ADHD and Keto, Part Two - What the Science Says
Can the ketogenic diet fix ADHD? That’s what we’re going to talk about today!
Last time, I shared my story about my decades-long struggles with ADHD and spoke about how going on keto has pretty much annihilated my symptoms.
So today I want to take a look at the scientific side of ADHD and keto.
I’ll briefly outline what ADHD is. Then we’ll dive into what the research says about keto’s effect on it. I’ll wrap up with a few tips for how to get started on the diet.
As a reminder, this is not medical advice and is not to be construed as such.
Symptoms of ADHD
So, very quickly, what are the symptoms of ADHD?
Let’s look at the diagnostic criteria that’s used. The current stance on it is that you can have either inattentive-type ADHD, hyperactive-type ADHD, or combined type.
In inattentive-type ADHD, you may have poor attention to detail, have trouble organizing tasks and activities, may misplace things frequently, get distracted easily, and/or other similar symptoms. This is by no means a complete list.
In hyperactive-type ADHD, you might fidget, have trouble staying seated, and/or act as if you were driven by a motor, just go go go. This is also not a complete list.
The complete list of diagnostic criteria can be found by looking up “DSM-5 ADHD criteria.”
The third type of ADHD is called combined type, which is exactly what it sounds like. You have enough inattentive symptoms on the list to qualify as inattentive, and enough hyperactive symptoms on the list to qualify as hyperactive.
I’m combined type. Lucky me! Double happiness!
The crappy thing about ADHD is that it’s much more than just spacing out in a meeting or twirling your hair so much you get split ends.
It really affects your whole life.
It can lead to things like procrastination, poor sleep patterns, increased risk-taking behavior, higher chance of bad eating habits and/or substance abuse, irritability and all other kinds of moodiness, issues in your relationships, a high stress level because of all of the above, and many other things.
Treatment of ADHD
Most of the time, if you are diagnosed with ADHD, the first recommended course of treatment will be medication.
Many people have found relief from their symptoms this way, and if a friend told me they were suffering, had been diagnosed by a mental health professional, and wanted to try ADHD medication, I would never be so bold as to tell them not to.
Yet, what if there was another way? What if there was a way to get your ADHD symptoms under control without having to rely on medication?
Keto and ADHD
Well, one such way is slowly starting to gain attention, and it’s the ketogenic diet. Slowly but surely, more research is coming out that indicates that keto has strong potential as a therapy for this condition.
I hope that in the future, more people learn about it. If I could wave a magic wand, I would make it required to be presented as a possible option to all ADHD sufferers after receiving their diagnosis. At least tell people the information and then let them decide.
Alright, so what does the science say so far about the ketogenic diet’s ability to alleviate ADHD symptoms? Keto was initially created as a treatment for epilepsy, and does display a very powerful ability to treat that condition, reducing or eliminating seizures in a large percentage of those who try it.
Is there any relationship between epilepsy and ADHD? There is a correlation, actually. In epileptic patients, the most prevalent comorbidity, or other condition they also have, is ADHD.
So it stands to reason that if keto can help epilepsy, it could probably help ADHD, but we don’t just want to use reason, we want data! Give us the numbers!
Studies on Keto and ADHD Symptoms
A study published in 2001 placed children on a ketogenic diet and followed up with them a year later. While it was a small study, it did show significant behavioral improvements in attention and social functioning.
I’ve also come across various other studies that document the ketogenic diet’s effects on ADHD symptoms. All of the ones that I have read were conducted on either children or animals, so nothing on adult humans so far, at least not that I’ve been able to find, but all showed statistically significant improvement of symptoms.
I also came across a fascinating case study, the subject of which was a six-year-old boy. He was in pretty bad shape coming into the study. He had autism, mental retardation, and ADHD.
They had put him in a special program to address his behavioral issues, and had tried two different medications. They tried valproic acid, which is mainly used to treat bipolar disorder, and methylphenidate, which is an ADHD medication. (That’s what Ritalin is made out of.)
Neither the behavioral therapy nor the medications helped him with his symptoms, in fact the ADHD medication made his autism symptoms worse while doing nothing for his attention issues. This is not to say that medication doesn’t work, but it didn’t work for him. The patient had severe difficulty controlling his emotions, and was hyperactive, even for a kid.
They did a PET scan on the child and discovered that his brain, without getting too technical on you here, wasn’t metabolizing glucose properly.
They placed him on - you guessed it - a classic ketogenic diet, transitioning him to the diet slowly over the course of four weeks.
The patient showed significant improvements as early as one month after beginning classic keto. He became less aggressive, less hyperactive, and in general exhibited more normal behavior.
It’s important to note that they did back off on the diet a bit, meaning that the child was on classic keto for one month, which is the very strict version of it with an extremely high fat content, followed by five months on what’s called a modified Atkins diet (in this boy’s case that worked out to 15-18 grams of carbs daily plus a bit more protein), and then another six months on the Low Glycemic Index Treatment, which allowed him to eat a few more carbs – still not that many! – but excluded any type of high-glycemic foods, so nothing really sugary or starchy.
Yet, even though they relaxed the diet a bit over the course of time, and weren’t doing hardcore, O.G. keto, the boy still had detectable levels of ketones in his urine, so he was still in ketosis.
They performed a follow-up analysis on the boy sixteen months after he had begun the dietary therapy. His improvements included reduced hyperactivity, better attention, a better ability to adapt to changes, and he displayed better communication. The boy’s behavior had changed significantly, especially with regard to his emotions.
His IQ when measured had gone from being not-so-hot at baseline to falling squarely within the normal range after treatment.
Meanwhile, PET scans of his brain also showed a dramatic improvement. Again, without getting too technical on you, his brain was functioning more like a brain is supposed to.
In terms of data in adults, while I haven’t come across any scientific studies yet, please get in touch with me if you have, there is tons of anecdotal evidence out there, including my story, of course. People report improved mental clarity, better sleep, emotions being more in check, all sorts of things.
How Does It Work?
As the evidence continues to accumulate, we are still trying to figure out exactly why the ketogenic diet can help with ADHD. What’s the mechanism behind it?
There are several theories.
Neurotransmitters
One has to do with our neurotransmitters. In the brain, there are many neurotransmitters, but let’s first talk about two of them: one called GABA (gamma-aminobutryic acid) and one called glutamate. GABA is the main relaxation neurotransmitter, while glutamate is the main excitatory neurotransmitter.
Okay so let’s think about this. If GABA calms you down and glutamate ramps you up, then what would you suspect in an ADHD brain? If you said, “not enough GABA and too much glutamate,” then your answer is consistent with scientific findings.
A study in 2019 found that folks on a ketogenic diet had more GABA in their spinal fluid, so they had more of this calming substance. So this may be one of the ways that keto helps to alleviate ADHD symptoms. Basically it calms you the eff down.
Another neurotransmitter that you often hear mentioned in conversations about ADHD is dopamine.
Dopamine has a role in many functions, among them help with our memories, attention, sleep and being awake, pleasure, and motivation.
ADHD is associated with a low level of dopamine. So does the ketogenic diet have any effect on this neurotransmitter? Signs point to yes.
At least one study has shown that keto can help with dopamine levels. So that is another mechanism by which the diet can help, although it does bear mentioning that GABA plays a part in regulating dopamine’s effect, so they’re connected.
What’s the bottom line of all of this? It appears the ketogenic diet can have a balancing effect on several of our neurotransmitters so our brains function more like they’re meant to.
Keto and the Gut Microbiome
In addition, the ketogenic diet has been shown to alter the gut microbiome.
Research has shown that people with ADHD have a different gut microbiome composition than those who do not, so we have a special combo of bugs in there, lucky us, and one study even showed that this different bacterial mix, so to speak, was present from infancy.
So there was a correlation between the gut flora of babies and their subsequent ADHD diagnoses later in life. Wild, isn’t it?
Other Theories
In addition to the theories about gut bacteria and neurotransmitters, other theories about why keto helps so many people with their ADHD include a reduction in inflammation and oxidative stress, so just putting less strain on ourselves, as well as a potential epigenetic impact, meaning the diet may help prevent some of the genes related to neurological problems from expressing themselves.
Getting Started on Keto
Okay, so you’ve heard arguments in favor of the ketogenic diet as a method for controlling ADHD and you want to give it a try. What now?
Remember this podcast is not medical advice as is not to be taken as such. I’m going to tell you what I would do, but ultimately it’s up to you to do your research and consult with your healthcare professional.
Step one is to get clear about your ADHD. I know that statement seems like a contradiction in terms, but bear with me.
Make a quick note of your current symptoms, their frequency, and how long you’ve had them for.
Then when you start the diet, write down the date! You’ll want to know exactly when you started so that you can be aware of how long you’ve been on it and how long it takes you to begin to see results.
I don’t want to call you out, my brethren, but us ADHD-ers are not, as a group, particularly famous for our patience, so write down the date you started keto so that if you feel like nothing’s happening at first, you can remind yourself it’s only been a couple of days, okay? Trust me on that one.
I’m lucky that I started on July 4th – Independence Day in the States – otherwise I really would have no idea how long I’ve been on this thing!
As a very general recommendation, you want to give the diet a solid three months in order to see if it will work for you, and after that decide if you wish to continue. Some people see effects within a matter of days, but it can take longer for others.
If you can, try to take some notes as you go along. I know, I know, another thing on the to-do list . . . gross . . . but something as simple as a quick note on your phone every Monday at lunchtime for example can help you really take stock of how things are going and whether or not they’re improving.
Jot down whatever you’d like, whether that’s your mood, how you’re sleeping, your ability to get things done, your overall mental clarity, whatever’s important to you.
Now if you’ve done any research on keto you may have seen that there are several variations of it so you may be confused about which one to try. If you are working with a healthcare professional, they will be able to guide you about which one to choose.
If you’re going it alone, it will be up to you to determine which version you want to try.
In my case, I went for a modified, less strict version of keto, with 75% of my calories coming from fat, 15% from protein, and 10% from carbs.
I limited myself to 20 grams of net carbs (carbs minus fiber) per day.
I paid special attention to my electrolyte intake, making sure to get enough sodium, potassium, and magnesium every day.
That worked for me.
As with anything related to health, if you do your own research, you’re guaranteed to hear conflicted advice about what to do and how to do it. Don’t let that hold you back.
At the end of the day, it’s just food. Don’t stress. If you want to give keto a shot, just remember, “try it, track it, tweak it.” Get started, see what happens, and go from there. You can do it.
Once you get going on the diet, you will hopefully begin to see changes. Now is the time to take stock of the bigger picture as well.
For me, the ketogenic diet has kicked my ADHD to the curb. . . almost completely!
If I go to bed at a ridiculous hour, though, my symptoms will still flare up a bit for a day or two after.
So in my case I know that I need to keep an eye on my food and, well, my pillow.
You’ll eventually work these things out for yourself too and hopefully have a good idea of what makes your ADHD better or worse.
Remember your notes are your friend.
The Future of Keto and ADHD
To sum it all up, the ketogenic diet shows a lot of promise as a treatment option for ADHD sufferers. I hope we see even more research about it in the future and that it becomes a part of the standard treatment recommendations.
So I hope this information has been helpful to you. If you know anyone who might benefit from it, please share it with them.
Thanks so much for being here, and have a happy and healthy day.
SOURCES:
https://www.cdc.gov/ncbddd/adhd/diagnosis.html
https://pubmed.ncbi.nlm.nih.gov/25594106/
https://ketodietapp.com/Blog/lchf/the-ketogenic-diet-a-promising-treatment-option-for-adhd
https://ketodietapp.com/Blog/lchf/the-ketogenic-diet-a-promising-treatment-option-for-adhd
https://my.clevelandclinic.org/health/articles/22581-dopamine
https://www.everydayhealth.com/adhd/gut-health-and-adhd-is-there-a-link/
DISCLAIMER: This content is for general informational purposes only. It must never be considered a substitute for the advice provided by a doctor or other qualified healthcare professional. Always seek the advice of your physician or other qualified healthcare professional with questions you may have regarding your health or medical condition.
