Autism and Dietary Therapy

Abstract

We report the history of a child with autism and epilepsy who, after limited response to other interventions following her regression into autism, was placed on a gluten-free, casein-free diet, after which she showed marked improvement in autistic and medical symptoms. Subsequently, following pubertal onset of seizures and after failing to achieve full seizure control pharmacologically she was advanced to a ketogenic diet that was customized to continue the gluten-free, casein-free regimen. On this diet, while still continuing on anticonvulsants, she showed significant improvement in seizure activity. This gluten-free casein-free ketogenic diet used medium-chain triglycerides rather than butter and cream as its primary source of fat. Medium-chain triglycerides are known to be highly ketogenic, and this allowed the use of a lower ratio (1.5:1) leaving more calories available for consumption of vegetables with their associated health benefits. Secondary benefits included resolution of morbid obesity and improvement of cognitive and behavioral features. Over the course of several years following her initial diagnosis, the child's Childhood Autism Rating Scale score decreased from 49 to 17, representing a change from severe autism to nonautistic, and her intelligence quotient increased 70 points. The initial electroencephalogram after seizure onset showed lengthy 3 Hz spike-wave activity; 14 months after the initiation of the diet the child was essentially seizure free and the electroencephalogram showed only occasional 1-1.5 second spike-wave activity without clinical accompaniments.

Potential Therapeutic Use of the Ketogenic Diet in Autism Spectrum Disorders

“…Beneficial effects of KGD in children with ASD symptoms have been reported in two independent studies (54, 55). The first study evaluated the role of KGD on 30 ASD children (54).…”

“…The other study (55) reports the administration of a gluten-free casein-free modified KGD (1.5:1 lipid:non-lipid ratio; medium-chain and polyunsaturated FA) for 14-months to a 12-year-old child with ASD and seizures with substantial medical comorbidities associated with a family history of metabolic and immune disturbances. Due to the improvements in seizure activity, improved electroencephalogram, cognitive and social skills, language function, and complete resolution of stereotypies, anticonvulsant medication doses were reduced without worsening of seizures.…”

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

“…Studies support that the ketogenic diet alters neural cellular metabolism through utilization of ketone bodies as an alternative fuel for the brain [10]. Initial case reports and a prospective pilot study of 30 individuals with autistic behavior suggests the KD may be effective as a treatment strategy for ASD [11–13]. Follow up clinical studies of 187 Greek and 45 Egyptian children have provided additional support that the KD may safely improve symptoms of certain individuals with ASD [14,15].…”

Neocortical Disorganization and Autism

“…Secondary benefits of the MCT diet included resolution of morbid obesity and improved cognition and behavior. The Childhood Autism Rating Scale score decreased from 49 (severe) to 17 (nonautistic); the child was essentially seizure free after 14 months on the diet; and a lengthy 3 Hz spike-wave EEG pattern improved, showing only occasional short discharges without clinical accompaniments [2]. Despite the limitations of a single case, this report seemed worthy of comment.…”

“…In a Swedish population study [1], the risk of autism spectrum disorder (ASD) in family members of persons with ASD was significantly higher than the risk in the general population, and the risk of ASD recurrence among family members decreased with decreasing genetic relatedness, from a 10-fold increased risk of recurrence in full siblings to a 2-fold increased risk of recurrence in cousins. Genetic factors explained half of the liability for autism [2]. Another population-based Swedish study based only on twins estimated a heritability of 80% [3].…”