Following last Friday’s PediaBlog post, “Autism: Eyes Point Internally,” a reader asks:
I have an autistic eleven-year-old son. I recently read an online article written by Emily Deans, M.D., Evolutionary Psychiatry, about various versions of the ketogenic diet having a positive effect on SOME autistic children. Does anyone have an opinion or knowledge of the efficacy of this diet upon the autistic child? (The terms mitochondrial and microbiome used by Dr. Petrosky lead me to ask this question.)
There has been some research investigating the potential benefits of using a ketogenic diet in autistic children after a small study from Greece in 2003 suggested some improvement of some autistic behaviors in some autistic children. As Dr. Deans explained in Psychology Today in 2011, the special diet was not well-tolerated by more than a third of the study’s 30 participants, but some of the kids who did tolerate it improved:
23 kids tolerated the diet beyond the initial 4 weeks, and of those, 5 more discontinued the diet due to lack of improvement during the first few cycles. Of the remaining 18 kids, two boys improved enough in symptoms to be taken out of the special school and placed in mainstream education. Overall the 18 ketogenic kids “presented with improvements in their social behavior and interactions, speech, cooperation, stereotypy, and… hyperactivity, which contributed significantly to their improvement in learning.”
The kids who did not stay on the diet were the most severely affected by autism, and the ones who had the best response were ones most mildly affected. Another interesting fact from the study is that the kids maintained their improvements through the two week washout periods and in the 6 months after the study was over. None of the kids had any complications (such as poor weight gain or selenium deficiency) seen in other trials of ketogenic diets in kids with epilepsy.
Overall (using the original sample size of 30), 26.66% of the kids benefited significantly from the diet.
Research has continued. A 2013 study, published in the journal PLOS ONE, found that a ketogenic diet improved core symptoms of autism… in mice. A 2014 review study, appearing in the open access (non-peer reviewed) journal Frontiers in Pediatrics, cites one case report and one study showing a decrease in seizures and improvement in behaviors from a ketogenic diet. (Ketogenic diets have been used for decades to treat poorly-controlled and complicated seizure disorders.) A more thorough review, published in 2015 in the open access journal Research in Autism Spectrum Disorders, concluded this about the effect of the ketogenic diet (KD) on symptoms of children with ASD:
The limited number of reports of improvements after treatment with the KD is insufficient to attest to the practicability of the KD as a treatment for ASD, but it is still a good indicator that this diet is a promising therapeutic option for this disorder.
So more research on ketogenic diets and autism is needed. (Here is one study that is currently recruiting participants.) It’s too early to say whether a ketogenic diet has merit as a credible and safe treatment option for children with autism, or whether it is, like so many sham therapies that have come before, a potentially dangerous waste of time, money, and health. Earlier this year, the U.S. Food and Drug Administration warned against bogus autism cures. Robert Preidt says the FDA cited “a long history of failed autism treatments and fads” in their warning:
Don’t fall for products claiming to cure autism, the U.S. Food and Drug Administration warns.
There’s no cure for the neurodevelopmental disorder, the agency said. Yet bogus “cures” and therapies abound — from toxin removal to raw camel milk.
Some of these fraudulent treatments could be harmful, and should be avoided, the agency said Wednesday.
Among them: chelation therapies, hyperbaric oxygen therapy and detoxifying clay baths.
The National Center for Complementary and Integrative Health (part of the National Institutes of Health) last year published evidence-based Clinical Guidelines, Scientific Literature, Info for Patients: Autism Spectrum Disorder and Complementary Health Approaches in order to evaluate the evidence, efficacy, and safety behind the use of some alternative therapies. Natural products and biologics (melatonin, omega-3 fatty acid supplementation, probiotics, secretin, vitamin B6 and magnesium, and chelation), special diets (gluten-free, casein-free, and ketogenic diets), mind and body practices (acupuncture and music therapy), and other approaches (hyperbaric oxygen therapy) were all evaluated as objectively as possible. According to the report, support for the use of ketogenic diets in children with autism is “limited” based on the current scientific evidence. Parents who are interested in pursuing treatments with a ketogenic diet should be aware of safety concerns:
The mechanism of action of the ketogenic diet is not fully understood, and caution should be taken to avoid deleterious adverse effects or refractory outcomes. Ketogenic diets should be supervised by a nutritionist to ensure that children get the appropriate nutritional requirements for growth. Reported adverse effects include short-term gastrointestinal-related disturbances, to longer-term cardiovascular complications.
The most effective complementary approach in treating autistic children?
A 2014 Cochrane review of 10 studies involving a total of 165 children with ASD found that music therapy was superior to “placebo” therapy or standard care for social interaction, non-verbal and verbal communication skills, initiating behavior, and social-emotional reciprocity. The review concluded that music therapy may help children with ASD to improve their skills in areas such as social interaction and communication, and may also contribute to increasing social adaptation skills in children with ASD and to promoting the quality of parent-child relationships.
An international, multi-center study published just yesterday in JAMA, however, has some disappointing results regarding improvisational music therapy in children with autism. Read more about the study and the methodological problems the researchers experienced with it here.
Readers wishing to learn more about autism spectrum disorder are invited to attend a workshop presented by Pediatric Alliance entitled “It Takes A Village: Autism/Learning Disabilities” this Saturday, August 12, at The Woodlands Foundation (134 Shenot Road, Wexford, PA). Here is the lineup of speakers for the event:
A Significant Difficulty – Autism Spectrum Disorder: A discussion with a focus on early diagnosis, new research, socialization, and other therapies — presented by Michael Petrosky, MD, FAAP, Pediatric Alliance — Wexford.
Executive Functioning: This encompasses cognitive, behavioral, and emotional regulation — presented by Dr. Erika Buchanan, Licensed Psychologist and Certified School Psychologist from the Center for Pediatric Neuropsychology.
Learning Disabilities and Navigating School Based Services — presented by Damian Ternullo, MD, FAAP, Pediatric Alliance — St. Clair.
Guest speaker: Kristin C. Weidus, Esq., Ruder Law – Advocates for the rights of children in public schools.
The Woodlands Foundation: Enrichment for people of all ages living with disabilities and chronic illness, while providing respite for families — presented by Jesse Solomon, Director of Programs.
Local resources will be available with materials and additional information following Q&A.
Learn more about “It Takes A Village: Autism/Learning Disabilities” and register for the class here.