This review by Pietrzak et al. provides an excellent review of the role of the ketogenic diet in neurological disorders encompassing the topics in this section.
Caution – there are several reports of lactation ketoacidosis occuring in the literature (see Possible Complications). For a prudent interpretation of the literature regarding breastfeeding, the link below to Dr. Andreas Eenfeldt – Diet Doctor, may be helpful – Breastfeeding on a low-carb diet – is it dangerous? Diet Doctor.
The evidence base for therapeutic carbohydrate restriction in ASD and ADHD is currently weak but lines of evidence from epilepsy and mitochondrial disease studies, mechanisms, and co-morbidity between conditions, point to a potential benefit of a TCR approach.
‘At present, there is strong evidence that mitochondrial and metabolic dysfunction may underlie the complex pathophysiology of ASD’ Cheng et al
ASD and ADHD can be co-morbid. They share common features in presentation and pathophysiology that include mitochondrial dysfunctions, genetics, and the microbiome. Allergies, food sensitivities, and fussy eating are common. The Gluten-free/Casein-free dietary approach is used in both ASD and ADHD with some success (see 1. and 2. below). When compared to the gluten-free casein-free diet, the ketogenic diet showed additional benefits (see 3. below).
There are a significant number of diet related studies for ADHD that lack consensus. Variations in the dietary approaches yield mixed results. Though none specifically use a low-carbohydrate approach, common themes include exclusion protocols and/or the removal of sugars/gluten/casein(dairy) which has many features in common with the therapeutic carbohydrate restriction approach.
Some of these results may also be influenced by different causal subtypes of ADHD where food choices may affect some more than others.
The totality of evidence suggests the potential benefits of an elimination diet (e.g. the few foods or oligoantigenic diet) in ADHD . With any dietary approach, nutritional sufficiency and the exclusion of ultra-processed food should be considered the first step.
Cunnane, S.C. et al. (2022) ‘Multimodal strategy to rescue the brain in mild cognitive impairment: ketogenic oral nutrition supplementation with B vitamins and aerobic exercise’, European Journal of Clinical Investigation, p. e13806. doi:10.1111/eci.13806.
Reviews, Perspectives and Mechanisms
Di Majo, D. et al. (2022) ‘Ketogenic and Modified Mediterranean Diet as a Tool to Counteract Neuroinflammation in Multiple Sclerosis: Nutritional Suggestions’, Nutrients, 14(12), p. 2384. Available at: https://doi.org/10.3390/nu14122384.
Systematic Reviews, Meta-Analyses and other reviews
Reviews and mechanisms
Updated 01 November 2022
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Latest Update: 01 March 2023