By Brooke Erickson, MS, CN
The Ketogenic Diet (KD) has gained a lot of attention lately and for good reason. Its therapeutic use, especially relating to metabolic and neurological conditions, has a lot of potential benefits and is currently a hot topic in scientific research. The KD was originally developed by the Mayo Clinic in the 1920’s for the treatment of epilepsy to control seizures. In addition to treating epilepsy, research has shown that the KD also improves mitochondrial function and while the exact root cause of autism is not known, recent studies are finding that mitochondrial dysfunction is an important factor that contributes to symptoms. There are limited clinical studies on the effects of the KD on autism as this is a new area of research, but so far the results looks promising, especially for improved cognition and behavior, as well as those who experience seizures.
A recent study compared the effect of the Modified Atkins Diet (MAD), a gluten-free/casein-free diet (GFCF), and a control diet and found that both the intervention diets showed significant improvement in autism-related test markers in comparison to the control diet.1 However, the MAD scored better results in cognition and sociability when compared to the GFCF diet. While this is only one small study, these results open the door for more research on the potential benefits of KD’s on autism, as well as the combination of both a KD and GFCF diet.
There are currently several different variations of the KD being used clinically. The classic KD is high in fat, adequate in protein, and low in carbohydrates with a ratio of 4:1 (fat: protein + carbohydrates) or 90% fat, 6% protein, 4% carbohydrate. This is the most structured version of diet and requires foods to be weighed using a food scale. Other modified versions of the diet have been adapted with macronutrient ratios ranging from 4:1 to 1:1. The MAD, used in the mentioned study, was developed by John Hopkins Hospital as a less restrictive alternative that doesn’t have limits on calories or protein with a ratio of approximately 0.8-1:1. This makes the MAD easier to manage, especially when eating out.
The nutritional approach of the KD is to mimic fasting and force the body into using fat as the primary fuel source instead of glucose. In this metabolic state, fats are converted to fatty acids and the liver produces ketone bodies, which can be used for energy. Ketone bodies are especially beneficial as an energy source for the brain because they can cross the blood-brain barrier. When there are a certain number of ketones in the blood you reach what is called ketosis. The goal of the diet is to maintain ketosis by restricting carbohydrates and sustaining the appropriate ratio of macronutrients.
The exact mechanisms that make the KD beneficial for autism is not fully understood, but we do know that it improves mitochondrial function while reducing inflammation and oxidative stress. One mechanism that is thought to factor into the benefits of the KD for autism is the calming effect that ketones have on nerve cells and their neuroprotective properties, which may help reduce autism-like behaviors and symptoms.
It’s important to note that the KD is not appropriate for everyone and you should consult with your doctor before starting the diet. There are several health conditions that are contraindicated and should be considered before starting a KD. If you are interested in learning more about the KD and whether it could be beneficial for you or your child please make an appointment with your doctor.
1. El-Rashidy, O et al. “KD versus gluten free casein free diet in autistic children: a case-control study” Metab Brain Dis. 2017 Dec;32(6):1935-1941
2. Cekici H, Sanlier N. “Current nutritional approaches in managing autism spectrum disorder: A review.” Nutr Neurosci. 2017 Aug 1:1-11
3. Cheng, N, Rho, JM, Masino, S. “Metabolic Dysfunction Underlying Autism Spectrum Disorder and Potential Treatment Approaches” Front Mol Neurosci. 2017; 10: 34.
An elimination diet can be a challenging endeavor as it entails making dramatic changes in your grocery shopping and cooking habits. It is a two to four-week process, which involves removing foods from your diet that could potentially be detrimental to your gastrointestinal system, weight status, energy level, memory, mood, muscular system, skin, etc
Here are some tips to support you and help you stay motivated through your elimination diet journey:
Maintain a positive attitude.
Keep your sights set on the belief you are taking steps towards healing your body. Try your best to not focus on how restrictive an elimination diet is or what foods you may have to cut out of your diet. Continue to remind yourself the elimination diet is a temporary process that is helping you discover your sensitivity to certain foods.
Make your food journal enjoyable.
Give yourself small rewards as you go through eat week of your elimination diet. Sometimes, it is helpful to view the elimination diet as a personal science experiment to achieve improved health status.
Practice mindful eating.
You may be removing some of your favorite splurges from your diet such as ice cream, coffee, and gluten-containing products. However, incorporating mindfulness during meal time will reduce stress and allow you to experience more satisfaction and awareness of the delicious, whole-foods you are eating. Focus your attention on the delicious fresh fruit and vegetables you are nourishing your body with.
Incorporate a food preparation day.
Life can get pretty busy. Having prepared meals for the week can assist you with sticking to the elimination diet and reduce your cravings. If the proper foods are already prepped for the busy work week, it will be easier to stick to and maintain the elimination diet.
Remember you can still dine out at restaurants, just do your best to plan ahead.Create your own allergy food chart you can provide the restaurant. Also, call the restaurant ahead of time and discuss your dietary restrictions and find menu options that fit your current diet plan.
Do not be afraid to ask for support from family and friends. This type of diet can be challenging and it is helpful to have family and friends involved in the process.
By: Hayley Cornell
Vital Kids Medicine, PLLC
3216 NE 45th Place suite #212
Seattle, WA 98105