Can a Ketogenic diet (low carbohydrate, high fat, adequate protein diet) be used as an additional metabolic therapy for Autism spectrum disorder?
According to the Autism Society in the US, about 1% of the world population has Autism spectrum disorder (ASD). The prevalence in the US is estimated at 1 in 59 births (Autism society, Online:2018). Statistics on ASD in South Africa is difficult to find.
ASD is an umbrella term for neurodevelopmental disorders, that as of May 2013, includes what was formerly known as Asperger syndrome, and classic autism. Signs typically appear during early childhood. The disorder affects a person’s ability to communicate and interact with others. It affects individuals differently and to varying degrees (ASPEN, 2018).
Parents of ASD children worldwide have turned to diet therapies and have experienced varying rates of success. Clinical studies with different dietary interventions are limited because of the many challenges faced by ASD children.
Studies on mice show promising results according to Susan Masino, PhD Trinity College. Masino tested the behavioural effects of a ketogenic diet using a mouse model that has characteristics of autism including low sociability. Results from the mice fed on a normal diet displayed behavioural symptoms of autism, however, after feeding them a ketogenic diet the autistic behaviour reversed significantly. They were more social and spent more time with other mice. Masino’s study also showed that the behavioural effects of the ketogenic diet were independent of its anti-seizure effect. (Masino, Online:2017)
It seems as if the research base regarding the ketogenic diet, other than epilepsy and seizure control, is still not substantial enough. However, more than 1,300 scientific articles have been published over 90 years regarding the ketogenic diet and epilepsy. Dr. Jong Rho a world-leading pediatric neurologist based in Canada is using this research to assess ketogenic mechanisms for other neurological and developmental conditions such as ASD (Jacqueline A. French, 2017).
While the exact action of the ketogenic diet is not completely understood yet, there are several reasons why the ketogenic diet may be effective for improved brain function and improvements in all areas of children with neurologic conditions (Lindsey B. Gano, 2014).
The ketogenic diet’s impact according to Dr. Rho may include the following:
|Ketogenic diet||Positive affect for ASD|
|Breakdown of fat to ketones.||Provide the energy-hungry brain with an alternate energy source than glucose and produce less oxidative stress.|
|Improved cellular metabolism.||Neuroprotective, preventing or decreasing neuronal injury or cell death.|
|It is anti-inflammatory.||Reduces inflammation which is a risk factor for seizures and other conditions.|
|It has epigenetic impacts.||It inhibits the expression of some genes linked to neurological problems.|
|It alters the microbiome of the gut (Newell C1, 2016).||It improves the cross talk between the gut and brain which has significance for ADS.|
|It impacts various ion channels.||It improves the transmission of nerve cell signals.|
|It promotes homeostasis.||Restoring physiological balance and equilibrium on cellular and systems level.|
|Reduce brain inflammation.||Implications for brain pathways.|
|Stabilizing of blood glucose levels.||More stable mood and behavior.|
|Normalizing of insulin levels.||Positive effect on inflammation.|
|Circulating ketone bodies.||Ketones have an inhibitory effect on nerve cells and therefor hyperactive behaviour.|
|More ketone bodies in the brain.||Maintains GABA, a neurotransmitter, at (Eleonora Napoli, Online:2014) a higher level.|
|May contain medium triglyceride (MCT) fats.||Control of yeast overgrowth.|
|A well-formulated ketogenic diet is nutrient dense.||Increase beneficial bacteria in the gastrointestinal system.|
More recent reports on individual ASD children showed:
- Significant improvement on the gluten free, casein free (GF/CF) diet but an even greater improvement on an adapted GF/CF ketogenic diet concerning social functioning and cognitive abilities (El-Rashidy O1, Online:2017).
- A May 2018 report in the Journal of Physiology and Behavior describes the improvement in core symptoms of ASD in 10 children on a ketogenic diet, plus MCT oil, for 6 months (Ryan W.Y. Lee, Online:2018)
Dr Julie Buckley a paediatrician from Florida believes there is enough evidence to recommend ketogenic eating to help children with neurologic, developmental or behavioural issues. She recommends a dairy-free ketogenic diet for every family having a child on the autism spectrum. Her own autistic daughter of 19 years old follows this diet with great success.
Evidence from these studies and reports indicate that at least certain types of autism respond to metabolic diet treatments. Additional research on the Ketogenic Diet may offer further clues to reversing the symptoms of autism.
Although the Ketogenic diet is a promising option for families of ASD children it is important to consider that ASD children have many challenges concerning feeding and nutrition (Bennie, 2015).
- Picky eating is one of the most common complains of parents.
- Selective eating.
- Not eating enough or overeating.
- Oral motor difficulties that prevent proper chewing and processing of food.
- Sensory issues around texture and colour.
- Digestive issues, such as yeast overgrowth and leaky gut.
- Allergies, food intolerances (gluten, casein, salicylates, phenolic compounds, oxalates, food additives and colourants).
- Nutrient deficiencies, such as B vitamins, Calcium, Vitamin A and D.
It is therefore important to have adequate support from a medical doctor to monitor health and progress, as well as a dietitian trained in ketogenic diet prescription to:
- Provide a well-formulated ketogenic diet.
- Ensure adequate growth for age.
- Monitor adequate intake of macro- and micronutrients.
- Support and monitor feeding problems.
- Prescribe appropriate probiotics and supplements.
A multi-disciplinary team approach is important to provide the best possible support structure for families facing the daily challenges of ASD.
In conclusion, it appears that the ketogenic diet, adapted to also be gluten free and casein free, may be an important additional therapy for children with ASD for the following reasons:
- Eliminate gluten and casein.
- Promote the use of ketones for fuel, and ongoing research is showing promising results concerning the advantages of ketone bodies for neurological health.
- Help calm the overactive nervous system.
- Improve gut health, which has a positive effect on behaviour and brain health.
Lindsey B. Gano, M. P. (2014). Ketogenic diets, mitochondria, and neurological diseases. Journal of Lipid Research, 2211-2228.
Jacqueline A. French, M. K. (2017, July). Clinical studies and anti-inflammatory mechanisms of treatments. Retrieved from HHS Public Access PMC: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5679081/pdf/nihms916357.pdf
Newell C1, B. M. (2016, september 1). pubmed. Retrieved from Pubmed abstract: https://www.ncbi.nlm.nih.gov/pubmed/27594980
Bennie, M. (2015, november 7). Retrieved from autiamawareness centre: https://autismawarenesscentre.com/feeding-challenges-helpful-hints-for-parents-of-children-with-autism/
Autism society. (Online:2018, July 21). Facts and statistics. Retrieved from Autism society: http://www.autism-society.org/what-is/facts-and-statistics/
ASPEN. (2018, JUly 21). What is Autism spectrum disorder. Retrieved from ASPEN: https://aspennj.org/what-is-autism-spectrum-disorder
Masino, P. S. (Online:2017, February 14). Professor Susan Masino – Metabolism and Brain Health. Retrieved from Scientia Global: http://www.scientia.global/professor-susan-masino-metabolism-brain-health/
Ryan W.Y. Lee, a. M.-J. (Online:2018). A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder. Physiol Behav, 205-211.
El-Rashidy O1, E.-B. F.-G. (Online:2017). Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Matab Brain Dis, 1935-1941.
Eleonora Napoli, N. D. (Online:2014). Potential Therapeutic Use of the Ketogenic Diet in Autism Spectrum Disorders. Frontiers in Pediatrics.