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. 2018 May 1:188:205-211.
doi: 10.1016/j.physbeh.2018.02.006. Epub 2018 Feb 5.

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

Ryan W Y Lee  1 , Michael J Corley  2 , Alina Pang  3 , Gaye Arakaki  4 , Lisa Abbott  5 , Michael Nishimoto  6 , Rob Miyamoto  7 , Erica Lee  8 , Susan Yamamoto  9 , Alika K Maunakea  10 , Annette Lum-Jones  11 , Miki Wong  12
Affiliations

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

Ryan W Y Lee et al. Physiol Behav. .

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

  1. Registration Number: NCT02477904

  2. URL: https://www.clinicaltrials.gov/ct2/show/NCT02477904?term=ketogenic+diet&cond=Autism&rank=1

Keywords: Autism; High fat; Intervention; Ketogenic diet; Neurodevelopment; Therapy.

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Conflict of interest statement

Conflict of interest

Authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Diagram of ASD ketogenic diet study participation.
Fig. 2
Fig. 2
ADOS-2 scores at baseline and 3 months on a modified KD/GF/MCT diet. a. ADOS-2 Comparison score significantly improved at 3 months on the modified KD/GF/MCT diet (Wilcoxon matched-pairs signed rank test, P = .006). b. ADOS-2 Total score significantly improved at 3 months on the modified KD/GF/MCT diet (Wilcoxon matched-pairs signed rank test, P = .020). c. ADOS-2 Social affect score significantly improved at 3 months on the modified KD/GF/MCT diet (Wilcoxon matched-pairs signed rank test, P = .006). d. ADOS-2 restricted repetitive behavior score was not significantly improved at 3 months on the modified KD/GF/MCT diet (Wilcoxon matched-pairs signed rank test, P = .125). **, P < .01; *, P < .05; N.S., not significant.
Fig. 3
Fig. 3
ADOS-2 scores at baseline, 3 months, and 6 months on a modified KD/GF/MCT diet. a. ADOS-2 Comparison Score significantly improved at 6 months on the modified KD/GF/MCT diet (Friedman Test, P = .057, P = .034). b. ADOS-2 Total score significantly improved at 3 and 6 months on the modified KD/GF/MCT diet (Friedman Test, P = .044, P = .019). c. ADOS-2 Social affect score significantly improved at 3 months on the modified KD/GF/MCT diet (Friedman Test, P = .044, P = .019). ADOS-2 Restricted Repetitive Behavior score did not significantly improve at 3 months or 6 months on the modified KD/GF/MCT diet (Friedman Test, P = .0736, P = .218). *, P < .05; N.S., not significant.
Fig. 4
Fig. 4
Association between baseline HDL and albumin and ADOS-2 score % change. a. Baseline HDL significantly associates with ADOS-2 score percent change. b. Baseline albumin significantly associates with ADOS-2 score percent change. c. HDL percent change significantly associates with ADOS-2 score percent change. d. Albumin percent change significantly associates with ADOS-2 score percent change. Spearman correlation.
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