Betaquik as an Adjunct to Dietary Management of Epilepsy in Adults on the Modified Atkins Diet

The purpose of this pilot study is to measure adherence and quality of life in adults with
intractable epilepsy following the Modified Atkins Diet (MAD) with Betaquik, a ready-to-use
medium chain triglyceride (MCT) emulsion, as an adjunct to the MAD.

The participants dietitian will recommend an appropriate daily intake of Betaquik based on
individual requirements. Participants will be asked to gradually introduce Betaquik into the
diet up to the target volume advised by the dietitian. Participants will then incorporate the
target volume of Betaquik into their diet and gradually increase carbohydrate intake up to a
maximum tolerated level and continue on the management regime until the end of the 26-week
period. At the end of the 26-week period participants will undergo a Betaquik washout. In
order to mitigate any impact of Betaquik tapering dietary effectiveness and sustained
ketosis, carbohydrate intake will be reduced concurrently to the original 20-30 grams daily.
This will continue for an additional 26-weeks (totaling 52-weeks). Both Betaquik introduction
and tapers will occur under the direction of their dietitian with their daily intake under
weekly review for the duration of the study. Vitaflo International Ltd. will supply Betaquik
directly to the participants homes free of charge. Participants will be provided with a
28-day supply of Betaquik renewed every four weeks.

The objective of this study is to evaluate the acceptability, tolerance and adherence of the
MAD including MCT - Betaquik in participants with a diagnosis of epilepsy.

This is an exploratory pilot study to evaluate the gastrointestinal tolerance, palatability
and participant adherence, over a 52-week period, of the MAD with and without Betaquik, for
the dietary management of participants with epilepsy.

Participants will be asked to collect daily information on any incidence of the following for
the first 3 months and weekly thereafter:

- Diarrhea and/or constipation as measured by stool frequency, color and consistency

- Bloating and/or distension

- Nausea and/or vomiting

- Burping/flatulence/regurgitation

- Abdominal discomfort/pain

If participants report any of the above then additional questions about the timing, duration,
cause and seriousness/severity of any adverse effects are to be recorded in the diary.

At the end of the 52-weeks all final questionnaires will be completed including those
assessing quality of life, clinical epilepsy status, dietary intake and adherence, Betaquik
and dietary carbohydrate intake and Betaquik tolerability. Final blood and urine samples will
be taken for clinical safety assessment and routine anthropometry measurements taken.

Statistics and Plans for Analysis: This is an exploratory pilot study and its primary aim is
to determine the acceptability, adherence and tolerance of the MAD with Betaquik as an
adjunct therapy. A t-test and chi-square will be used with the quantitative measures, under
the direction of a biostatistician. Qualitative measures will be described in a narrative
summarizing the study outcomes.

Inclusion Criteria:

- Diagnosis of epilepsy; suffering from recurrent seizures (> or equal to 2 seizures per
month) despite at least two anticonvulsant medication trials.

- Aged 18 years and above.

- Not on the ketogenic diet.

- Absence of any metabolic or mitochondrial disorder that precludes the use of MCT and
the ketogenic diet.

- Willingly given, written, informed consent from the patient or caregiver.

- Ability to comply with study protocol and keep written records.

Exclusion Criteria:

- Non-compliant with previously recommended treatments.

- Significantly underweight (BMI <18.5), untreated dysphagia, or severe gastroesophageal
reflux.

- Kidney disease, including history of nephrolithiasis.

- Uncontrolled or untreated hypercholesterolemia (>300mg/dL) or hypertriglyceridemia
(>200mg/dL) within the last two years.

- Prior use of Betaquik at any time for any duration.

- Any serious medical, psychological, or social condition precluding the study
intervention.

- Use of additional macro/micronutrient supplement during the study period, unless
clinical indicated and prescribed by the investigator (must be recorded electronic
medical records).

- Women who are pregnant/breastfeeding at the start of the study or planning to become
pregnant during the study period.

- N.B.: Women who become pregnant unexpectedly during this study may, in consultation
with their doctor, continue on the study's dietary product if they wish but will not
have any investigations that would not normally be carried out during pregnancy.