Ketogenic Diet and ADHD

Attention-deficit hyperactivity disorder (ADHD) is a condition that impairs a person’s ability to focus. It also makes them easily distracted, impulsive, or excessively energetic.

There are medications available for people with ADHD. But another approach is to control symptoms using home remedies like the food we eat.

In the 1970s, Dr. Benjamin Feingold, Chief Emeritus of the Department of Allergy at the Kaiser Foundation Hospital, started encouraging his patients to make changes in their diets. He noted that these dietary changes prompted a noticeable decrease in asthma symptoms, hives, and even behavioral problems.

Dr. Feingold’s diet, and variations on it, have since been studied and used by parents hoping to help their children improve ADHD symptoms.

Research hasn’t conclusively defined the diet helps everyone with ADHD, but it has been shown to help some people with the condition.

Fortunately, the literature also includes plenty of clues on how we can naturally mitigate ADHD symptoms. This article will put the spotlight on the ketogenic diet as a dietary intervention for ADHD.

What is ADHD?

Do you find it difficult to pay attention? Do you consider the need to move continuously when you should be calm and relaxed? Do you find yourself continually disturbing others?

These are the most generally known characteristics of ADHD. But the disorder, as a whole, is much more complicated than merely struggling to stay focused and calm.

In general, ADHD is described by a lack of behavioral control. It also shows neurological deficits in four areas:

  • Working memory
  • Self-regulation of emotions
  • Internalization of speech
  • Behavioral analysis and synthesis.

Because of how nuanced the characteristics of ADHD are, the disorder is generally broken down further into three main types:

1. Inattentive Type

When at least five of the following symptoms occur often:

  • Struggle with paying attention to detail and makes wild exaggerations.
  • Has difficulties staying focused on tasks or activities, like lectures, homework, and conversations.
  • Does not look to listen when being spoken to.
  • Does not follow through on instructions like schoolwork, chores, or job duties.
  • Does not manage time well, has messy, disorderly work, and misses deadlines.
  • Avoids or hates tasks that require sustained mental effort.
  • Frequently loses essential things, such as school papers, books, keys, wallet, cell phone, and eyeglasses.
  • Is easily distracted.
  • Forgets to pay bills or do daily tasks, such as doing chores and running duties.

2. Hyperactive-Impulsive Type

When at least five of the following symptoms occur often: 

  • Fidgets or squirms continually when seated.
  • Not able to stay seated when required.
  • Runs about or climbs where it is improper.
  • Unable to play or do leisure activities composedly.
  • Always “on the go” or active.
  • Talks more than is required.
  • Talks while other people are having a conversation.
  • Has trouble waiting for things, such as standing in line.
  • Interrupts or intrudes on others without consent. Older teens and adults may sometimes take over what others are doing without asking.

3. Combined Type

When the person shows a combination of Inattentive and Hyperactive-Impulsive Types

There is no lab test to diagnose ADHD. Diagnosis includes collecting data from parents, teachers, and other people. It also includes filling out checklists and having a medical evaluation to manage out other medical problems.

But keep in mind that these symptoms are not the result of being defiant, hostile, or unable to understand a task or instructions. These ADHD symptoms are the visible expression of modifiable and non-modifiable circumstances obstructing the brain to function correctly.

What Causes ADHD

ADHD is one of the most studied and written about neurological disorders among childhood and teens. The same thing goes for its remedy.

However, it is not the case of what causes ADHD.

Current data implies that the cause of ADHD is multifactorial. Meaning, both genetics and environmental factors play a role.

Let’s take a closer look at the variables that we recognize play a role in the disorder:

  • Genetics. Three out of four children with ADHD have a relative with the disorder, meaning that hereditary inheritance may play a role in ADHD. The current analysis is inconclusive. However, genetic research implies the association of genes related to dopamine and serotonin receptors and transporters. These are neurotransmitters that help regulate behavior.
  • Gestational stressors. It also believed that premature birth and mothers who smoke, drink alcohol, and endure extreme stress while pregnant has something to do with the development of ADHD.
  • Childhood trauma. Whether it is a physical injury like brain injury or emotional abuse, childhood trauma can produce many of the traits of ADHD.
  • Toxin exposure. Heavy metal and exposure to chemicals like organochlorine, mercury, lead, and more can hurt brain development that may cause ADHD.
  • Diet. The effect of diet and dietary supplements is still unclear. But a few considerable data imply that nutritional factors are associated with ADHD. For example, low levels of iron, copper, magnesium, zinc, and omega-3 fatty acids are usually found in children with ADHD. Meanwhile, sugar, artificial food colorings, and preservatives are associated with the risk of ADHD.

This is not a complete list of all the factors that can affect the formation and progression of ADHD — and the cause is still far from being known. However, the current research provides evidence of the most effective long-term treatment strategy.

Dietary Interventions

According to the analysis, dietary interventions seem to support roughly one in every four children with ADHD.

Around 10% of children with ADHD may encounter a full discharge of similar symptoms to successful drug treatment. Among all the “ADHD diets” analyzed, the “few foods diet” appears to be the most effective.

Simply put, this diet limits a person’s calorie intake to only a few less commonly consumed foods. Some examples are pear, lamb or venison, rice, peas, and low allergenic potential.

It also reduces many of the foods and food ingredients that may trigger ADHD symptoms, such as:

  • Artificial colorings, such as red 40 and yellow 5
  • Artificial flavorings, such as synthetic vanilla
  • Artificial sweeteners, such as aspartame, saccharin, and sucralose
  • Chemicals usually found in some foods, such as salicylates found in apricots, berries, and tomatoes
  • Preservatives, such as butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), and butyl hydroquinone (TBHQ)
  • Butylated hydroxyanisole and Butylated hydroxytoluene
  • Carrageenan
  • Monosodium or monopotassium glutamate
  • Any hydrolyzed, textured, or modified protein
  • Added sugars
  • High glycemic foods
  • Any food allergens

Although this diet is the most restrictive of the diets intended to help those with ADHD, it is highly efficient for many reasons:

  • It lessens the person’s toxic load.
  • It inhibits allergic reactions and food sensitivities.
  • It reduces sugar intake.

By maintaining these qualities, the few foods diet addresses many potential causes of ADHD symptoms. However, this extreme restriction comes with the risk of nutrient deficiency. So it must be supervised by a qualified professional (e.g., dietitian) to ensure optimal health.

If several food diets are not feasible, your next best choice is to restrict the intake of the foods and food ingredients from the above list. This procedure is a bit less limiting, but it still can aid in alleviating some ADHD symptoms.

Another dietary mediation worth exploring for ADHD treatment is the keto diet. It works as a pseudo-elimination diet that simulates many characteristics of the few food diets. This can lead to further positive developments throughout the brain with the aid of ketones.

The Ketogenic Diet and ADHD

The ketogenic diet has a long-standing spot in neurology.

It was first used to help children with treatment-resistant epilepsy in the 1920s. Since then, keto has been verified effective as a treatment for various cases of epilepsy.

There is also a plethora of studies showing that the keto diet can improve dysfunctional metabolic pathways. Mind you, these are associated with neurological disorders like autism spectrum disorder, Parkinson’s disease, and Alzheimer’s disease.

Interestingly enough, several of these conditions share similarities with ADHD. Does this indicate that keto can treat patients with ADHD as well?

Unfortunately, the research on keto and ADHD is limited, and the highest quality research that you may find was conducted on dogs, not humans.

Regardless, the data shows helpful insights into how carb restriction may affect ADHD-related behaviors. In this 6-month dietary experiment, 21 dogs with ADHD and idiopathic epilepsy were put on either a keto diet or a standard diet.

When compared with the standard diet, the keto diet resulted in a significant change in ADHD-related behaviors. The authors hypothesized that this has something to do with the changes in energy metabolism in the brain. This usually occurs after the body starts burning more ketones for fuel.

Hopefully, the promising outcomes will compel more experiments on the keto diet as a possible ADHD dietary mediation.

What Research Supports Following an ADHD Diet?

A study published in the Lancet Journal observed children with ADHD following a modified diet for five weeks.

The study discovered that ADHD symptoms developed during the dietary phase of the diet. However, ADHD symptoms recurred when foods were reintroduced into the diet.

There have been many types of research on the outcomes of food color additives. However, the studies present mixed results. More research is still required to link food color additives to ADHD symptoms.

Why Keto May be Helpful for ADHD

There is no denying that the keto diet as a possible treatment for people with ADHD is worth exploring.

For one, it reduces many of the unhealthy ingredients that may worsen ADHD-related signs. Plus, it helps stimulate ketone production.

When our brain begins burning more ketones for fuel, it creates a cascade of impacts that may ease many ADHD-related symptoms. Here’s how ketones make it possible:

  • Ketones are a more effective energy source than sugar. Ketone bodies (beta-hydroxybutyrate, in particular) are a more useful energy source than glucose. In other words, by utilizing ketones for fuel, your nerve cells will be able to do their role in a way that doesn’t cause excess damage.
  • Ketones improve mitochondrial efficiency and production. The ketogenic diet entices a synchronized up-regulation of mitochondrial genes. It also does the same for genes included in energy metabolism while stimulating the biogenesis of mitochondria. This improves the capacity of brain cells and protects it from metabolic dysfunction that can cause ADHD-related symptoms.
  • Ketones enhance GABAergic tone and decrease glutamatergic tone. Glutamate is the brain’s primary excitatory neurotransmitter and is the precursor for GABA, the brain’s primary inhibitory neurotransmitter. It is necessary for neural communication, memory formation, learning, and regulation. But under specific conditions, glutamate can damage or kill nerve cells, which can trigger ADHD symptoms. Although the mechanisms are still unclear, ketones were found to reduce glutamatergic tone. It is also found to develop GABAergic tone, which helps prevent brain cell damage and create the function.
  • Ketones trigger the expression of BDNF. BDNF or Brain-derived neurotrophic factor is a protein that stimulates the growth and reproduction of specific neurons in the nervous system. And ketones were found to trigger the creation of BDNF in ways that can enhance the function of the hippocampus, cortex, and basal forebrain. These are areas of the brain that play an essential role in learning, memory, and higher thinking. From a practical view, this means that the combination of behavioral therapy and ketone burning may be an efficient treatment for some cases of ADHD.

Although the keto diet can give you all these advantages, it may also produce an adverse reaction. Moreso, if the ADHD symptoms are linked to allergies and intolerances to common keto-friendly foods.

For this analysis, you may need to explore different dietary strategies and natural treatments. This is to see what works best for you or your loved one with ADHD.

Downsides of the Keto Diet

Some people who are new to the keto diet experience headaches, fatigue, irritability, nausea, and difficulty sleeping. It is commonly called “keto flu,” according to Marcelo Campos, M.D. This is not flu at all, and the adverse symptoms are commonly temporary. Otherwise, you need to see a doctor.

When following a diet long term, growing kidney stones is another risk, especially if you’re often dehydrated. 

Like any other approach, following a new and restrictive diet needs professional supervision. For one, limiting your carb intake may limit your consumption of essential micronutrients. So it is important to reinforce with the appropriate vitamins and minerals to avoid deficiencies.

And it should be noted that most keto practices are short term. On the other hand, the long-term result of a keto diet is not fully understood.

And some specialists are wary. According to Joel Nigg, Ph.D.:

“Ketogenic diets do have proof of helping with seizures and may decrease hyperactivity in individuals with epilepsy. Beyond that, the ketogenic diet, per se, is not adequately studied in ADHD to continue recommending it for that purpose in non-epileptic individuals.”

Also, a registered dietitian and a mother to a daughter with ADHD, Abby Langer, said, “There is still no sufficient evidence that the diet will help with ADHD — for children or adults — and it’s extremely concerning to me when people put their children on diets.”

Every adult and child with ADHD is different. For some people, more traditional steps may be useful in treating symptoms. Moreover, putting your loved one with ADHD in any diet must have medical supervision.

Putting it All Together

Boy playing with play dough

Although the information on how different dietary strategies affect patients with ADHD is inconclusive, there are a few approaches that have the potential to help:

  • Discard all dubious food additives that the person may be sensitive to (i.e., artificial colorings, flavorings, sweeteners, and preservatives).
  • Limit added sugar and high GI food consumption.
  • Eliminate all foods that the person is allergic or sensitive to.
  • Stimulate ketone generation with a keto diet or supplement with ketone-boosting supplements (i.e., MCT oil).
  • Address any vitamin and mineral losses with micronutrient dense foods or supplements.
  • Use science-backed supplements, such as melatonin, fish oil, zinc, or melatonin, when necessary.

At this time, the research on ADHD shows that these are the qualities that the ideal ADHD diet should have. By following these guidelines, many of the symptoms of ADHD can be reversed. If not, the symptoms can be reduced.

With that said, the study on dietary interventions and supplementation for ADHD is still inadequate. So it is best not to use these suggestions as a replacement for prescriptions and behavioral therapy.

Keep in mind: The best ADHD medication plan will consist of the prescriptions, therapies, and dietary strategies that fit a person’s needs.