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

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


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Autism Spectrum Disorder / diet therapy*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Diet, Gluten-Free / methods*
  • Diet, Ketogenic / methods*
  • Female
  • Humans
  • Male
  • Severity of Illness Index
  • Single-Blind Method
  • Statistics, Nonparametric
  • Treatment Outcome
  • Triglycerides / therapeutic use*


  • Triglycerides