A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder

Abstract

Purpose The ketogenic diet is a low-carbohydrate, moderate protein, high-fat diet that has emerged as a potential treatment for autism spectrum disorder. Autism spectrum disorder is a neurodevelopmental disorder of social communication, and restricted, repetitive behaviors and interests in need of novel therapies. An open-label clinical trial was done in Honolulu, Hawaii to test a modified ketogenic diet for improvement of core clinical impairments in children with ASD. Intervention A modified ketogenic gluten-free diet regimen with supplemental MCT was completed in 15 children ages 2 to 17 years for 3 months. Clinical (ADOS-2, CARS-2) and biochemical measures were performed at baseline and 3-months on the ketogenic diet. Main outcome Children administered a modified ketogenic gluten-free diet with supplemental MCT significantly improved core autism features assessed from the ADOS-2 after 3 months on diet (P = 0.006). No significant difference was observed in restricted and repetitive behavior score (P = 0.125) after 3 months on the diet protocol. Substantial improvement (> 30% decrease ADOS-2 total score) was observed in six participants, moderate improvement (> 3 units) in two participants, and minor/no improvement in seven participants. Ten participants assessed at a six-month time point sustained improvement in total ADOS-2 and social affect subdomain scores comparing baseline and 6 months (P = 0.019; P = 0.023), but no significant improvement in restricted and repetitive behavior scores were noted (P = 0.197). Significant improvements in CARS-2 items after 3 months of the modified ketogenic protocol were observed in imitation, body use, and fear or nervousness (P = 0.031, P = 0.008, P = 0.039). The percent change on ADOS-2 score from baseline to 3 months was associated with baseline high-density lipoprotein levels (ρ = −0.67, P = 0.007) and albumin levels (ρ = −0.60, P = 0.019). Moreover, the percent change from baseline to 3 months in ADOS-2 scores was significantly associated with percent change in high-density lipoprotein levels (ρ = 0.54, P = 0.049) and albumin levels (ρ = 0.67, P = 0.010). Conclusions A modified gluten-free ketogenic diet with supplemental MCT is a potentially beneficial treatment option to improve the core features of autism spectrum disorder and warrants further investigation. Trial registration Trial Registry: Clinicaltrials.gov Registration Number: NCT02477904URL: https://www.clinicaltrials.gov/ct2/show/NCT02477904?term=ketogenic+diet&cond=Autism&rank=1

Electrical Control in Neurons by the Ketogenic Diet

“…Finally, some clinical studies have tested the feasibility of the ketogenic diet for the treatment of other neurological disorders. A clinical trial revealed that a modified version of the ketogenic diet improved core autism features in patients with autism spectrum disorder (Lee et al, 2018 ), and this was supported by animal studies (Ruskin et al, 2013 , 2017 ). In addition, pilot clinical studies reported that the MCT ketogenic diet improved the cognitive performance of patients with Alzheimer’s disease or mild cognitive impairment (Reger et al, 2004 ), and also reported that the ketogenic diet improved Parkinson’s disease symptoms (Vanitallie et al, 2005 ).…”

The role of microbiota in autism spectrum disorders

“…Two non placebo-controlled studies were conducted (recruiting respectively 30 and 15 patients), both confirming the beneficial effects of KD in autistic patients. 96,97 Further studies are required to confirm these preliminary data and to analyze the possible impact of KD on autistic behavior.…”

Gut–Brain Axis: Role of Gut Microbiota on Neurological Disorders and How Probiotics/Prebiotics Beneficially Modulate Microbial and Immune Pathways to Improve Brain Functions

“…The bacterial diversity and the abundance of Prevotella , Bifidobacterium , and Desulfovibrio taxa were found to be higher in ASD children with MTT treatment. The gastrointestinal disturbances and the alternation in the composition of the gut microbiota were restored or reversed by probiotics [ 123 , 124 ] and dietary [ 125 ] treatment in ASD children.…”