Does ketogenic diet help Autism spectrum disorder

Autism spectrum disorder (ASD) is a lifelong neurodevelopmental disorder that is characterized by stereotyped behavior and deficits in communication and social interaction. Autism spectrum disorder affects 3.4–6.7 per 1,000 children. Boys are four times more likely than girls to have Autism spectrum disorder.

The core features of Autism spectrum disorder patients are social communication deficits and repetitive sensory–motor behaviors. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), patients who are diagnosed with Autism spectrum disorder must have persistent deficits in social communication and repetitive and unusual sensory–motor behaviors. Comorbidities in Autism spectrum disorder are common and include epilepsy, sleep disorders, gastrointestinal (GI) symptoms, and psychopathologies such as anxiety, depression, attention deficit hyperactivity disorder, and intellectual disability. Sleep disturbances occur in 50–80% Autism spectrum disorder children, and sleep disorder is associated with behavioral dysregulation. Epilepsy is also one of the most common comorbidities in Autism spectrum disorder children, and the average prevalence reaches 26%. Autism spectrum disorder individuals who have epilepsy are likely to exhibit more severe autism-related symptoms. GI symptoms, which range from 23 to 70% in ASD children, are related to the severity of Autism spectrum disorder. Approximately 31% of children with Autism spectrum disorder have intelligence quotient scores below 70. The cost of raising a child with Autism spectrum disorder is 1.4–3.6 million dollars according to the level of intellectual disability, and the largest expenses are special education costs and the loss of parental productivity. When children grow up, supportive living accommodations and the loss of individual productivity become the highest costs. Therefore, Autism spectrum disorder places a large burden on society and the affected families. There are no effective drugs for Autism spectrum disorder. Several interventions, such as special education and behavioral interventions, provide some benefits, but these interventions do not improve all core symptoms of Autism spectrum disorder and have less effects on comorbidities, including epilepsy. Therefore, new therapies are urgently needed to broaden the management options and improve the prognosis of these patients.

A ketogenic diet is a dietary intervention therapy in neurological disorders such as epilepsy and Autism spectrum disorder. A ketogenic diet may be an effective therapy for ASD because it might improve Autism spectrum disorder core symptoms and could benefit its comorbidities, including seizures. The efficiency of a ketogenic diet must be monitored using urinary ketones and serum beta-hydroxybutyrate (BHB). Some evidence showed that a ketogenic diet improved the core features of Autism spectrum disorder patients .

A Ketogenic Diet may improve social behavior in Autism spectrum disorder via normalizing GABA, improving mitochondrial function, ameliorating inflammatory activity and oxidative stress in the brain, inhibiting the mTOR signaling pathway, and modulating the gut microbiota . However, the effects of Ketogenic Diet vary widely between Autism spectrum disorder patients, and the underlying mechanisms are not known. Autism spectrum disorder children may also reject Ketogenic Diet food because of their selective eating habits, which complicates the introduction of a Ketogenic Diet to Autism spectrum disorder patients. Some studies showed that Autism spectrum disorder children have nutrient deficiencies, including vitamin D and folic acid. Long-term treatment of a Ketogenic Diet likely aggravates the nutritional deficiency. The benefits of a long-term Ketogenic Diet treatment in Autism spectrum disorder children are not known. Therefore, more studies with larger samples and long-term Ketogenic Diet treatment are needed to demonstrate the beneficial effects of a Ketogenic Diet and its side effects in children with Autism spectrum disorder.