Ketogenic Diet and ADHD

There is a lot of “buzz” in the media about the virtues of the so-called ketogenic diet. It seems to be mentioned on the cover of every health magazine. As we might expect, it also comes with claims to help ADHD. Recently, I contributed to an article released by ADDitude Mag about the keto diet and how it might affect ADHD. Here, I expand my remarks prepared for that article. So, let’s take a closer look.

What is a Ketogenic Diet?

A ketogenic diet is low in carbohydrates and high in fats. According to a diet review by authors from the Harvard School of Public Health, while there is no set of standard intake ratios for a keto diet, popular versions comprise 70–80 percent fats (e.g. cheese, cream, meat, eggs), 10–20 percent protein (fish, meats, seeds, nuts are all OK), and about 5–10 percent carbohydrates (this means cutting out sweets, rice, grains, white potatoes, milk, beans and most fruit). Due to the reduced intake of carbohydrates, the body runs out of glucose stored for energy, and instead uses dietary and stored fat, turning it into molecules called ketone bodies. This metabolic process is called ketosis, and is sometimes described as tricking the body into thinking it’s starving and thus burning fat.

Can it really reduce ADHD symptoms?

I do not recommend the ketogenic diet for children with ADHD. Ketogenic diets do have evidence of helping with seizures and may reduce hyperactivity and improve attention, in individuals with epilepsy. Beyond that, the ketogenic diet is not sufficiently studied in ADHD to support recommending it for that purpose in non-epileptic individuals. Remember our principle that we want some pretty good evidence of value before trying a potentially risky intervention for a child.

Factors to Consider

For someone with ADHD, the traditional ketogenic diet can be very challenging. Side effects can include “keto flu,” which includes stomach pains, headaches, irritability, nausea, difficulty sleeping, and fatigue. These side effects often lead people to give up on the ketogenic diet early. Those who do continue this diet and successfully induce ketosis should be hesitant to continue this diet long-term, as most studies have been short-term, and the long-term risks versus benefits are unknown–particularly for developing children. Additional research is required to conclude the positive and negative effects of the ketogenic diet on the symptoms of ADHD, and safety for children, before the ketogenic diet should be used for ADHD.

Recommendations

If individuals with ADHD want to consider dietary intervention, they can supplement with omega-3 fatty acids (fish oil or algae supplements), reduce food additives by eating less pre-processed and packaged food, or consult a dietitian to undertake a hypoallergenic or restriction diet. Each of those dietary interventions has some modest empirical support for a subset of individuals with ADHD. Some of my own research has targeted these specific areas of focus.

Any restriction diet–whether a ketogenic diet or a hypoallergenic or other diet, should be done under dietetic or medical supervision to ensure adequate nutrition, particularly in developing children. For families working with ADHD, also consider supportive counseling as a behavior program may be needed to help motivate a child. These diets are difficult and not always fun for kids.

 

Dr. Nigg cannot advise on individual cases for ethical, legal, and logistical reasons.