Autism is a neurodevelopmental disorder that affects language development and social function. The uncertainty about what causes autism in the majority of “idiopathic” cases, has hampered the development of a universally beneficial treatment, aside from symptomatic treatment of autism-related behaviors such as aggression or anxiety. Limited clinical evidence raises the intriguing possibility that a Ketogenic Therapy might be helpful to alleviate some of the abnormal behaviors seen in children with autism spectrum disorders. Using an MCT version, 10 of 18 autistic children demonstrated moderate or significant behavioral improvement (by a blinded rater) after a 6-month trial of providing the diet for 4 weeks of KD diet treatment alternating with 2 weeks of normal diet, in 6-week cycles (Evangeliou et al., 2003).
“Although treatment strategies for children with autism spectrum disorders are under development, the Ketogenic Diet is available now and could offer multiple benefits. For example, children with autism and uncontrolled seizures have few options, and this research suggests a Ketogenic Diet could reduce seizures and improve behavior.” Susan Masino, PhD, Trinity College, Harford, Conn. 2013.
None of the commonly tried diets for autism, including gluten-free and casein-free, has proven effective in controlled clinical studies. The available medical treatments address the comorbid behavioral conditions related to autism but do not affect the core symptoms that result in the autism diagnosis. The occurrence of autism is currently one in 88 people in the U.S. and continues to increase.
The Ketogenic Diet, because of its very restricted carbohydrates and limited proteins, forces the body to use fat rather than glucose as an energy source and thus produces a metabolic state similar to fasting. Ketogenic Diets have been used successfully to treat epilepsy in people since 1921 and epilepsy is common in people who have autism. A study published in 2003 demonstrated that some children with autism on an intermittent Ketogenic Diet experienced a significant reduction in autistic symptoms.
A recent case report published in The Journal of Child Neurology describes a child diagnosed at age four with autism who had limited response to other treatments but gained benefit on a gluten-free, casein-free diet.
She developed seizures after starting puberty and continued to have seizures despite the use of anti-seizure medication. With the assistance of our nutritionist, Beth Zupec-Kania, her gluten-casein-free diet was modified to make it ketogenically balanced using medium-chain triglycerides as the main source of fat. Significant improvements in multiple areas are described:
In addition to improvement in seizures, there was a 60-pound weight loss subsequent to initiation of the gluten-free casein-free Ketogenic Diet, as well as improved cognitive and language function, marked improvement in social skills, increased calmness, and complete resolution of stereotypes. Intravenous immunoglobulin treatments continued, since delays in delivery of immunoglobulin G were associated with illness accompanied by convulsion. Based on the clinical improvement, the electroencephalogram improvement, and development of a side effect involving extreme medication associated somnolence, anticonvulsant medication doses were reduced (first lamotrigine by 50%, and then ethosuximide by 25%) without worsening of seizures. Cholesterol was 152 mg/dl before starting diet, and was 160 mg/dl after more than a year on the diet.
Masino and her colleagues, who had been studying the Ketogenic Diet for a variety of neurological disorders, learned that certain biological compounds increase in the brain while on the Ketogenic Diet. She hypothesized that a compound called adenosine may be key to the diet’s effects and may also be helpful in alleviating symptoms of autism. Masino tested the behavioral effects of a Ketogenic Diet using a mouse model that has characteristics of autism, including low sociability, poor perception of social cues and highly repetitive behaviors. As expected, the mice fed a normal diet displayed behavioral symptoms of autism but after feeding a Ketogenic Diet to the autistic mice for three to four weeks, autistic behaviors reversed significantly and they behaved like normal mice. The mice fed a Ketogenic Diet were more social and spent more time with other mice; they were also able to perceive social communication cues regarding food choice. Ketogenic Diet-fed mice also spent significantly less time grooming, indicating reduced repetitive self-directed behavior. “Together, these behaviors represent the complement of core symptoms used to diagnose autism, and all were reversed by the Ketogenic Diet,” said Masino.
Because seizures are common in persons with autism spectrum disorders, it was important to determine if the effects of the diet were related to the Ketogenic Diet’s well-known ability to treat epilepsy. Based on tests, including EEG recordings and induced seizures, the researchers found that the mice used in the study did not have epilepsy. Therefore, the behavioral effects of the diet are independent of its anti-seizure effects.
In addition to Masino’s hypothesis regarding adenosine, inflammation is considered an important factor in causing autism: a general decrease in inflammation due to the Ketogenic Diet could underlie its effectiveness against autistic symptoms. Masino’s laboratory proved for the first time that a Ketogenic Diet can reduce inflammation in rats. Other research groups are now looking at the effects of the Ketogenic Diet on inflammation in autism.
Many clinicians have pointed out that people with autism have a narrow range of dietary preferences and therefore a restricted Ketogenic Diet may not be well tolerated. Our nutritionist, Beth Zupec-Kania, has found success by modifying the diet for children with autism to allow for preferences but still maintain ketosis. For example use of medium-chain triglycerides allows for generous amounts of carbohydrate. Although the classic Ketogenic Diet is gluten-free, many with autism follow casein-free restrictions as well. This added restriction is entirely feasible. Tasty beverages, ketogenic crackers and breads can be prepared from nut flours and oils. In addition, the volume of food on these high-fat, low-carbohydrate diets is much smaller than typical servings which assists with completion of meals.
Evidence from these studies and reports indicates that at least certain types of autism respond to metabolic diet treatments. At this time, with few treatment options, new treatment strategies for autism are needed. Additional research on the Ketogenic Diet may offer clues to reversing symptoms of autism. Here are a few studies.
- Potential Therapeutic Use of the Ketogenic Diet in Autism Spectrum Disorders
- Autism and Dietary Therapy: Case Report and Review of the Literature
- A Modified Ketogenic Gluten-Free Diet with MCT Improves Behavior in Children with Autism Spectrum Disorder
Think the Ketogenic Diet is right for you? Talk to your doctor before adopting a Ketogenic Diet, or connect with one of our qualified diet professionals to determine a course of action that is right for you.
What are the benefits of Ketosis?
Achieving a state of ketosis can have many benefits from treating chronic illnesses to optimizing performance. While the benefits are well documented, the underlying mechanism of action is not entirely known. The diet seems to enhance the ability of mitochondria, the power plants of our cells, to deliver our bodies’ energy needs in a manner that reduces inflammation and oxidative stress. Through optimizing the way our body uses energy, we fortify our bodies’ ability to take on the ever-growing stressors of our modern way of living.
Can a high fat diet be healthy?
According to David Diamond PhD, “Saturated fat does not clog the arteries: Coronary heart disease is a chronic condition, the risk of which can be effectively reduced from healthy lifestyle interventions. We have known for 150 years that a high carbohydrate diet contributes to fat in the blood and contributes to obesity.” He goes on to say, “the poor science that was used to support the idea that increased fat intake increases cholesterol and damages arteries was authored by Ancel Keys who had no background in nutrition, but did have a BA in Economics and a PhD in Fish Physiology. Keys’ theory that fat in diet causes increased risk for high cholesterol and heart attack was based on extremely flawed science and “became dogma without ever being rigorously assessed.” “A generation of citizens has grown up since the Diet/Heart Hypothesis (of Ancel Keys) was launched as official dogma. They have been led by the greatest scientific deception of our times: the notion that consumption of animal (saturated) fat causes heart disease.” George Mann MD, Nutrition Today, 1985. “The belief that atherosclerosis is due to high cholesterol has been perpetuated by powerful forces using tactics to preserve the profits and reputations of those who promote them.” Paul Rosch M.D, Scandinavian Cardiovascular Journal, 2008. “The diet heart hypothesis is sustained by social, political and financial institutions which have little to do with science and established success in public health.” Uffe Ravnskov MD PhD, 2008.
Ready to get started? Learn the basics…
The Ketogenic Diet, also referred to as the ketosis diet, or Keto for short, is a way of eating that mimics the effects of fasting. By consuming a diet rich in quality fats, adequate in protein, and low in net carbohydrates (total carbs minus fiber), the body’s metabolism begins to utilize fat as its main source of fuel, rather than carbs. This shift has profound effects on metabolism for both the sick and healthy alike. The diet shows promise for improving or reversing many neurological conditions and metabolic disorders. For the healthy, the diet represents a tool for preventing chronic disease, as well as optimizing cognition and body composition (i.e. fat loss).
What is ketosis?
The term ketosis refers to a byproduct of the breakdown of fat into useable energy, called ketone bodies, or ketones for short. This fat can be derived directly from the food we eat, or adipose tissue stored throughout your body (otherwise known as body fat). Ketones are used directly by the body to power itself. This breakdown of fat into useful energy is similar to the process that dietary carbohydrates undergo in producing glucose to fuel the body. In other words, ketones are to fat what glucose is to carbohydrates. Ketosis is defined as having blood ketone levels > .5 millimolar/L.
How do I get into ketosis?
There are two methods to make the metabolic shift from using glucose to ketones as your main source of energy.
Fasting – the method of complete cessation of caloric intake for a prolonged period of time has been used to treat disease as far back as 400 B.C. when Hippocrates, the Father of Modern Medicine, employed the method for a myriad of ailments. Though this should be done under medical supervision, fasting is a safe, effective (and, some would say, the easiest) way to get into ketosis, quickly. For the average adult, a 48-hour fast will generally result in ketosis. After this fast, adopting a Ketogenic Diet will allow you to stay in ketosis. We recommend starting the fast at least 3 hours before bedtime on the first day, and eating at the same time 2 days later. While fasting means many things to many people, we define it here as the total restriction of macronutrients. We recommend boosting water consumption in order to avoid dehydration, and many find black coffee or plain tea to help maintain focus and performance during the fast. Children go into ketosis much faster and therefore can be started on the diet without fasting.
Diet – adopting a high fat, moderate protein, and low net-carb diet, will result in ketosis, and will take 2-3 weeks to achieve this state, as defined above. The diet is most basically explained by the ratio of macronutrients (fat, protein and net-carbs) in your diet, as it relates to fat. A classic Ketogenic Diet has a ratio of 4 parts fat, to 1 part protein + carbs (referred to as a 4:1 ratio). This 4:1 ratio is the high end of the spectrum as it relates to fat intake, though modifications to the diet can see this ratio go as low as 2:1. The ratio you adopt depends on the therapeutic benefit you are trying to achieve as well as the diet that is achievable for your lifestyle. We will go into diet options below, but you can also link to them here.
How long should I be on the diet?
We at the Charlie Foundation believe that a 3-month commitment to the diet is a minimum commitment to allow your body to fully acclimate to the new fat based fuel source. Since most people following a western diet are not proficient at metabolizing fat optimally, this period allows the body time to become “fat-adapted”, utilizing dietary fat efficiently and effectively. There are a variety of nutritional plans that will enable a ketogenic lifestyle, and flexibility is one of the hallmarks of the diet that make it easy to adopt as a life-long tool to enhance your health. Our nutritionists can help figure out both the short and long-term options best suited for you and your lifestyle.
Am I a candidate for the Ketogenic Diet?
While the short answer is yes for the majority of people consuming a western diet, we urge you to consult your general practitioner prior to making the switch to Keto. The Charlie Foundation will provide you with the information and tools necessary to adopt the diet, and partnering with your doctor during this process will ensure the most therapeutic outcome. We also suggest that you connect with a diet professional who can help you form a plan in collaboration with your doctor, who may be less familiar with the diet.
Types of Ketogenic Diets
There are a variety of diets that will allow you to get into ketosis. The major differentiating factor between them all is the amount of calories that come from protein, carbs and fat, which are what we call “macronutrients”, or nutrients in our food that have a caloric value. The three macronutrients differ in many ways, namely, their caloric values, as well as how the body uses them. Fat is the most calorically dense macronutrient, having 9 calories per gram, compared to 4 calories per gram for both carbs and protein. In a homeostatic state, the body utilizes fat and carbs for energy production, while it uses protein to rebuild the cells of our body. While this is generally the case, an overconsumption of protein can lead the body to break down the excess protein into glucose (which is what carbs break down into)
- Classic Ketogenic Diet
- Modified Ketogenic Diet
- MCT Oil Diet
- Modified Atkins
- Low Glycemic Index Diet (LGIT)
- Intermittent Fasting
If you think you can benefit from adopting a Ketogenic Diet, we encourage you to consult one of our dietitians, visit a participating hospital, or contact us so that we may guide you towards the most fruitful option given your specific needs.