz) 600 × 800 16 Yes Wi-Fi,
3G CDMA,
3G GSM
Yes Yes Yes 4 GB
(3 GB)
No No Yes Yes (US only) No
Amazon.com Kindle Touch 2011 2012 $139 6 No eInk Pearl 213 g (7.5 oz) 600 × 800 16 Yes Wi-Fi Yes Yes Yes 4 GB
(3 GB)
No No Yes Yes (US only) No
Amazon.com Kindle 3 Wi-Fi 3G (now Kindle Keyboard 3G)[2] 2010 2011 $189 6 No eInk Pearl 247 g (8.7 oz) 600 × 800 16 No Wi-Fi,
3G CDMA,
3G GSM
Yes Yes Yes 4 GB
(3 GB)
No No Yes Yes (US only) No
Amazon.com Kindle 3 Wi-Fi (now Kindle Keyboard)[3] 2010 2011 $139 6 No eInk Pearl 241 g (8.5 oz) 600 × 800 16 No Wi-Fi Yes Yes Yes 4 GB
(3 GB)
No No Yes Yes (US only) No
Amazon.com Kindle DX 1st gen white 2009 2011 $489 9.7 No eInk 540 g (19 oz) 824 × 1200 16 No 3G CDMA (USA),
3G GSM
Yes Yes Yes 4 GB
(3.3 GB)
No No Yes (limited) Yes (US only) No
Amazon.com Kindle DX 4th gen graphite 2010 2012 $379 9.7 No eInk Pearl 535 g (18.9 oz) 824 × 1200 16 No 3G HSDPA/GSM Yes Yes Yes 4 GB
(3.3 GB)
No No Yes (limited) Yes (US only) No
Amazon.com Kindle 2 2009 2010 $359 6 No eInk 289 g (10.2 oz) 600 × 800 16 No 3G CDMA (USA),
3G GSM (World)
Yes Yes Yes 2 GB
(1.4 GB)
No No Yes (limited) Yes (US only) No
Amazon.com Kindle 2007 2009 $399 6 No eInk 289 g (10.2 oz) 600 × 800 4 No CDMA No Yes No 256 MB
(180 MB)
SD Yes Yes (limited) Yes (US only) No
Asus EEE Reader DR-900 2010 2010 €319 9 No SiPix 440 g (16 oz) 768 × 1024 16 Yes WLAN Yes Yes Yes 2 GB microSD No Yes No Yes
Barnes & Noble Nook 2009 2011 $259 6 No eInk 343 g (12.1 oz) 600 × 800 16 Bottom Wi-Fi, UMTS (option) No Yes (FW v1.5) 2 GB
(1.3 GB)
microSDHC Yes Yes
(FW v1.3)
Yes No
Barnes & Noble Nook Simple Touch 2011 ? $139 6 No eInk Pearl 212 g (7.5 oz) 600 × 800 16 Yes Wi-Fi No Yes Yes 2 GB microSDHC No No Yes No
Bookeen Cybook Odyssey HD FrontLight[4] 2012 ? €149.99 6 (with PDF reflow) Yes eInk Pearl + HSIS[5] 212 g (7.5 oz) 758 × 1024 16 Yes Wi-Fi, 802.11bgn No French, wiktionary Yes 2 GB microSDHC No Yes Yes No
Bookeen Cybook Odyssey 2011 ? €149 6 No[6] eInk Pearl + HSIS[7] 195 g (6.9 oz) 600 × 800 16 Yes Wi-Fi, 802.11bgn No French Yes 2 GB microSDHC No Yes Yes No
Bookeen Cybook Orizon 2010 ? €229.99 6 No[6] eInk SiPix 245 g (8.6 oz) 600 × 800 16 Yes Wi-Fi, 802.11bgn, Bluetooth 2.1+EDR No No Yes 2 GB microSDHC No Yes Yes No
Bookeen Cybook Opus 2009 ? €199 5 No[6] eInk 150 g (5.3 oz) 600 × 800 4 No No No No Yes 1 GB microSDHC Yes No Yes No
Bookeen Cybook Gen3 2007 ? $350 6 No eInk 174 g (6.1 oz) 600 × 800 4, 8 or 16 No No No No Yes 16 MB, 512MB, 1 GB SD Yes No Yes No
bq[8] movistar ebook bq 2011 ? €169 6 No AUO +SiPix 244 g (8.6 oz) 600 × 800 16 Yes Wi-Fi ? Yes ? 2 GB microSDHC max 16 GB No[Secure Digital|microSDHC] Yes Yes No
Condor Technology[9] eGriver Touch[10] 2010 ? $350 6 No eInk 240 g (8.5 oz) 600 × 800 16 Yes Wi-Fi Optional Yes Yes 2 GB SDHC No Yes ? No
Condor Technology[9] eGriver IDEO[10] 2010 ? $230 6 No eInk ? 600 × 800 16 No No Optional Yes Yes 1 GB SDHC No No ? No
Ectaco JetBook Color[11] 2012 ? $599.95 9.7 No Triton Color E Ink 662 g (23.4 oz) 1200 × 1600 ? Yes Yes Yes Yes Yes Yes (unknown size)[12] microSDHC up to 32 GB ? ? ? Yes[13]
Elonex 621EB 2009 ? £157 no VAT 6 No eInk 180 g (6.3 oz) 600 × 800 8 No No ? No ? 512 MB microSDHC ? ? ? No
EnTourage eDGe 2010 2011[14] $499 9.7 No eInk & LCD 1,400 g (49 oz) 825 × 1200 8 Yes Yes, Wi-Fi, Bluetooth Yes
(Pico TTS)
Yes Yes 3 GB (322 MB for apps) SD max 32 GB Yes Yes Yes Yes
EnTourage Pocket eDGe 2010 2011[14] $399 6 No eInk & LCD 700 g (25 oz) 600 × 800 16 Yes Wi-Fi, Bluetooth Yes
(Pico TTS)
Yes Yes 3 GB microSD No Yes Yes ?
Fnac FnacBook[15] 2010 2011 [16] €229 6 No eInk 240 g (8.5 oz) 600 × 800 16 Yes Wi-Fi, GPRS, Edge, HSDPA Yes Yes ? 2 GB microSD No Wi-Fi: Yes,[17] HDSPA: Limited Yes[18] ?
Foxit Software eSlick 2009 2010[19] $259.99 6 No eInk 180 g (6.3 oz) 600 × 800 16 No No No No No 512 MB SDHC Yes No ? ?
Icarus Reader Excel 2012 ? €349.95 9.7 No eInk Pearl 530 g (19 oz) 825 × 1200 16 Yes Wi-Fi) Yes Yes ? 4 GB SDHC 32 GB No Yes ? ?
Icarus Reader Icarus Reader Go[20] 2010 ? £95 6 No eInk 178 g (6.3 oz) 600 × 800 8 No Wi-Fi, UMTS (option) No No (FW v1.5) 2 GB
(1.3 GB)
microSD No No Yes ?
Icarus Reader Icarus Reader Sense[21] 2010 ? €229 6 No SiPix 240 g (8.5 oz) 600 × 800 16 Yes Wi-Fi No Yes Yes 2 GB
(1.3 GB)
microSD No Yes Yes ?
iRex Technologies Digital Reader 800 2010 2010[22] €499 8.1 No eInk 360 g (13 oz) 768 × 1024 16 Yes No ? Yes Yes 128 MB SDHC Yes No Yes ?
iRex Technologies Digital Reader 1000 2008 2010[22] £599 10.2 No eInk 700 g (25 oz) 1024 × 1280 16 YesWacom pen No No Yes Can use dictionaries in various formats Yes No SD No No Yes Yes
iRex Technologies iLiad 2006 2010[22] €649 8.1 No eInk 480 g (17 oz) 768 × 1024 16 Yes Wi-Fi No No Yes 64 MB SD, CF No No Yes ?
Iriver Story 2009 ? £230 6 No eInk 233 g (8.2 oz) 600 × 800 8 No No ? ? ? 2 GB SDHC ? ? Yes ?
Iriver Iriver Story HD 2011 ? $139 6 No eInk Pearl[23] 207 g (7.3 oz) 768 × 1024 16 No Wi-Fi No Yes ? 2 GB SDHC No No Yes Yes
JinKe Hanlin V5[24] 2009 ? $199 5 No eInk 160 g (5.6 oz) 600 × 800 8 No ? Yes ? ? 512 MB SDHC 16 GB ? ? ? ?
JinKe Hanlin V3 2007 2008 €240 6 No eInk ? 600 × 800 12 No No No No Yes 384 MB SDHC Yes No Yes No
JinKe Hanlin V2 2006 2007 $349 6 No eInk ? 600 × 800 4 ? ? ? ? ? ? ? ? ? ? ?
Kobo Inc.[25] Kobo Glo 2012 ? $130 6 Yes eInk Pearl 185 g (6.5 oz) 758 × 1024 16 Yes Wi-Fi No Yes No 2 GB microSD No Yes Yes Yes
Kobo Inc.[25] Kobo Mini 2012 ? $80 5 No eInk Vizplex V110 134 g (4.7 oz) 600 × 800 16 Yes Wi-Fi No Yes No 2 GB No No Yes Yes Yes
Kobo Inc.[25] Kobo Touch 2011 ? $129 6 No eInk Pearl 200 g (7.1 oz) 600 × 800 16 Yes Wi-Fi No Yes No 2 GB microSD No Yes Yes Yes
Kobo Inc.[25] Kobo eReader Wireless N647 2010 2011 $130 6 No eInk 221 g (7.8 oz) 600 × 800 16 No Wi-Fi No Yes ? 1 GB SD 4 GB No No Yes ?
Kobo Inc.[25] Kobo eReader N416 2010 2011 $149 6 No eInk 221 g (7.8 oz) 600 × 800 8 No Bluetooth No Yes ? 1 GB SD No Yes Yes ?
Kogan Technologies[26] Kogan eBook Reader[26] 2010 ? $189 6 No eInk 228 g (8.0 oz) 600 × 800 16 No No No Yes Yes 2 GB SDHC No No ? ?
Kolporter eClicto 2007 ? 899 6 No eInk 174 g (6.1 oz) 600 × 800 4 No No No No ? 512 MB SD Yes No ? ?
Kyobo Inc. Kyobo E-reader Mirasol 2011 ? 349k 5.7 No Mirasol 294 g (10.4 oz) 768 × 1024 ? Yes Wi-Fi Yes Yes ?  ? GB SDHC No Yes ? Yes
Onyx International[27] Boox X60[28] 2010 ? $329 6 No eInk 298 g (10.5 oz) 600 × 800 8 Stylus[29] Wi-Fi Optional Yes Yes 512 MB SDHC [30] Yes ? ?
Onyx International Boox X61S[31] 2011 ? ? 6 No eInk Pearl 275 g (9.7 oz) 600 × 800 16 No No ? ? Yes 2 GB SDHC ? ? ? ?
Onyx International Boox i62[32] 2011 ? ? 6 No eInk Pearl 238 g (8.4 oz) 600 × 800 16 Yes (IR) Yes ? ? ? 4 GB SDHC ? ? ? ?
Onyx International[27] Boox M92[33] 2011 ? $499.99 9.7 No eInk Pearl 520 g (18 oz) 825 × 1200 16 Stylus[33] Wi-Fi Optional Yes Yes 4096 MB SDHC Yes Yes ? ?
PocketBook PocketBook 360 Plus 2011 ? $239.99 5 No eInk 150 g (5.3 oz) 600 × 800 16 No Wi-Fi 802.11b/g Yes Yes Yes 2 GB microSDHC Yes Yes Yes [34]
PocketBook PocketBook Pro 903 2010 ? $399 9.7 No eInk 581 g (20.5 oz) 825 × 1200 16 Stylus Wi-Fi 802.11b/g, Bluetooth, UMTS + GPRS Yes Yes Yes 2 GB microSDHC Yes Yes Yes [34]
PocketBook PocketBook Pro 902 2010 ? $349 9.7 No eInk 530 g (19 oz) 825 × 1200 16 No Wi-Fi 802.11b/g, Bluetooth Yes Yes Yes 2 GB microSDHC Yes Yes Yes [34]
PocketBook PocketBook Pro 603[35] 2010 ? ? 6 No eInk 280 g (9.9 oz) 600 × 800 16 Stylus Wi-Fi 802.11b/g, Bluetooth, UMTS + GPRS Yes Yes Yes 2 GB microSDHC Yes Yes Yes [34]
PocketBook PocketBook Pro 602[36] 2010 ? ? 6 No eInk 250 g (8.8 oz) 600 × 800 16 No Wi-Fi 802.11b/g, Bluetooth Yes Yes Yes 2 GB microSDHC Yes Yes Yes [34]
Samsung Papyrus 2009 ? $299 5 No eInk 184 g (6.5 oz) 600 × 800 8 Yes No Yes Yes ? 512M No ? ? Yes ?
Samsung E6 2010 ? $399 6 No eInk 315 g (11.1 oz) 600 × 800 8 Stylus Wi-Fi 802.11b/g, Bluetooth Yes Yes Yes 2 GB
(1.4 GB)
microSD Yes Limited Yes ?
Sony Reader Wi-Fi PRS-T2 2012 ? $129.99 6 No eInk Pearl 167 g (5.9 oz) 600 × 800 16 Yes 2-Point Multi-touch Wi-Fi No Yes collections 2 GB
(1.3 GB)
microSDHC No ? Yes ?
Sony Reader Pocket Edition PRS-350[37] 2010 2011 $179.99 5 No eInk Pearl 155 g (5.5 oz) 600 × 800 16 Yes No No Yes collections 2 GB
(1.4 GB)
No No No Yes ?
Sony Reader Touch Edition PRS-650[38] 2010 2011 $229.99 6 No eInk 215 g (7.6 oz) 600 × 800 16 Yes No No Yes collections 2 GB
(1.4 GB)
SDHC, MS Pro DUO No No Yes ?
Sony Reader Daily Edition PRS-900 2009 2011 $349 7.1 No eInk 283 g (10.0 oz) 600 × 1024 16 Yes No No Yes ? 2 GB SDHC, MS Pro DUO ? ? Yes ?
Sony Reader Touch Edition PRS-600 2009 2010 $199.99 6 No eInk 286 g (10.1 oz) 600 × 800 8 Yes No No Yes ? 512 MB
(380 MB)
SDHC, MS PRO Duo No No Yes ?
Sony Reader Pocket Edition PRS-300 2009 2010 $199.99 5 No eInk 220 g (7.8 oz) 600 × 800 8 No No No No ? 512 MB
(480 MB)
No No No Yes ?
Sony Reader Pocket Edition PRS-300SC 2011 ? $149.99 5 No eInk Vizplex 220 g (7.8 oz) 600 × 800 8 No No No No ? 512 MB
(350 MB)
No No No Yes ?
Sony Reader PRS-700 2008 2009 $349.99 6 Yes eInk 283 g (10.0 oz) 600 × 800 8 Yes ? ? ? ? 512 MB SDHC ? ? Yes ?
Sony Reader PRS-505 2008 2009 $299.99 6 No eInk 250 g (8.8 oz) 600 × 800 8 No No No No ? 256 MB,
(192 MB)
SD, MS No No Yes ?
Sony Reader PRS-500 2006 2008 $299 6 No eInk 250 g (8.8 oz) 600 × 800 8 No No No No No 92 MB SD No No Yes ?
Sony Reader PRS-T1 2011 ? $129.99 6 No eInk Pearl 168 g (5.9 oz) 600 × 800 16 Yes (IR) Wi-Fi No Yes Yes 2 GB (1.3 GB) Micro-SD No Yes Yes ?
Sony Librié 2004 2005 ¥40,000 6 No eInk 190 g (6.7 oz) 600 × 800 4 No No No Yes No 10 MB Yes No Yes ? ?
Spring Design[39] Alex eReader 2010 2011 $399 6 No eInk & LCD 221 g (7.8 oz) 600 × 800 8 Yes Wi-Fi No Yes No 2 GB SD Yes Yes ? ?
textr beagle 2012 $13 [40] 5 [41] LED LED 128 grams (with batteries) 600 x 800 8 no text-to-speech 4 GB two AAA batteries
Maker Model Intro year End year Orig MSRP Screen size (inch) Self-lit Screen type Weight Screen pixels Screen shades Touch screen[a] Wireless network Text-to-speech Integrated dictionary Directory organization Internal storage Card reader slot Replaceable battery Web browser Library compatible USB peripherals

Non-electronic-paper displays

Maker Model Intro year Screen size (inch) Screen type Weight Screen pixels Screen shades Hours reading[b] Operating system Touch screen[a] Wireless network Text-to-speech Integrated dictionary Directory organization Internal storage Card reader slot Replaceable battery Web browser Library compatible USB peripherals
Aluratek Libre Touch eBook Reader 2011 7 LCD 199 g (7.0 oz) 480 × 800 ? 8 Android 1.5 Yes Yes, Wi-Fi No No ? 4 GB microSD No Yes Yes No
Aluratek Libre Air eBook Reader 2011 5 LCD 170 g (6.0 oz) 480 × 640 16 grey scale 20 Linux+Xwindows No Yes, Wi-Fi No No ? 512 MB microSD No No Yes No
Aluratek Libre Color eBook Reader 2010 7 LCD 245 g (8.6 oz) 480 × 800 ? 24 MicroC/OS-II No No No No ? 2 GB SD No No Yes No
Aluratek Libre Pro eBook Reader 2009 5 LCD 190 g (6.7 oz) 480 × 640 16 grey scale 24 Linux+Xwindows No No No No ? 256 MB SD No No Yes No
Amazon.com Kindle Fire 2011 7 LCD(IPS)[42] 413 g (14.6 oz) 600 × 1024 24-bit color 8 Android 2.3 Yes Wi-Fi No[c] Yes ? 8 GB
(6 GB)
No No Yes Yes (US only) No
Apple Inc. iPad (3rd generation) 2012 9.7 LCD(IPS)[43] 652 g (23.0 oz), 662 g (23.4 oz) 2048 × 1536 24-bit? color 10 iOS Yes Wi-Fi, 3G Yes iBooks & system-wide dictionary with iOS 5 Yes 16-64 GB SD via camera connection kit No Yes ? Yes
Apple Inc. iPad 2 2011 9.7 LCD(IPS)[44] 613 g (21.6 oz) 768 × 1024 24-bit? color 10 iOS Yes Wi-Fi, 3G Yes iBooks & system-wide dictionary with iOS 5 Yes 16-64 GB SD via camera connection kit No Yes ? Yes
Apple Inc. iPad 2010 9.7 LCD 601 g (21.2 oz) 768 × 1024 24-bit? color 9 iOS Yes Wi-Fi Yes iBooks & system-wide dictionary with iOS 5 Yes 16-64 GB SD via Camera Connection Kit No Yes ? Yes
Barnes & Noble Nook Color 2010 7 LCD 450 g (16 oz) 600 × 1024 16M 8 Android 2.2 Yes Wi-Fi 802.11b/g/n for B&N Kids Books Yes Yes 2 GB, 1 GB available microSDHC No Yes Yes ?
Ectaco jetBook 2008 5 LCD 212 g (7.5 oz) 480 × 640 16 20 Linux No No No Yes Yes 112 MB SDHC No No Yes No
Elonex 705EB 2010 7 LED 190 g (6.7 oz) 480 × 800 256? 8 ? No No ? No ? 4 GB microSDHC ? No ? No
Notion Ink Adam[45] 2011 10.1 Pixel Qi 725 g (25.6 oz) 600 × 1024 ? 15 Android Yes Wi-Fi, 3G Yes ? ? 1GB DDR2 RAM
1GB SLC
microSD Yes Yes ? ?
PocketBook PocketBook IQ 701 2010 7 LCD 516 g (18.2 oz) 600 × 800 262K color 8 Android 2.0 Yes Wi-Fi Yes Yes Yes 2 GB SDHC Yes Yes Yes No
TrekStor eBook Reader 3.0 2011 7 LCD 275 g (9.7 oz) 800 × 480 ? 8 MicroC/OS-II No No No No Yes 2 GB microSDHC No No Yes No
Zzbook eReader HD[46] 2010 7 TFT-LCD 300 g (11 oz) 800 × 480 16 8 Linux No No ? ? ? 2 GB microSD ? ? ? ?
Maker Model Intro year Screen size (inch) Screen type Weight Screen pixels Screen shades Hours reading[b] Operating system Touch screen[a] Wireless network Text-to-speech Integrated dictionary Directory organization Internal storage Card reader slot Replaceable battery Web browser Library compatible USB peripherals

 

File format support

See Comparison of e-book formats for details on the file formats.

The most notable formats are:

  • .epub is a free and open e-book standard used by most e-book readers.
  • .azw is Amazon’s proprietary e-book file format for the Kindle.
Maker Model Number .arg .azw .chm .djvu .doc .epub .html .lbr .lit .mobi .mp3 .opf .pdb .pdg .pdf .tr3 .txt .fb2 .rtf .tcr .cbr .cbz .gif .jpg .png .tiff .bmp .docx .html .wmv .flv .m4v .mov .avi .mpeg1/2/4
Aluratek Liber Touch eBook Reader 9 No No No No No Yes No No No No Yes No No No Yes No Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) No No No Yes Yes Yes ? ? ? ? No Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only)
Aluratek Libre Air eBook Reader 11 No No No No No Yes Partial (non-DRM only) No No Partial (non-DRM only) Yes No No No Yes No Partial (non-DRM only) Partial (non-DRM only Partial (non-DRM only) No No No Yes Yes Yes ? ? ? ? No No No No No No
Aluratek Libre Color eBook Reader 10 No No No No No Yes Partial (non-DRM only) No No No Yes No No No Yes No Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) No No No Yes Yes Yes ? ? ? ? Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only) Partial (non-DRM only)
Aluratek Libre Pro eBook Reader 8 No No No No No Yes No No No Partial (non-DRM only) Yes No No No Yes No Partial (non-DRM only) Partial (non-DRM only) No No No No Yes Yes No ? ? ? ? No No No No No No
Amazon.com Kindle 3 Wi-Fi & 3G 12+ No Yes ? No Yes[47] No Yes[47] No No Partial (no DRM) Yes No No No Yes Yes Yes No ? ? ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ?
Amazon.com Kindle DX 12 No Yes ? No ? No Yes No No Partial (no DRM) Yes No No No Yes Yes Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Amazon.com Kindle 2 12 No Yes ? No ? No Yes No No Partial (no DRM) Yes No No No Yes Yes Yes No Yes ? ? No No ? ? ? ? ? ? ? ? ? ? ? ?
Amazon.com Kindle ? No Yes ? ? No No Yes No No Partial (no DRM) Yes No No No No No Yes No Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Asus Eee Reader DR900 ? No No No No No Yes Yes No No No Yes No No No Yes No Yes Yes No No No Yes Yes Yes Yes ? ? ? ? ? ? ? ? ? ?
Barnes & Noble Nook Color[48][49] 15+ No No No No Yes Yes Yes No No No Yes No Yes No Yes No Yes No No No ? ? ? ? ? ? ? ? Yes ? ? ? ? ? ?
Barnes & Noble nook[50] 4 No No No No No Yes Yes No No No Yes No Yes No Yes No No No No No ? ? ? ? ? ? ? No No ? ? ? ? ? ?
Barnes & Noble Nook Touch[51] 8 No No No No No Yes Yes No No No No No Yes No Yes No No No No No ? ? Yes Yes Yes ? Yes No No ? ? ? ? ? ?
Bookeen Cybook Orizon[52] 8 No No No No No Yes Yes No No No No No No No Yes No Yes Yes No No ? ? Yes Yes Yes ? ? ? Yes ? ? ? ? ? ?
Bookeen Cybook Opus[53] 6 No No No No Yes Yes Yes No No Yes No No No No Yes No Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Bookeen Cybook Gen3[53] 7 No No ? No ? Yes Yes No No Yes Yes No No No Yes No Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
bq movistar ebook bq 14 No No Yes Yes No Yes Yes No No No Yes No No No Yes No Yes Yes Yes No No No Yes Yes Yes No Yes No Yes No No No No No No
Condor Technology Associates[9] eGriver IDEO[10] 18 No No ? Yes ? Yes Yes No No Yes Yes Yes Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Condor Technology Associates[9] eGriver Touch[10] 8 No No ? Yes ? Yes Yes No No Yes Yes Yes Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
EBS Technology[54] Agebook+6 12 No No ? No ? Yes Yes No No No Yes Yes No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Ectaco JetBook Color[11] ? ? ? ? Yes ? Yes ? ? ? Yes Yes ? ? ? Yes ? Yes Yes Yes ? ? ? Yes Yes Yes ? Yes ? ? ? ? ? ? ? ?
Elonex eBook ? ? ? ? ? ? Yes Yes ? ? ? ? ? ? ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Endless ideas BeBook One (Hanlin V3 clone)[55] 23 No No ? Yes ? Yes Yes No Yes Yes Yes No No No Yes No Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Endless ideas BeBook Mini (Hanlin V5 clone)[55] 23 No No ? Yes ? Yes Yes No Yes Yes Yes No No No Yes No Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Foxit Corp. eSlick ? ? ? ? ? ? Yes ? ? ? ? Yes ? Yes ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Hanvon WISEreader N516[56] ? No ? No ? No Yes Yes No No No Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Hanvon WISEreader N518[57] ? No ? No ? No Yes Yes No No No Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Hanvon WISEreader N520[58] ? No ? No ? No Yes Yes No No No Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Hanvon WISEreader N526[59] ? No ? No ? No Yes Yes No No No Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Interead COOL-ER ? ? ? ? ? ? Yes Yes ? ? ? Yes ? ? ? Yes ? Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
iPapyrus Inc.[60] iPapyrus 6[61] ? ? ? ? ? ? Yes ? ? ? ? ? ? ? ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
iRex Technologies Digital Reader 800 ? ? ? ? ? ? Yes ? ? ? ? ? ? ? ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
iRex Technologies Digital Reader 1000 9 ? ? ? ? ? Yes Yes ? ? ? ? ? ? ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
iRex Technologies iLiad ? ? ? ? ? ? Yes ? ? ? Yes ? ? ? ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Iriver Story ? No ? No ? Yes Yes Yes Yes No ? Yes ? ? ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Maker Model Number .arg .azw .chm .djvu .doc .epub .html .lbr .lit .mobi .mp3 .opf .pdb .pdg .pdf .tr3 .txt .fb2 .rtf .tcr .cbr .cbz .gif .jpg .png .tiff .bmp .docx .html .wmv .flv .m4v .mov .avi .mpeg1/2/4
Iriver IRiver Story HD 15 No No No Yes Yes Yes Yes Yes No No No ? No ? Yes ? Yes Yes No ? No Yes Yes Yes Yes No Yes Yes Yes No No No No No No
italica GmbH[62] Paperback 1.0 6[63] No No ? No ? Yes Yes No No Yes Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
JinKe Hanlin V2 ? ? ? ? ? Yes Yes Yes ? Yes Yes Yes ? ? ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
JinKe Hanlin V3 19 ? ? ? Yes ? Yes Yes ? Yes Yes Yes ? ? ? Yes ? Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
JinKe Hanlin V5 ? ? ? ? ? Yes Yes Yes ? Yes Yes Yes ? ? ? Yes ? Yes Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Kobo[25] eReader 3 No No No No No Yes No No No No No No No No Yes No No No No No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Kobo eReader WiFi 9 No No No No No Yes Yes No No No No No No No Yes No Yes No No No Yes Yes Yes Yes Yes ? ? ? ? ? ? ? ? ? ?
Kobo eReader Touch[64] 14 No No No No No Yes Yes No No Partial (raw markup) No No No No Yes No Yes No No No Yes Yes Yes Yes Yes Yes No Yes Yes ? ? ? ? ? ?
Kogan Technologies[26] Kogan eBook Reader 16[65] No No ? Yes ? Yes Yes No No Yes Yes Yes Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Kolporter eClicto ? No ? No No ? Yes Yes No No No Yes No No No Yes No No No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Newsmy[66] e6210[67] ? No No No No No Yes Yes No No No Yes No No No Yes No Yes Yes No No No No Yes Yes Yes No Yes No Yes No No No No No No
Onyx International[27] Boox 60[61] 18 No No Yes Yes Yes Yes Yes No No Partial (no DRM) Yes ? No ? Yes ? Yes Yes Yes ? Yes Yes Yes Yes Yes ? Yes Yes Yes ? ? ? ? ? ?
Onyx International Boox X61S[68] 22 No No Yes Yes Yes Yes Yes No No Partial (no DRM) Yes No Yes No Yes No Yes Yes Yes No No No Yes Yes No Yes Yes Yes Yes No No No No No No
Onyx International[27] Boox M90[61] 18 No No Yes Yes Yes Yes Yes No No Partial (no DRM) Yes ? No ? Yes ? Yes Yes Yes ? Yes Yes Yes Yes Yes ? Yes Yes Yes ? ? ? ? ? ?
Onyx International[27] Boox M92[61] 18 No No Yes Yes Yes Yes Yes No No Partial (no DRM) Yes ? No ? Yes ? Yes Yes Yes ? Yes Yes Yes Yes Yes ? Yes Yes Yes ? ? ? ? ? ?
PocketBook PocketBook 360 Plus 18 No No Yes Yes Yes Yes Yes No No Yes Yes No ? No Yes No Yes Yes Yes Yes ? ? ? Yes Yes Yes Yes Yes Yes ? ? ? ? ? ?
PocketBook PocketBook Pro 602 18 No No Yes Yes Yes Yes Yes No No Yes Yes No ? No Yes No Yes Yes Yes Yes ? ? ? Yes Yes Yes Yes Yes Yes ? ? ? ? ? ?
PocketBook PocketBook Pro 603 18 No No Yes Yes Yes Yes Yes No No Yes Yes No ? No Yes No Yes Yes Yes Yes ? ? ? Yes Yes Yes Yes Yes Yes ? ? ? ? ? ?
PocketBook PocketBook Pro 902 18 No No Yes Yes Yes Yes Yes No No Yes Yes No ? No Yes No Yes Yes Yes Yes ? ? ? Yes Yes Yes Yes Yes Yes ? ? ? ? ? ?
PocketBook PocketBook Pro 903 18 No No Yes Yes Yes Yes Yes No No Yes Yes No ? No Yes No Yes Yes Yes Yes ? ? ? Yes Yes Yes Yes Yes Yes ? ? ? ? ? ?
Samsung Papyrus 3 No No No No Yes No No No No No Yes No No No Yes No No No No No No No No No No No No No No No No No No No No
Samsung E6 ? No No No No Yes Yes No No No No Yes No No No Yes No Yes No No No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Sony Librié ? No ? No ? No No No No No No No No No No No Yes No No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Sony Reader Pocket Edition PRS-300[69] 6 No No ? No ? Yes Yes No No No No No No No Yes No Yes No Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Sony Reader PRS-500[70] 9 No No No No No Yes No No No No Yes No No No Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Sony Reader PRS-505 ? ? ? ? ? ? Yes No ? Yes Yes Yes ? ? ? Yes ? Yes No Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Sony Reader Touch Edition PRS-600[71] 12 No No ? No ? Yes No No No No Yes No No No Yes No Yes No Yes ? ? ? Yes Yes Yes ? Yes ? ? ? ? ? ? ? ?
Sony Reader PRS-700 ? ? ? ? ? ? Yes ? ? ? ? Yes ? ? ? Yes ? Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Sony Reader Daily Edition PRS-900[72] 11 No No ? No ? Yes Yes No No No Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Spring Design[39] Alex eReader 5 No No ? No ? Yes Yes No No No Yes No No No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Stereo International Enterprise Co, Ltd (Taiwan)[73] ES600[73] 8 No No ? Yes ? Yes Yes No No Yes Yes Yes Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
TrekStor eBook Reader 3.0 8 No No No No No Yes No No No No Yes No No No Yes No Yes Yes Partial (only from FileMgr No No No Yes Yes No No Yes No No No No No No No No
Velocity Micro[74] Cruz Reader 14+ No No ? No ? Yes Yes No No No Yes No Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Velocity Micro[75] Cruz Tablet T103 14+ No No ? No ? Yes Yes No No No Yes No Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Velocity Micro[76] Cruz Tablet T301 14+ No Yes ? No ? Yes Yes No No No Yes No Yes No Yes No Yes No ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Wolder Electronics[77] Boox-S[61] 14 No No ? No ? Yes Yes No No Partial (no DRM) Yes ? No ? Yes ? Yes ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Maker Model Number .arg .azw .chm .djvu .doc .epub .html .lbr .lit .mobi .mp3 .opf .pdb .pdg .pdf .tr3 .txt .fb2 .rtf .tcr .cbr .cbz .gif .jpg .png .tiff .bmp .docx .html .wmv .flv .m4v .mov .avi .mpeg1/2/4

This list is missing many of the 1st and 2nd generation e-reader devices from the 1990s to 2005.

This list can be expanded by adding Unicode support information for e-readers. Such information is very difficult to find right now.

Changes

Rebranded devices

  • Hanlin V3BeBook (EU): BeBook, Koobe (HU), Astak EZ Reader (US), Lbook (UA) Papyre (Spain)
  • Netronix EB001 → Astak Mentor EZ Reader, Cybook Gen3 (200 MHz version)
  • Netronix EB600 → Cool-er, eClicto, Elonex eBook, eSlick, Astaka Mentor EZ Reader, Cybook Gen3 (400 MHz version),
  • Condor eGriver touch → Medion OYO, Prestigio PER5062B, Icarus Sense, Pandigital Novel 6″ Personal eReader, Qisda QD060B00
  • TrekStor eBook Reader 3.0 → Prestigio Nobile PER3172B

Announced devices or prototypes

  • Adam by Notion Ink (Shipped January 2011)
  • txtr, (October 2009), 6 inch reader from Wizpac
  • Readius by Polymer Vision (Autumn 2008) UPDATE: Polymer Vision filed for Chapter 11 bankruptcy in July 2009. This ebook reader will not be coming to market in its current form.
  • eDGe, dual screen, by enTourage (Available since April 2010)[78]
  • Slate, 8.9 inch screen, by Hewlett-Packard (June–September 2010)[79]
  • E6 Slider, 6 inch reader, by Samsung (Spring 2010)[80]
  • Samsung E61 with QWERTY design (early 2010)[81]
  • Takeop – an eBook project by Mircea Batranu (proj-2007/ prez-2009)[82]

Discontinued models and products

Other mobile text viewers

A Symbian OS smartphone used as an e-book reader

Some portable multimedia players and smartphones include a text viewer, e.g. several Cowon players, including the Cowon D2 and the iAUDIO U3 and Mobipocket Reader for Symbian OS and Windows Mobile mobile phones and devices. Adobe Reader mobile also turns Windows Mobile devices (for example, Samsung Omnia) into e-book viewers. Apple’s iPad, iPhone,[85] and iPod Touch are acquiring status as e-book readers through a variety of e-reader apps. WordPlayer, FBReader, Aldiko or Mantano Reader turn Android phones into e-book readers. The BlackBerry PlayBook has a number of excellent e-book applications. Palm OS based devices and smartphones are also usable for reading books. PalmOS supports PalmDoc, iSilo, Mobipocket reader, PDF, HTML conversion, text format, Handstory, TealDoc among many other software titles, and word processing.

Some mobile devices support word processing. Some fully functional tablet notebooks (with screens that turn 180 degrees and lie with the back to the keyboard) and subnotebooks are used as e-book readers.

See also

Weblinks

  • E-book Reader Matrix on MobileRead Wiki (offering different table layout and separate tables by reader size)

Table notes

  1. ^ a b c d Touch screen: “Yes” – finger touchable; “Stylus” – touchable with stylus only; “No” – no touch screen
  2. ^ a b battery life, usually requires Wifi/3G to be turned off
  3. ^ Android 2.3 has built-in TTS that can be used by certain apps. However, the Kindle app is not one of them.

References

  1. ^ “Kindle Touch versus Kindle 3”. reviewsebookreaders.com. Retrieved 2011-09-30.
  2. ^ “Kindle 3 Wi-Fi 3G”. Amazon.com. Retrieved 2010-07-30.
  3. ^ “Kindle 3 Wi-Fi”. Amazon.com. Retrieved 2010-07-30.
  4. ^ “official page of the Cybook Odyssey HD FrontLight”. Bookeen.com. Retrieved 2012-11-10.
  5. ^ “More about the Cybook Odyssey and the High Speed Ink System technology”. Bookeen.com. Retrieved 2011-10-27.
  6. ^ a b c “Can I read in the dark with the Cybook?”. Bookeen.com. Retrieved 2012-08-28.
  7. ^ “More about the Cybook Odyssey and the High Speed Ink System technology”. Bookeen.com. Retrieved 2011-10-27.
  8. ^ “bq Readers”. Retrieved 2012-06-06.
  9. ^ a b c d “Condor Technology Associates”. Ctaindia.com. Retrieved 2010-04-05.
  10. ^ a b c d IDEO, eGriver Touch
  11. ^ a b “jetBook Color Deluxe Specs”. Retrieved 2012-05-06.
  12. ^ “JetBook Color User manual (English)”. Retrieved 2012-05-06.
  13. ^ “JetBook Color Accesories”. Retrieved 2012-05-06.
  14. ^ a b http://blog.laptopmag.com/would-the-entourage-edge-have-survived-in-a-post-honeycomb-world
  15. ^ “Fnac web”.
  16. ^ http://www.numerama.com/magazine/18716-le-fnacbook-ne-seduit-pas-la-fnac-prepare-une-initiative-en-totale-rupture.html
  17. ^ http://www.clubic.com/livre-electronique/actualite-407706-fnacbook-mise-a-jour-firmware-2-navigateur.html
  18. ^ http://www.journaldugeek.com/2011/01/26/test-fnacbook/
  19. ^ “Foxit kills off eSlick ebook reader, focuses on licensing software instead”. 2010-08-04. Retrieved 2011-08-27.
  20. ^ “Icarus Go”. Icarusreader.com. Retrieved 2011-05-13.
  21. ^ “Icarus Sense”. Icarusreader.com. Retrieved 2011-05-13.
  22. ^ a b c Calvin Reid (June 10, 2010). “IREX Files for Bankruptcy”. publishersweekly.com. Retrieved 2011-11-02.
  23. ^ “E Ink: Customer Showcase: Story HD by iRiver”. eink.com. Retrieved 2012-02-11.
  24. ^ Petr Hájek (2009-12-28). “Hanlin eReader V5 review: paper or e-paper, that is the question”. Maxiorel.com. Retrieved 2010-12-07.
  25. ^ a b c d e f “Kobo eReader”.
  26. ^ a b c “iKogan eBook Reader”. kogan.com.au. Retrieved 2010-07-28.
  27. ^ a b c d e “Onyx International”. onyxboox.com. Retrieved 2010-04-05.
  28. ^ Boox X60 (spanish), Boox-S (spanish)
  29. ^ “Onyx Boox”. the-ebook-reader.com. Retrieved 2010-12-17.
  30. ^ “Onyx Boox”. onyx-boox.com. Retrieved 2010-12-17.
  31. ^ “Onyx Boox X61S review (in Polish)”.
  32. ^ “Onyx Boox i62”.
  33. ^ a b “Onyx Boox M92 technical specifications”.
  34. ^ a b c d e “You ask — we answer”. PocketBook International S.A. Retrieved 2011-07-24.
  35. ^ PocketBook Pro 603
  36. ^ PocketBook Pro 602
  37. ^ PRS-350SC | Reader Pocket Edition | Sony | Sony Style USA
  38. ^ PRS-650 | Reader Touch Edition | Sony | Sony Style USA
  39. ^ a b c “Spring Design, Inc”. Retrieved 2011-06-14.
  40. ^ http://finance.yahoo.com/news/5-absurdly-cheap-versions-pricey-130017436.html
  41. ^ http://us.txtr.com/beagle/
  42. ^ “Kindle Fire – Full Color 7″ Multi-Touch Display with Wi-Fi – More than a Tablet”. Amazon.com. Retrieved 2011-11-28.
  43. ^ “iPad 2 Technical Specifications”. Apple. Retrieved 2012-04-29.
  44. ^ “iPad 2 Technical Specifications”. Apple. Retrieved 2011-06-12.
  45. ^ “Tech Specs”. NotionInk.com. Retrieved 2011-01-01.
  46. ^ “eReader HD”. zzbook.co.uk. Retrieved 2011-03-29.
  47. ^ a b “Sending Personal Documents to Kindle”. Amazon.com: Transferring, Downloading, and Sending Files to Kindle.
  48. ^ “NOOKcolor Tech Specs – Barnes & Noble”. Barnesandnoble.com. Retrieved 2010-12-31.
  49. ^ “NOOKcolor User Guide – Barnes & Noble”. Barnesandnoble.com. Retrieved 2010-12-31.
  50. ^ “NOOK Tech Specs – Barnes & Noble”. Barnesandnoble.com. Retrieved 2010-12-07.
  51. ^ “NOOK Tech Specs – Barnes & Noble”. Barnesandnoble.com. Retrieved 2012-06-06.
  52. ^ “Cybook Orizon File formats”. Bookeen. Retrieved 2011-03-21.
  53. ^ a b “File formats”. Bookeen. Retrieved 2010-12-07.
  54. ^ “EBS Technology”. EBS Technology. Retrieved 2012-06-06.
  55. ^ a b “FAQ – eBooks”. Mybebook.com. Retrieved 2010-12-07.
  56. ^ “WISEreader N516”. Hanvon.com. Retrieved 2010-04-05.
  57. ^ “WISEreader N518”. Hanvon.com. Retrieved 2010-04-05.
  58. ^ “WISEreader N520”. Hanvon.com. Retrieved 2010-04-05.
  59. ^ “WISEreader N526”. Hanvon.com. Retrieved 2010-04-05.
  60. ^ “iPapyrus Inc”. iPapyrus Inc. Retrieved 2010-03-03.
  61. ^ a b c d e Boox 60 (spanish), Boox-S (spanish)
  62. ^ “italica GmbH”. Italicareader.com. Retrieved 2010-04-05.
  63. ^ “italica Readers”. Italicareader.com. Retrieved 2010-12-07.
  64. ^ “Kobo eReader Touch – Kobo Books”. Kobobooks.com. Retrieved 2011-07-04.
  65. ^ “eBook Reader with 1500 Free eBook, Buy 6″ E Ink eBook Reader – Kogan Technologies Pty Ltd”. Kogan.com.au. Retrieved 2010-12-07.
  66. ^ “Newsmy website”.
  67. ^ “Newsmy e6210 technical specifications”.
  68. ^ “Onyx Boox A61S (in Russia)”.
  69. ^ “PRS-300 | Reader Pocket Edition | Sony | Sony Style USA”. Sonystyle.com. Retrieved 2010-12-07.
  70. ^ Sony Electronics, Inc.. “Sony eSupport – PRS-500 – Support Information”. Esupport.sony.com. Retrieved 2010-12-07.
  71. ^ “PRS-600 | Reader Touch Edition | Sony | Sony Style USA”. Sonystyle.com. Retrieved 2010-12-07.
  72. ^ “PRS-900BC | Reader Daily Edition | Sony | Sony Style USA”. Sonystyle.com. Retrieved 2010-12-07.
  73. ^ a b “Stereo International Enterprise Co, Ltd (Taiwan)”.
  74. ^ “Velocity Micro Cruz Reader”. Velocity Micro. Retrieved 2012-06-06.
  75. ^ “Velocity Micro Cruz Tablet T103”. Velocity Micro. Retrieved 2010-12-31.
  76. ^ “Velocity Micro Cruz Tablet T301”. Velocity Micro. Archived from the original on 2010-12-13. Retrieved 2012-06-06.
  77. ^ “Wolder Electronics”. Wolder.com. Retrieved 2010-04-05.
  78. ^ Wed 30 Dec. “Entourage eDGe”. Entourage eDge.
  79. ^ Tue 06 Apr. “The HP Slate”. The Best eReaders. Retrieved 2010-04-06.
  80. ^ Wed 01 Jan. “First hands on: Samsung E6 e-book reader”.
  81. ^ Samsung E61 — e-book reader with QWERTY keyboard and without touchscreen (February 2010)
  82. ^ Mircea Batranu. “takeop the product who change the world”.
  83. ^ “eSlick Reader”. Foxit website. Foxit Corporation. 2010. Retrieved 2011-01-17.
  84. ^ Plastic Logic Next Generation Product
  85. ^ Stone, Brad (2010-06-21). “Amazon and Barnes & Noble Cut E-Reader Prices”. The New York Times.

External links

Wikimedia Commons has media related to: E-book readers
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Read these Release Notes carefully before downloading Flash Player 10.1 for Android 2.2.

 

To learn more about the new features added in Flash Player 10.1, go to:http://www.adobe.com/products/flashplayer/.

The build number for Flash Player 10.1 for Android 2.2 is 10.1.106.16.

System Requirements

System requirements for platforms supported by Flash Player 10.1 are available at http://www.adobe.com/products/flashplayer/systemreqs/index.html#mobile.

Features and Enhancements

Flash Player 10.1 is the first runtime release of the Open Screen Project that enables uncompromised Web browsing of expressive applications, content and video across devices.

Support for new platforms

Flash Player 10.1 is available for a broad range of mobile devices, including smartphones, netbooks and other Internet-connected devices, allowing your content to reach your customers wherever they are.

The consistent Flash Player browser-based runtime is the most productive way to deliver content to users across operating systems and devices. Runtime consistency reduces the cost of creating, testing and deploying content across different device, software, network and user contexts and helps improve business results.

Designed for mobility

To make it possible to deploy SWF content on smartphones and other mobile devices that have limited processing power and memory availability compared to PCs, a tremendous amount of work has gone into to making Flash Player 10.1 “ready for mobility”. This work includes performance improvements, such as rendering, scripting, memory, start-up time, battery and CPU optimizations, in addition to hardware acceleration of graphics and video. Improvements in memory utilization and management, start-up time, CPU usage, and rendering/scripting performance benefit PCs as well as mobile devices.

Flash Player 10.1 also introduces new mobile-ready features that take advantage of native device capabilities – including support for mobile input models and accelerometer input — bringing unprecedented creative control and expressiveness to the mobile browsing experience.

SWF Focus Mode 

Flash Player 10.1 integrates seamlessly with Mobile Browsers that support Touch & Gestures through the use of SWF Focus Mode. The first tap over an embedded SWF will set “Focus” and allow drag events to go to Flash (if the content contains a listener for the event). This will enable users to interact with Flash content as needed, but still pan and zoom around the page as normal.

Mobile Text Input 

Flash Player 10.1 provides support for use of native device virtual keyboards with TextField support if no physical keyboard is detected. A virtual keyboard is automatically raised and lowered in response to focus changes on text fields when editing text on mobile devices supporting a virtual keyboard to enable unobstructed and intuitive text editing. The focused text field is centered in the visible region of the page and appropriately zoomed/scrolled to ensure it is not obscured by the virtual keyboard. Upon screen rotation, incoming calls, or other system events, any already existing text input is retained. The virtual keyboard works with TextField but does not currently work with the Text Layout Framework or other Flash Text Engine text.

Easier Full-Screen Mode Activation 

Because of the smaller screen real-estate on mobile devices, Full-Screen Mode will significantly enhance the user experience for media, game play, and other rich content. A new HTML Parameter, FullScreenOnSelection, will enable developers to allow their users to launch Full-Screen Mode with a single tap over the content.

Long-Tap to Full-Screen Mode 

Users can now long-tap on any SWF and select Full-Screen Mode. The HTML Parameter AllowFullScreen is disabled for this feature, so that a user can activate Full Screen Mode for any SWF on mobile devices.

Optimized SWF Management for Mobile 

Flash Player 10.1 optimizes SWF loading and playback for mobile CPU and memory limitations to provide a better user experience. Instances are loaded or deferred based on SWF priority, visibility and available memory and CPU resources to enable more immediate browsing experiences without waiting for every SWF on a page to load. Developers can indicate SWF priority through a new HTML parameter, hasPriority. Deferred instances are loaded after the HTML page load is complete, and off screen and invisible instances are started when they become visible. Flash Player will also automatically pause SWF playback it is not in view or the foreground application, for example when a call is received or alarm goes off, to reduce CPU utilization, battery usage and memory usage.

Sleep Mode 

The Flash Player timer slows down when the mobile device goes into screen-saver or similar mode to reduce CPU and battery consumption on mobile devices. The timer returns to the default setting when a wake-up event is triggered. There is no interruption in audio/video playback. Incoming phone calls pause Flash Player.

Adaptive Frame Rate 

Flash Player will monitor and lower the SWF frame rate to provide greater processing power for rendering, which can improve content usability and conserve CPU utilization on resource constrained mobile devices. If the frame rate drops below the threshold, Flash Player will drop frames to achieve the defined default frame rate of the SWF.

Developer Productivity

Global Error Handler 

The new global error handler enables developers to write a single handler to process all runtime errors that weren’t part of a try/catch statement. Improve application reliability and user experience by catching and handling unexpected runtime errors and present custom error messages. When using the global error handler in a SWF running in the debug player, error pop-ups will not be shown. The Global error handler is disabled in the current build, but will be available in a future refresh of Flash Player 10.1.

Globalization Support 

New ActionScript globalization APIs allow Flash Player to use the values chosen in the operating system preferences to process text and lists and present information based on location context, without any knowledge of locale requirements. Choose a specific format independent of the currently selected locale on the operating system. Locale specific information and processing can include: date, time, currency and number formatting; currency and number parsing; string comparison for sorting or searching for text; and upper/lower case conversions.

Enhanced Browser Integration 

Flash Player 10.1 offers enhanced conformance to consistent browser usability guidelines, ensuring optimized user experiences.

Out-of-Memory Management 

Flash Player 10.1 prevents out-of-memory browser crashes by shutting down instances where a SWF attempts to allocate more memory than is available on the device. When a SWF tries to allocate more memory than is available on a device, Flash Player 10.1 adds logic to shut down Flash Player to prevent the browser from crashing. Users will receive notification to restart the SWF, or will see a notice to refresh the page if all instances must be shutdown. In the former case, Flash Player displays a Click-to-Play icon in place of the SWF. In the latter case, Flash Player displays an insufficient resources warning.

Expanded options for high quality media delivery

Flash Player 10.1 includes a number of media quality of service improvements and is ready to take advantage of upcoming Adobe media servers that will provide new ways to deliver rich media experiences and create new business models. With new HTTP streaming capabilities, Content Providers can use their standard HTTP infrastructure to stream media. Streaming performance is also enhanced with improved support for live events, buffer control and peer assisted networking.

Peer-Assisted Networking (requires “Stratus” on Adobe Labs)

The RTMFP protocol now supports groups, which enables an application to segment its users to send messages and data only between members of the group. Application level multicast provides one (or a few) -to-many streaming of continuous live video and audio live video chat using RTMFP groups.

HTTP Streaming 

HTTP streaming enables delivery of video-on-demand and live streaming using standard HTTP servers, or from HTTP servers at CDNs, leveraging standard HTTP infrastructure and SWF-level playback components. The addition of HTTP streaming will enable expanded protocol options to deliver live and recorded media to Flash Player.

Note: Content protected using Adobe Flash Access™ is not supported in Flash Player on Android 2.2.

Stream Reconnect (requires FMS 3.5.3 server)

Stream reconnect allows an RTMP stream to continue to play through the buffer even if the connection is disrupted, thereby making media experiences more tolerant of short term network failures and enabling non-disruptive video playback. When a connection is re-established the stream resumes playback. Developers can add re-connection logic in ActionScript to re-establish server connection and resume streaming without any disruption in the video.

Smart Seek (Requires FMS 3.5.3 server)

Smart seek allows you to seek within the buffer and introduces a new “back” buffer so you can easily rewind or fast forward video without going back to the server, reducing the start time after a seek. Smart seek can speed and improve the seeking performance of streamed videos and enable the creation of slow motion, double time, or “instant replay” experiences for streaming video.

Buffered Stream Catch-Up

Buffered stream catch-up allows developers to set a target latency threshold that triggers slightly accelerated video playback to ensure that live video streaming stays in sync with real time over extended playback periods.

Fast Switch (previously called Dynamic Streaming enhancements) (requires FMS 4 server)

The Dynamic Streaming capability introduced in Flash Player 10 and FMS 3.5 is enhanced to improve switching times between bitrates, reducing the time to receive the best content quality for available bandwidth and processing speed. Users no longer need to wait for the buffer to play through, resulting in a faster bitrate transition time and an uninterrupted video playback experience, regardless of bandwidth fluctuations.

Fixes and Enhancements in Flash Player 10.1.92.8

Adobe Flash Player 10.1.92.8 includes security enhancements described in Security Bulletin APSB10-16.

Fixes and Enhancements in Flash Player 10.1.92.10

AdobeFlash Player on Android 2.2 supports the same H.264 profiles as Flash Player on desktop platforms. On Android, the hardware H.264 decoder is used when the hardware decoder is available (not already in use) and capable of decoding the H.264 video stream; the software decoder is used in all other situations.

Fixes and Enhancements in Flash Player 10.1.95.2

Adobe Flash Player 10.1.95.2 includes a fix for an issue with H.264 video playback that caused audio to play back at slow speeds on certain devices.

Features, Fixes and Enhancements in Flash Player 10.1.105.6

Adobe Flash Player 10.1.105.6 includes security enhancements described in Security Bulletin APSB10-26.

Features:

Screen Orientation Lock:

Content authors can now choose to lock content displayed in Full-Screen mode to a single orientation.  This will prevent content from being scaled and rotated when the user rotates their screen.

International Language Support for Input Text and IME:

Flash Player now supports the entry of international text for Input Text and IME.   This feature also introduces a number of general usability enhancements to improve western text entry on devices with on-screen keyboards.

Fixes and Enhancements

Audio:

·         Loading WAV files via HTTP no longer causes the browser to hang.

Input:

·         Improvements to touch accuracy correct instances where small objects were not correctly responding to touch events.

·         When a user clicks on a TextField when in Full Screen mode, Flash Player will exit Full Screen mode to facilitate text entry.

Rendering:

·         Values for stage.fullScreenHeight and stage.fullScreenWidth are now correctly updated when the screen orientation changes from landscape to portrait.

·         Crashes related to playing content while zoomed in have been resolved.

Video:

·         Improved Hardware Video Decoding Support:

– All H.264 encoding profiles are now supported on the HTC Nexus One

– All H.264 video except 720p is supported on TI OMAP 3630-based devices (Motorola Droid 2, Droid X

– H.264 baseline video is now supported on TI OMAP Motorola Droid

·         Multiple optimizations improve video playback performance and quality on Android 2.2 devices

·         Locking the screen orientation to portrait mode during video playback now works as expected.

Known Issues and Limitations

General:

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Ketogenic diet

The ketogenic diet is a high-fat, adequate-protein, low-carbohydrate diet that in medicine is used primarily to treat difficult-to-control (refractory) epilepsy in children. The diet mimics aspects of starvation by forcing the body to burn fats rather than carbohydrates. Normally, the carbohydrates contained in food are converted into glucose, which is then transported around the body and is particularly important in fuelling brain function. However, if there is very little carbohydrate in the diet, the liver converts fat into fatty acids and ketone bodies. The ketone bodies pass into the brain and replace glucose as an energy source. An elevated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in the frequency of epileptic seizures.[1] This diet is neuroprotective, and may be efficacious in treating a wide variety of neurological disorders.[2]

The original therapeutic diet for pediatric epilepsy provides just enough protein for body growth and repair, and sufficient calories[Note 1] to maintain the correct weight for age and height. This classic ketogenic diet contains a 4:1 ratio by weight of fat to combined protein and carbohydrate. This is achieved by excluding high-carbohydrate foods such as starchy fruits and vegetables, bread, pasta, grains and sugar, while increasing the consumption of foods high in fat such as cream and butter.[1]

Most dietary fat is made of molecules called long-chain triglycerides (LCTs). However, medium-chain triglycerides (MCTs)—made from fatty acids with shorter carbon chains than LCTs—are more ketogenic. A variant of the classic diet known as the MCT ketogenic diet uses a form of coconut oil, which is rich in MCTs, to provide around half the calories. As less overall fat is needed in this variant of the diet, a greater proportion of carbohydrate and protein can be consumed, allowing a greater variety of food choices.[3][4]

The classic therapeutic ketogenic diet was developed for treatment of pediatric epilepsy in the 1920s and was widely used into the next decade, but its popularity waned with the introduction of effective anticonvulsant drugs. In the mid 1990s, Hollywood producer Jim Abrahams, whose son’s severe epilepsy was effectively controlled by the diet, created the Charlie Foundation to promote it. Publicity included an appearance on NBC’s Dateline programme and …First Do No Harm (1997), a made-for-television film starring Meryl Streep. The foundation sponsored a multicentre research study, the results of which—announced in 1996—marked the beginning of renewed scientific interest in the diet.[1]

The diet is effective in half of the patients who try it, and very effective in one third of patients.[5] In 2008, a randomised controlled trial showed a clear benefit for treating refractory epilepsy in children with the ketogenic diet.[6] A treatment of 6 to 24 months duration frequently results in a ≥ 90% decrease or elimination of seizures.[7]

There is some evidence that adults with epilepsy may benefit from the diet, and that a less strict regime, such as a modified Atkins diet, is similarly effective.[1] Clinical trials and studies in animal models suggest that ketogenic diets provide neuroprotective and disease-modifying benefits for a number of adult neurodegenerative disorders.[7][8] As of 2008, research in this area is regarded as having provided insufficient data to produce clear practice parameters for clinical protocols.[5][9]
Contents

1 Epilepsy
2 History
2.1 Fasting
2.2 Diet
2.3 Anticonvulsants and decline
2.4 MCT diet
2.5 Revival
3 Efficacy
3.1 Trial design
3.2 Outcomes
4 Indications and contra-indications
5 Interactions
6 Adverse effects
7 Implementation
7.1 Initiation
7.2 Maintenance
7.3 Discontinuation
8 Variants
8.1 Classic
8.2 MCT oil
8.3 Modified Atkins
8.4 Low glycemic index treatment
8.5 Prescribed formulations
8.6 Worldwide
9 Mechanism of action
9.1 Seizure pathology
9.2 Seizure control
10 Other applications
11 Notes
12 References
13 Further reading
14 External links

Epilepsy

Epilepsy is one of the most common neurological disorders after stroke,[10] and affects at least 50 million people worldwide.[11] It is diagnosed in a person having recurrent unprovoked seizures. These occur when cortical neurons fire excessively, hypersynchronously, or both, leading to temporary disruption of normal brain function. This might affect, for example, the muscles, the senses, consciousness, or a combination. A seizure can be focal (confined to one part of the brain) or generalised (spread widely throughout the brain and leading to a loss of consciousness). Epilepsy may occur for a variety of reasons; some forms have been classified into epileptic syndromes, most of which begin in childhood. Epilepsy is considered refractory to treatment when two or three anticonvulsant drugs have failed to control it. About 60% of patients will achieve control of their epilepsy with the first drug they use, whereas about 30% do not achieve control with drugs. When drugs fail, other options include epilepsy surgery, vagus nerve stimulation and the ketogenic diet.[10]
History

The ketogenic diet is a mainstream, nonpharmacologic therapy that was developed to reproduce the success and remove the limitations of the non-mainstream use of fasting to treat epilepsy.[Note 2] Although popular in the 1920s and 30s, it was largely abandoned in favour of new anticonvulsant drugs.[1] Most individuals with epilepsy can successfully control their seizures with medication. However, 20–30% fail to achieve such control despite trying a number of different drugs.[9] For this group, and for children in particular, the diet has once again found a role in epilepsy management.[1][12]
Fasting
Scan of newspaper column. See image description page for full text.
A news report of Dr Hugh Conklin’s “water diet” treatment from 1922

Ancient Greek physicians treated diseases, including epilepsy, by altering their patients’ diet. An early treatise in the Hippocratic Corpus, On the Sacred Disease, mentions the disease; it dates from c. 400 BC. Its author argued against the prevailing view that epilepsy was supernatural in origin and cure, and proposed that dietary therapy had a rational and physical basis.[Note 3] In the same collection, the author of Epidemics describes the case of a man whose epilepsy is cured as quickly as it had appeared, through complete abstinence of food and drink.[Note 4] The royal physician Erasistratus declared, “One inclining to epilepsy should be made to fast without mercy and be put on short rations.”[Note 5] Galen believed an “attenuating diet”[Note 6] might afford a cure in mild cases and be helpful in others.[13]

The first modern study of fasting as a treatment for epilepsy was in France in 1911.[14] Twenty epilepsy patients of all ages were “detoxified” by consuming a low-calorie vegetarian diet, combined with periods of fasting and purging. Two benefited enormously, but most failed to maintain compliance with the imposed restrictions. The diet improved the patients’ mental capabilities, in contrast to their medication, potassium bromide, which dulled the mind.[15]

Around this time, Bernarr Macfadden, an American exponent of physical culture, popularised the use of fasting to restore health. His disciple, the osteopathic physician Hugh Conklin, of Battle Creek, Michigan, began to treat his epilepsy patients by recommending fasting. Conklin conjectured that epileptic seizures were caused when a toxin, secreted from the Peyer’s patches in the intestines, was discharged into the bloodstream. He recommended a fast lasting 18 to 25 days to allow this toxin to dissipate. Conklin probably treated hundreds of epilepsy patients with his “water diet” and boasted of a 90% cure rate in children, falling to 50% in adults. Later analysis of Conklin’s case records showed 20% of his patients achieved freedom from seizures and 50% had some improvement.[12]

Conklin’s fasting therapy was adopted by neurologists in mainstream practice. In 1916, a Dr McMurray wrote to the New York Medical Journal claiming to have successfully treated epilepsy patients with a fast, followed by a starch- and sugar-free diet, since 1912. In 1921, prominent endocrinologist H. Rawle Geyelin reported his experiences to the American Medical Association convention. He had seen Conklin’s success first-hand and had attempted to reproduce the results in 36 of his own patients. He achieved similar results despite only having studied the patients for a short time. Further studies in the 1920s indicated that seizures generally returned after the fast. Charles Howland, the parent of one of Conklin’s successful patients and a wealthy New York corporate lawyer, gave his brother John a gift of $5,000 to study “the ketosis of starvation”. As professor of paediatrics at Johns Hopkins Hospital, John Howland used the money to fund research undertaken by neurologist Stanley Cobb and his assistant William G. Lennox.[12]
Diet

In 1921, Rollin Woodyatt reviewed the research on diet and diabetes. He reported that three water-soluble compounds, β-hydroxybutyrate, acetoacetate and acetone (known collectively as ketone bodies), were produced by the liver in otherwise healthy people when they were starved or if they consumed a very low-carbohydrate, high-fat diet. Russel Wilder, at the Mayo Clinic, built on this research and coined the term ketogenic diet to describe a diet that produced a high level of ketones in the blood (ketonemia) through an excess of fat and lack of carbohydrate. Wilder hoped to obtain the benefits of fasting in a dietary therapy that could be maintained indefinitely. His trial on a few epilepsy patients in 1921 was the first use of the ketogenic diet as a treatment for epilepsy.[12]

Wilder’s colleague, paediatrician Mynie Peterman, later formulated the classic diet, with a ratio of one gram of protein per kilogram of body weight in children, 10–15 g of carbohydrate per day, and the remainder of calories from fat. Peterman’s work in the 1920s established the techniques for induction and maintenance of the diet. Peterman documented positive effects (improved alertness, behaviour and sleep) and adverse effects (nausea and vomiting due to excess ketosis). The diet proved to be very successful in children: Peterman reported in 1925 that 95% of 37 young patients had improved seizure control on the diet and 60% became seizure-free. By 1930, the diet had also been studied in 100 teenagers and adults. Clifford Barborka, also from the Mayo Clinic, reported that 56% of those older patients improved on the diet and 12% became seizure-free. Although the adult results are similar to modern studies of children, they did not compare as well to contemporary studies. Barborka concluded that adults were least likely to benefit from the diet, and the use of the ketogenic diet in adults was not studied again until 1999.[12][16]
Anticonvulsants and decline

During the 1920s and 1930s, when the only anticonvulsant drugs were the sedative bromides (discovered 1857) and phenobarbital (1912), the ketogenic diet was widely used and studied. This changed in 1938 when H. Houston Merritt and Tracy Putnam discovered phenytoin (Dilantin), and the focus of research shifted to discovering new drugs. With the introduction of sodium valproate in the 1970s, drugs were available to neurologists that were effective across a broad range of epileptic syndromes and seizure types. The use of the ketogenic diet, by this time restricted to difficult cases such as Lennox–Gastaut syndrome, declined further.[12]
MCT diet
A glass bottle of 250 ml of Liquigen, a white opaque liquid
Medium-chain triglyceride (MCT) oil emulsion

In the 1960s, it was discovered that medium-chain triglycerides (MCTs) produce more ketones per unit of energy than normal dietary fats (which are mostly long-chain triglycerides).[17] MCTs are more efficiently absorbed and are rapidly transported to the liver via the hepatic portal system rather than the lymphatic system.[6] The severe carbohydrate restrictions of the classic ketogenic diet made it difficult for parents to produce palatable meals that their children would tolerate. In 1971, Peter Huttenlocher devised a ketogenic diet where about 60% of the calories came from the MCT oil, and this allowed more protein and up to three times as much carbohydrate as the classic ketogenic diet. The oil was mixed with at least twice its volume of skimmed milk, chilled, and sipped during the meal or incorporated into food. He tested it on twelve children and adolescents with intractable seizures. Most children improved in both seizure control and alertness, results that were similar to the classic ketogenic diet. Gastrointestinal upset was a problem, which led one patient to abandon the diet, but meals were easier to prepare and better accepted by the children.[17] The MCT diet replaced the classic ketogenic diet in many hospitals, though some devised diets that were a combination of the two.[12]
Revival

The ketogenic diet achieved national media exposure in the US in October 1994, when NBC’s Dateline television programme reported the case of Charlie Abrahams, son of Hollywood producer Jim Abrahams. The two-year-old suffered from epilepsy that had remained uncontrolled by mainstream and alternative therapies. Abrahams discovered a reference to the ketogenic diet in an epilepsy guide for parents and brought Charlie to the Johns Hopkins Hospital, which had continued to offer the therapy. Under the diet, Charlie’s epilepsy was rapidly controlled and his developmental progress resumed. This inspired Abrahams to create the Charlie Foundation to promote the diet and fund research.[12] A multicentre prospective study began in 1994, the results were presented to the American Epilepsy Society in 1996 and were published[18] in 1998. There followed an explosion of scientific interest in the diet. In 1997, Abrahams produced a TV movie, …First Do No Harm, starring Meryl Streep, in which a young boy’s intractable epilepsy is successfully treated by the ketogenic diet.[1]

By 2007, the ketogenic diet was available from around 75 centres in 45 countries, and less restrictive variants, such as the modified Atkins diet, were in use, particularly among older children and adults. The ketogenic diet was also under investigation for the treatment of a wide variety of disorders other than epilepsy.[1]
Efficacy

The ketogenic diet reduces seizure frequency by more than 50% in half of the patients who try it and by more than 90% in a third of patients.[5] Three-quarters of children who respond do so within two weeks, though experts recommend a trial of at least three months before assuming it has been ineffective.[9] Children with refractory epilepsy are more likely to find the ketogenic diet to be effective than to benefit from trying another anticonvulsant drug.[1] There is some evidence that adolescents and adults may also benefit from the diet.[9]
Trial design

Early studies reported high success rates: in one study in 1925, 60% of patients became seizure-free, and another 35% of patients had a 50% reduction in seizure frequency. These studies generally examined a cohort of patients recently treated by the physician (what is known as a retrospective study) and selected patients who had successfully maintained the dietary restrictions. However, these studies are difficult to compare to modern trials. One reason is that these older trials suffered from selection bias, as they excluded patients who were unable to start or maintain the diet and thereby selected from patients who would generate better results. In an attempt to control for this bias, modern study design prefers a prospective cohort (the patients in the study are chosen before therapy begins) in which the results are presented for all patients regardless of whether they started or completed the treatment (known as intent-to-treat analysis).[19]

Another difference between older and newer studies is that the type of patients treated with the ketogenic diet has changed over time. When first developed and used, the ketogenic diet was not a treatment of last resort; in contrast, the children in modern studies have already tried and failed a number of anticonvulsant drugs, so may be assumed to have more difficult-to-treat epilepsy. Early and modern studies also differ because the treatment protocol has changed. In older protocols, the diet was initiated with a prolonged fast, designed to lose 5–10% body weight, and heavily restricted the calorie intake. Concerns over child health and growth led to a relaxation of the diet’s restrictions.[19] Fluid restriction was once a feature of the diet, but this led to increased risk of constipation and kidney stones, and is no longer considered beneficial.[5]
Outcomes

The largest modern study with an intent-to-treat prospective design was published in 1998 by a team from the Johns Hopkins Hospital[20] and followed-up by a report published in 2001.[21] As with most studies of the ketogenic diet, there was no control group (patients who did not receive the treatment). The study enrolled 150 children. After three months, 83% of them were still on the diet, 26% had experienced a good reduction in seizures, 31% had had an excellent reduction and 3% were seizure-free.[Note 7] At twelve months, 55% were still on the diet, 23% had a good response, 20% had an excellent response and 7% were seizure-free. Those who had discontinued the diet by this stage did so because it was ineffective, too restrictive or due to illness, and most of those who remained were benefiting from it. The percentage of those still on the diet at two, three and four years was 39%, 20% and 12% respectively. During this period the most common reason for discontinuing the diet was because the children had become seizure-free or significantly better. At four years, 16% of the original 150 children had a good reduction in seizure frequency, 14% had an excellent reduction and 13% were seizure-free, though these figures include many who were no longer on the diet. Those remaining on the diet after this duration were typically not seizure-free but had had an excellent response.[21][22]

It is possible to combine the results of several small studies to produce evidence that is stronger than that available from each study alone—a statistical method known as meta-analysis. One of four such analyses, conducted in 2006, looked at 19 studies on a total of 1,084 patients.[23] It concluded that half the patients achieved a 50% reduction in seizures and a third achieved a 90% reduction.[5]

The first randomised controlled trial was published in 2008, which had an intent-to-treat prospective design, but no blinding. This study enrolled 145 children, half of whom were randomly selected to start the ketogenic diet immediately and half to start after a three-month delay. The children who received delayed treatment acted as a control, which is particularly important for medical conditions such as epilepsy where patients may get better or worse regardless of treatment. Of the children in the diet group, 38% had at least a 50% reduction in seizure frequency, 7% had at least a 90% reduction, and one child became seizure-free. Only 6% of the control group saw a greater than 50% reduction in seizure frequency and no children had a 90% reduction. The mean seizure frequency of the diet group fell by a third; the control group’s mean seizure frequency actually got worse.[6]
Indications and contra-indications
Anticonvulsants
Experts on the ketogenic diet recommend it be strongly considered for children with uncontrolled epilepsy who have tried and failed two or three anticonvulsant drugs;[9] most children who start the ketogenic diet have failed at least three times this number.[24]

The ketogenic diet is indicated as an adjunctive (additional) treatment in children with drug-resistant epilepsy.[25][26][27] It is approved by national clinical guidelines in Scotland,[27] England and Wales[25] and reimbursed by nearly all US insurance companies.[28] Children with a focal lesion (a single point of brain abnormality causing the epilepsy) who would make suitable candidates for surgery are more likely to become seizure-free with surgery than with the ketogenic diet.[9][29] In the UK, the National Institute for Health and Clinical Excellence advises that the diet should not be recommended for adults with epilepsy.[25] About a third of epilepsy centres that offer the ketogenic diet also offer a dietary therapy to adults. Some clinicians consider the two less restrictive dietary variants—the low glycemic index treatment and the modified Atkins diet—to be more appropriate for adolescents and adults.[9] A liquid form of the ketogenic diet is particularly easy to prepare for, and well tolerated by, infants on formula and children who are tube-fed.[4][30]

Advocates for the diet recommend that it be seriously considered after two medications have failed, as the chance of other drugs succeeding is only 10%.[9][31][32] The diet can be considered earlier for some epilepsy and genetic syndromes where it has shown particular usefulness. These include Dravet syndrome, infantile spasms, myoclonic-astatic epilepsy and tuberous sclerosis complex.[9]

A survey in 2005 of 88 paediatric neurologists in the US found that 36% regularly prescribed the diet after three or more drugs had failed; 24% occasionally prescribed the diet as a last resort; 24% had only prescribed the diet in a few rare cases; and 16% had never prescribed the diet. There are several possible explanations for this gap between evidence and clinical practice.[33] One major factor may be the lack of adequately trained dietitians, who are needed to administer a ketogenic diet programme.[31]

Because the ketogenic diet alters the body’s metabolism, it is a first-line therapy in children with certain congenital metabolic diseases. However, it is absolutely contraindicated in others. The diseases pyruvate dehydrogenase (E1) deficiency and glucose transporter 1 deficiency syndrome prevent the body from using carbohydrates as fuel, which leads to a dependency on ketone bodies. The ketogenic diet is beneficial in treating the seizures and some other symptoms in these diseases and is an absolute indication.[34] In contrast, the diseases pyruvate carboxylase deficiency, porphyria and other rare genetic disorders of fat metabolism prevent any use of the diet.[9] A person with a disorder of fatty acid oxidation is unable to metabolise fatty acids, which replace carbohydrates as the major energy source on the diet. On the ketogenic diet, their body would consume its own protein stores for fuel, leading to ketoacidosis, and eventually coma and death.[35]
Interactions

The ketogenic diet is usually initiated in combination with the patient’s existing anticonvulsant regime, though patients may be weaned off anticonvulsants if the diet is successful. There is some evidence of synergistic benefits when the diet is combined with the vagus nerve stimulator or with the drug zonisamide, and that the diet may be less successful in children receiving phenobarbital.[5]
Adverse effects

The ketogenic diet is not a benign, holistic or natural treatment for epilepsy; as with any serious medical therapy, there may be complications. These are generally less severe and less frequent than with anticonvulsant medication or surgery.[28] Common but easily treatable short-term side effects include constipation, low-grade acidosis and hypoglycaemia if there is an initial fast. Raised levels of lipids in the blood affect up to 60% of children[36] and cholesterol levels may increase by around 30%.[28] This can be treated by changes to the fat content of the diet, such as from saturated fats towards polyunsaturated fats, and, if persistent, by lowering the ketogenic ratio.[36] Supplements are necessary to counter the dietary deficiency of many micronutrients.[5]

Long-term use of the ketogenic diet in children increases the risk of retarded growth, bone fractures and kidney stones.[5] The diet reduces levels of insulin-like growth factor 1, which is important for childhood growth. Like many anticonvulsant drugs, the ketogenic diet has an adverse effect on bone health. Many factors may be involved such as acidosis and suppressed growth hormone.[36] About 1 in 20 children on the ketogenic diet will develop kidney stones (compared with one in several thousand for the general population). A class of anticonvulsants known as carbonic anhydrase inhibitors (topiramate, zonisamide) are known to increase the risk of kidney stones, but the combination of these anticonvulsants and the ketogenic diet does not appear to elevate the risk above that of the diet alone.[37] The stones are treatable and do not justify discontinuation of the diet.[37] Johns Hopkins Hospital now gives oral potassium citrate supplements to all ketogenic diet patients, resulting in a sevenfold decrease in the incidence of kidney stones.[38] However, this empiric usage has not been tested in a prospective controlled trial.[9] Kidney stone formation (nephrolithiasis) is associated with the diet for four reasons:[37]

Excess calcium in the urine (hypercalciuria) occurs due to increased bone demineralisation with acidosis. Bones are mainly composed of calcium phosphate. The phosphate reacts with the acid, and the calcium is excreted by the kidneys.[37]
Hypocitraturia: the urine has an abnormally low concentration of citrate, which normally helps to dissolve free calcium.[37]
The urine has a low pH, which stops uric acid from dissolving, leading to crystals that act as a nidus for calcium stone formation.[37]
Many institutions traditionally restricted the water intake of patients on the diet to 80% of normal daily needs;[37] this practice is no longer encouraged.[5]

In adults, common side effects include weight loss, constipation, raised cholesterol levels and, in women, menstrual irregularities including amenorrhoea.[39]
Implementation

The ketogenic diet is a medical nutrition therapy that involves participants from various disciplines. Team members include a registered paediatric dietitian who coordinates the diet programme; a paediatric neurologist who is experienced in offering the ketogenic diet; and a registered nurse who is familiar with childhood epilepsy. Additional help may come from a medical social worker who works with the family and a pharmacist who can advise on the carbohydrate content of medicines. Lastly, the parents and other caregivers must be educated in many aspects of the diet for it to be safely implemented.[4]

Implementing the diet can present difficulties for caregivers and the patient due to the time commitment involved in measuring and planning meals. Since any unplanned eating can potentially break the nutritional balance required, some people find the discipline needed to maintain the diet challenging and unpleasant. Some people terminate the diet or switch to a less demanding diet, like the Modified Atkins Diet or the Low Glycemic Index Treatment, because they find the difficulties too great.[40]
Initiation

The Johns Hopkins Hospital protocol for initiating the ketogenic diet has been widely adopted.[41] It involves a consultation with the patient and their caregivers and, later, a short hospital admission.[19] Because of the risk of complications during ketogenic diet initiation, most centres begin the diet under close medical supervision in hospital.[9]

At the initial consultation, patients are screened for conditions that may contraindicate the diet. A dietary history is obtained and the parameters of the diet selected: the ketogenic ratio of fat to combined protein and carbohydrate, the calorie requirements and the fluid intake.[19]

The day before admission to hospital, the proportion of carbohydrate in the diet may be decreased and the patient begins fasting after his or her evening meal.[19] On admission, only calorie- and caffeine-free fluids[35] are allowed until dinner, which consists of “eggnog”[Note 8] restricted to one-third of the typical calories for a meal. The following breakfast and lunch are similar, and on the second day, the “eggnog” dinner is increased to two-thirds of a typical meal’s caloric content. By the third day, dinner contains the full calorie quota and is a standard ketogenic meal (not “eggnog”). After a ketogenic breakfast on the fourth day, the patient is discharged. Where possible, the patient’s current medicines are changed to carbohydrate-free formulations.[19]

When in the hospital, glucose levels are checked several times daily and the patient is monitored for signs of symptomatic ketosis (which can be treated with a small quantity of orange juice). Lack of energy and lethargy are common but disappear within two weeks.[18] The parents attend classes over the first three full days, which cover nutrition, managing the diet, preparing meals, avoiding sugar and handling illness.[19] The level of parental education and commitment required is higher than with medication.[42]

Variations on the Johns Hopkins protocol are common. The initiation can be performed using outpatient clinics rather than requiring a stay in hospital. Often there is no initial fast (fasting increases the risk of acidosis and hypoglycaemia and weight loss). Rather than increasing meal sizes over the three-day initiation, some institutions maintain meal size but alter the ketogenic ratio from 2:1 to 4:1.[9]

For patients who benefit, half achieve a seizure reduction within five days (if the diet starts with an initial fast of one to two days), three-quarters achieve a reduction within two weeks, and 90% achieve a reduction within 23 days. If the diet does not begin with a fast, the time for half of the patients to achieve an improvement is longer (two weeks) but the long-term seizure reduction rates are unaffected.[42] Parents are encouraged to persist with the diet for at least three months before any final consideration is made regarding efficacy.[9]
Maintenance

After initiation, the child regularly visits the hospital outpatient clinic where they are seen by the dietitian and neurologist, and various tests and examinations are performed. These are held every three months for the first year and then every six months thereafter. Infants under one year old are seen more frequently, with the initial visit held after just two to four weeks.[9] A period of minor adjustments is necessary to ensure consistent ketosis is maintained and to better adapt the meal plans to the patient. This fine-tuning is typically done over the telephone with the hospital dietitian[19] and includes changing the number of calories, altering the ketogenic ratio, or adding some MCT or coconut oils to a classic diet.[5] Urinary ketone levels are checked daily to detect whether ketosis has been achieved and to confirm that the patient is following the diet, though the level of ketones does not correlate with an anticonvulsant effect.[19] This is performed using ketone test strips containing nitroprusside, which change colour from buff-pink to maroon in the presence of acetoacetate (one of the three ketone bodies).[43]

A short-lived increase in seizure frequency may occur during illness or if ketone levels fluctuate. The diet may be modified if seizure frequency remains high, or the child is losing weight.[19] Loss of seizure-control may come from unexpected sources. Even “sugar-free” food can contain carbohydrates such as maltodextrin, sorbitol, starch and fructose. The sorbitol content of suntan lotion and other skincare products may be high enough for some to be absorbed through the skin and thus negate ketosis.[31]
Discontinuation

About 20% of children on the ketogenic diet achieve freedom from seizures, and many are able to reduce the use of anticonvulsant drugs or eliminate them altogether.[5] Commonly, at around two years on the diet, or after six months of being seizure-free, the diet may be gradually discontinued over two or three months. This is done by lowering the ketogenic ratio until urinary ketosis is no longer detected, and then lifting all calorie restrictions.[44] This timing and method of discontinuation mimics that of anticonvulsant drug therapy in children, where the child has become seizure free. When the diet is required to treat certain metabolic diseases, the duration will be longer. The total diet duration is up to the treating ketogenic diet team and parents; durations up to 12 years have been studied and found beneficial.[9]

Children who discontinue the diet after achieving seizure freedom have about a 20% risk of seizures returning. The length of time until recurrence is highly variable but averages two years. This risk of recurrence compares with 10% for resective surgery (where part of the brain is removed) and 30–50% for anticonvulsant therapy. Of those that have a recurrence, just over half can regain freedom from seizures either with anticonvulsants or by returning to the ketogenic diet. Recurrence is more likely if, despite seizure freedom, an electroencephalogram (EEG) shows epileptiform spikes, which indicate epileptic activity in the brain but are below the level that will cause a seizure. Recurrence is also likely if an MRI scan shows focal abnormalities (for example, as in children with tuberous sclerosis). Such children may remain on the diet longer than average, and it has been suggested that children with tuberous sclerosis who achieve seizure freedom could remain on the ketogenic diet indefinitely.[44]
Variants
Classic
A series of four pie charts for the typical American diet, the induction phase of the Atkins diet, the classic ketogenic diet and the MCD ketogenic diet. The typical American diet has about half its calories from carbohydrates where the others have very little carbohydrate. The Atkins diet is higher in protein than the others. Most of the fat in the MCT diet comes from MCT oil.
The ratio of calorific contributions from food components of four diets, by weight

The ketogenic diet is calculated by a dietitian for each child. Age, weight, activity levels, culture and food preferences all affect the meal plan. First, the energy requirements are set at 80–90% of the recommended daily amounts (RDA) for the child’s age (the high-fat diet requires less energy to process than a typical high-carbohydrate diet). Highly active children or those with muscle spasticity require more calories than this; immobile children require less. The ketogenic ratio of the diet compares the weight of fat to the combined weight of carbohydrate and protein. This is typically 4:1, but children who are younger than 18 months, older than 12 years, or who are obese may be started on a 3:1 ratio. Fat is energy-rich, with 9 kcal/g (38 kJ/g) compared to 4 kcal/g (17 kJ/g) for carbohydrate or protein, so portions on the ketogenic diet are smaller than normal. The quantity of fat in the diet can be calculated from the overall energy requirements and the chosen ketogenic ratio. Next, the protein levels are set to allow for growth and body maintenance, and are around 1 g protein for each kg of body weight. Lastly, the amount of carbohydrate is set according to what allowance is left while maintaining the chosen ratio. Any carbohydrate in medications or supplements must be subtracted from this allowance. The total daily amount of fat, protein and carbohydrate is then evenly divided across the meals.[35]

A computer program such as KetoCalculator may be used to help generate recipes.[45] The meals often have four components: heavy whipping cream, a protein-rich food (typically meat), a fruit or vegetable and a fat such as butter, vegetable oil or mayonnaise. Only low-carbohydrate fruits and vegetables are allowed, which excludes bananas, potatoes, peas and corn. Suitable fruits are divided into two groups based on the amount of carbohydrate they contain, and vegetables are similarly divided into two groups. Foods within each of these four groups may be freely substituted to allow for variation without needing to recalculate portion sizes. For example, cooked broccoli, Brussels sprouts, cauliflower and green beans are all equivalent. Fresh, canned or frozen foods are equivalent, but raw and cooked vegetables differ, and processed foods are an additional complication. Parents are required to be precise when measuring food quantities on an electronic scale accurate to 1 g. The child must eat the whole meal and cannot have extra portions; any snacks must be incorporated into the meal plan. A small amount of MCT oil may be used to help with constipation or to increase ketosis.[35]

The classic ketogenic diet is not a balanced diet and only contains tiny portions of fresh fruit and vegetables, fortified cereals and calcium-rich foods. In particular, the B vitamins, calcium and vitamin D must be artificially supplemented. This is achieved by taking two sugar-free supplements designed for the patient’s age: a multivitamin with minerals and calcium with vitamin D.[5] A typical day of food for a child on a 4:1 ratio, 1,500 kcal (6,300 kJ) ketogenic diet comprises:[28]

Breakfast: egg with bacon
28 g egg, 11 g bacon, 37 g of 36% heavy whipping cream, 23 g butter and 9 g apple.
Snack: peanut butter ball
6 g peanut butter and 9 g butter.
Lunch: tuna salad
28 g tuna fish, 30 g mayonnaise, 10 g celery, 36 g of 36% heavy whipping cream and 15 g lettuce.
Snack: keto yogurt
18 g of 36% heavy whipping cream, 17 g sour cream, 4 g strawberries and artificial sweetener.
Dinner: cheeseburger (no bun)
22 g minced (ground) beef, 10 g American cheese, 26 g butter, 38 g cream, 10 g lettuce and 11 g green beans.
Snack: keto custard
25 g of 36% heavy whipping cream, 9 g egg and pure vanilla flavouring.

MCT oil

Normal dietary fat contains mostly long-chain triglycerides (LCT). Medium-chain triglycerides are more ketogenic than LCTs because they generate more ketones per unit of energy when metabolised. Their use allows for a diet with a lower proportion of fat and a greater proportion of protein and carbohydrate,[5] leading to more food choices and larger portion sizes.[3] The original MCT diet developed by Peter Huttenlocher in the 1970s derived 60% of its calories from MCT oil.[17] Consuming that quantity of MCT oil caused abdominal cramps, diarrhoea and vomiting in some children. A figure of 45% is regarded as a balance between achieving good ketosis and minimising gastrointestinal complaints. The classical and modified MCT ketogenic diets are equally effective and differences in tolerability are not statistically significant.[9] The MCT diet is less popular in the United States; MCT oil is more expensive than other dietary fats and is not covered by insurance companies.[5]
Modified Atkins

First reported in 2003, the idea of using a form of the Atkins diet to treat epilepsy came about after parents and patients discovered that the induction phase of the Atkins diet controlled seizures. The ketogenic diet team at Johns Hopkins Hospital modified the Atkins diet by removing the aim of achieving weight loss, extending the induction phase indefinitely, and specifically encouraging fat consumption. Compared with the ketogenic diet, the modified Atkins diet (MAD) places no limit on calories or protein, and the lower overall ketogenic ratio (approximately 1:1) does not need to be consistently maintained by all meals of the day. The MAD does not begin with a fast or with a stay in hospital and requires less dietitian support than the ketogenic diet. Carbohydrates are initially limited to 10 g per day in children or 20 g per day in adults, and are increased to 20–30 g per day after a month or so, depending on the effect on seizure control or tolerance of the restrictions. Like the ketogenic diet, the MAD requires vitamin and mineral supplements and children are carefully and periodically monitored at outpatient clinics.[46]

The modified Atkins diet reduces seizure frequency by more than 50% in 43% of patients who try it and by more than 90% in 27% of patients.[5] Few adverse effects have been reported, though cholesterol is increased and the diet has not been studied long term.[46] Although based on a smaller data set (126 adults and children from 11 studies over five centres), these results from 2009 compare favourably with the traditional ketogenic diet.[5]
Low glycemic index treatment

The low glycemic index treatment (LGIT) is an attempt to achieve the stable blood glucose levels seen in children on the classic ketogenic diet while using a much less restrictive regime. The hypothesis is that stable blood glucose may be one of the mechanisms of action involved in the ketogenic diet,[9] which occurs because the absorption of the limited carbohydrates is slowed by the high fat content.[4] Although it is also a high-fat diet (with approximately 60% calories from fat),[4] the LGIT allows more carbohydrate than either the classic ketogenic diet or the modified Atkins diet, approximately 40–60 g per day.[5] However, the types of carbohydrates consumed are restricted to those that have a glycemic index lower than 50. Like the modified Atkins diet, the LGIT is initiated and maintained at outpatient clinics and does not require precise weighing of food or intensive dietitian support. Both are offered at most centres that run ketogenic diet programmes, and in some centres they are often the primary dietary therapy for adolescents.[9]

Short-term results for the LGIT indicate that at one month approximately half of the patients experience a greater than 50% reduction in seizure frequency, with overall figures approaching that of the ketogenic diet. The data (coming from one centre’s experience with 76 children up to the year 2009) also indicate fewer side effects than the ketogenic diet and that it is better tolerated, with more palatable meals.[5][47]
Prescribed formulations
A cream-coloured powder is poured from a tin into a measuring jug on an electronic kitchen scale.
Measuring KetoCal—a powdered formula for administering the classic ketogenic diet

Infants and patients fed via a gastrostomy tube can also be given a ketogenic diet. Parents make up a prescribed powdered formula, such as KetoCal, into a liquid feed.[19] Gastrostomy feeding avoids any issues with palatability, and bottle-fed infants readily accept the ketogenic formula.[31] Some studies have found this liquid feed to be more efficacious and associated with lower total cholesterol than a solid ketogenic diet.[5] KetoCal is a nutritionally complete food containing milk protein and is supplemented with amino acids, fat, carbohydrate, vitamins, minerals and trace elements. It is used to administer the 4:1 ratio classic ketogenic diet in children over one year. The formula is available in both 3:1 and 4:1 ratios, either unflavoured or in an artificially sweetened vanilla flavour and is suitable for tube or oral feeding.[48] Other formula products include KetoVolve[49] and Ketonia.[50] Alternatively, a liquid ketogenic diet may be produced by combining Ross Carbohydrate Free soy formula with Microlipid and Polycose.[50]
Worldwide

There are theoretically no restrictions on where the ketogenic diet might be used, and it can cost less than modern anticonvulsants. However, fasting and dietary changes are affected by religious and cultural issues. A culture where food is often prepared by grandparents or hired help means more people must be educated about the diet. When families dine together, sharing the same meal, it can be difficult to separate the child’s meal. In many countries, food labelling is not mandatory so calculating the proportions of fat, protein and carbohydrate is difficult. In some countries, it may be hard to find sugar-free forms of medicines and supplements, to purchase an accurate electronic scale, or to afford MCT oils.[51]

Jewish dietary laws prevent mixing meat and milk in one dish. In Asia, the normal diet includes rice and noodles as the main energy source, making their elimination difficult. Therefore the MCT-oil form of the diet, which allows more carbohydrate, has proved useful. In India, religious beliefs commonly affect the diet: some patients are vegetarians, will not eat root vegetables or avoid beef. The Indian ketogenic diet is started without a fast due to cultural opposition towards fasting in children. The low-fat, high-carbohydrate nature of the normal Indian and Asian diet means that their ketogenic diets typically have a lower ketogenic ratio (1:1) than in America and Europe. However, they appear to be just as effective.[51]

In many developing countries, the ketogenic diet is expensive because dairy fats and meat are dearer than grain, fruit and vegetables. The modified Atkins diet has been proposed as a lower-cost alternative for those countries; the slightly more expensive food bill can be offset by a reduction in pharmaceutical costs if the diet is successful. The modified Atkins diet is less complex to explain and prepare and requires less support from a dietitian.[52]
Mechanism of action
Seizure pathology

Ketone bodies
Skeletal formula of 3-hydroxybutyric acid
β-hydroxybutyrate
Skeletal formula of 3-oxobutanoic acid
acetoacetic acid
Skeletal formula of acetone
acetone

The brain is composed of a network of neurons that transmit signals by propagating nerve impulses. The propagation of this impulse from one neuron’s synapse to another is typically controlled by neurotransmitters, though there are also electrical pathways between some neurons. Neurotransmitters can inhibit impulse firing (primarily done by γ-aminobutyric acid, or GABA) or they can excite the neuron into firing (primarily done by glutamate). A neuron that releases inhibitory neurotransmitters from its terminals is called an inhibitory neuron, while one that releases excitatory neurotransmitters is an excitatory neuron. When the normal balance between inhibition and excitation is significantly disrupted in all or part of the brain, a seizure can occur. The GABA system is an important target for anticonvulsant drugs, since seizures may be discouraged by increasing GABA synthesis, decreasing its breakdown, or enhancing its effect on neurons.[10]

The nerve impulse is characterised by a great influx of sodium ions through channels in the neuron’s cell membrane followed by an efflux of potassium ions through other channels. The neuron is unable to fire again for a short time (known as the refractory period), which is mediated by another potassium channel. The flow through these ion channels is governed by a “gate” which is opened by either a voltage change or a chemical messenger known as a ligand (such as a neurotransmitter). These channels are another target for anticonvulsant drugs.[10]

There are many ways in which epilepsy occurs. Examples of pathological physiology include: unusual excitatory connections within the neuronal network of the brain; abnormal neuron structure leading to altered current flow; decreased inhibitory neurotransmitter synthesis; ineffective receptors for inhibitory neurotransmitters; insufficient breakdown of excitatory neurotransmitters leading to excess; immature synapse development; and impaired function of ionic channels.[10]
Seizure control

Although many hypotheses have been put forward to explain how the ketogenic diet works, it remains a mystery. Disproven hypotheses include systemic acidosis (high levels of acid in the blood), electrolyte changes and hypoglycaemia (low blood glucose).[19] Although many biochemical changes are known to occur in the brain of a patient on the ketogenic diet, it is not known which of these has an anticonvulsant effect. The lack of understanding in this area is similar to the situation with many anticonvulsant drugs.[53]

On the ketogenic diet, carbohydrates are restricted and so cannot provide for all the metabolic needs of the body. Instead, fatty acids are used as the major source of fuel. These are used through fatty-acid oxidation in the cell’s mitochondria (the energy-producing part of the cell). Humans can convert some amino acids into glucose by a process called gluconeogenesis, but cannot do this for fatty acids.[54] Since amino acids are needed to make proteins, which are essential for growth and repair of body tissues, these cannot be used only to produce glucose. This could pose a problem for the brain, since it is normally fuelled solely by glucose, and fatty acids do not cross the blood–brain barrier. Fortunately, the liver can use fatty acids to synthesise the three ketone bodies β-hydroxybutyrate, acetoacetate and acetone. These ketone bodies enter the brain and substitute for glucose.[53]

The ketone bodies are possibly anticonvulsant in themselves; in animal models, acetoacetate and acetone protect against seizures. The ketogenic diet results in adaptive changes to brain energy metabolism that increase the energy reserves; ketone bodies are a more efficient fuel than glucose, and the number of mitochondria is increased. This may help the neurons to remain stable in the face of increased energy demand during a seizure, and may confer a neuroprotective effect.[53]

The ketogenic diet has been studied in at least 14 rodent animal models of seizures. It is protective in many of these models and has a different protection profile than any known anticonvulsant. Conversely, fenofibrate, not used clinically as an antiepileptic, exhibits experimental anticonvulsant properties in adult rats comparable to the ketogenic diet.[55] This, together with studies showing its efficacy in patients who have failed to achieve seizure control on half a dozen drugs, suggests a unique mechanism of action.[53]

Anticonvulsants suppress epileptic seizures, but they neither cure nor prevent the development of seizure susceptibility. The development of epilepsy (epileptogenesis) is a process that is poorly understood. A few anticonvulsants (valproate, levetiracetam and benzodiazepines) have shown antiepileptogenic properties in animal models of epileptogenesis. However, no anticonvulsant has ever achieved this in a clinical trial in humans. The ketogenic diet has been found to have antiepileptogenic properties in rats.[53]
Other applications

The ketogenic diet may be a successful treatment for several rare metabolic diseases. Case reports of two children indicate that it may be a possible treatment for astrocytomas, a type of brain tumour. Autism, depression, migraine headaches, polycystic ovary syndrome and type 2 diabetes mellitus have also been shown to improve in small case studies.[19] There is evidence from uncontrolled clinical trials and studies in animal models that the ketogenic diet can provide symptomatic and disease-modifying activity in a broad range of neurodegenerative disorders including amyotrophic lateral sclerosis, Alzheimer’s disease and Parkinson’s disease,[19] and may be protective in traumatic brain injury and stroke.[7][8] Because tumour cells are inefficient in processing ketone bodies for energy, the ketogenic diet has also been suggested as a treatment for cancer, [56] including glioma. [57] As of 2008, there is insufficient evidence to support the use of the ketogenic diet as a treatment for these conditions;[9] however, clinical trials for many of them are ongoing.[5]

In March 2009, caprylidene (Axona) was approved as a medical food by the US Food and Drug Administration for the “dietary management of the metabolic processes and nutritional requirements associated with mild to moderate Alzheimer’s disease”. Glucose metabolism by the brain is impaired in Alzheimer’s disease, and it is proposed that ketone bodies may provide an alternative energy source. Caprylidene is a powdered form of the MCT caprylic triglyceride.[58]
Notes

^ In this article, kcal stands for calories as a unit of measure (4.1868 kJ), and calories stands for “energy” from food.
^ Unless otherwise stated, the term fasting in this article refers to going without food while maintaining calorie-free fluid intake.
^ Hippocrates, On the Sacred Disease, ch. 18; vol. 6.
^ Hippocrates, Epidemics, VII, 46; vol. 5.
^ Galen, De venae sect. adv. Erasistrateos Romae degentes, c. 8; vol. 11.
^ Galen, De victu attenuante, c. 1.
^ A good reduction is defined here to mean a 50–90% decrease in seizure frequency. An excellent reduction is a 90–99% decrease.
^ Ketogenic “eggnog” is used during induction and is a drink with the required ketogenic ratio. For example, a 4:1 ratio eggnog would contain 60 g of 36% heavy whipping cream, 25 g pasteurised raw egg, vanilla and saccharin flavour. This contains 245 kcal (1,025 kJ), 4 g protein, 2 g carbohydrate and 24 g fat (24:6 = 4:1).[18] The eggnog may also be cooked to make a custard, or frozen to make ice cream.[35]

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^ Musa-Veloso K, Cunnane SC. Measuring and interpreting ketosis and fatty acid profiles in patients on a high-fat ketogenic diet. In: Stafstrom CE, Rho JM, editors. Epilepsy and the ketogenic diet. Totowa: Humana Press; 2004. p. 129–41. ISBN 1-58829-295-9.
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^ Zupec-Kania B. KetoCalculator: a web-based calculator for the ketogenic diet. Epilepsia. 2008 Nov;49 Suppl 8:14–6. doi:10.1111/j.1528-1167.2008.01824.x. PMID 19049577
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Further reading

Freeman JM, Kossoff EH, Freeman JB, Kelly MT. The Ketogenic Diet: A Treatment for Children and Others with Epilepsy. 4th ed. New York: Demos; 2007. ISBN 1-932603-18-2.

External links

Matthew’s Friends. A UK charity and information resource.
The Charlie Foundation. A US charity and information resource, set up by Jim Abrahams.
epilepsy.com: Dietary Therapies & Ketogenic News. Information and regular research news updates.
A Talk with John Freeman: Tending the Flame. An interview discussing the ketogenic diet that appeared in BrainWaves, Fall 2003, Volume 16, Number 2.

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