Autism and nutrition: does the ketogenic diet offer perspective?

Source: Jeleefstijlalsmedicijn

[Introduction]

This article delves deeper into autism and nutrition, particularly the potential of the ketogenic diet as a metabolic intervention for autism. Autism is a form of neurodiversity that brings limitations for many people. We discuss the challenges that people with autism and their families often face, the limitations of current treatments, and a new perspective in metabolic psychiatry. Small studies and surveys in this area suggest improvements in social interactions, cognitive functions, and overall quality of life, making the ketogenic diet a promising option.

Adults with a form of autism report on average a lower quality of life, especially regarding relationships, housing, and health. At the same time, many of them do not view their neurological differences as a defect, but as part of their identity within the neurodiversity perspective. Therefore, we present the ketogenic diet here as an option to alleviate specific complaints, not as a universal ‘cure’. Clear information about both the benefits and limitations of this option helps people with autism, their loved ones, and healthcare professionals to make a well-informed decision together.

[Published on October 1, 2025] [Modified on December 19, 2025]

Author: Jaap Versfelt
Scientific reviewers:
Dr Eline Dekeyster, associate professor, senior lecturer Leiden University, leader of the Lifestyle Brain Interaction research group
Drs Alexa Schrickel, researcher Leiden University

[Key messages]

Reading time 16 minutes

1. The number of diagnosed cases of autism is increasing and affects 1-2 percent of the population in the Netherlands.
2. Existing treatments for autism, such as behavioral therapy and medication, often have limited effectiveness and can have significant side effects.
3. The relationship between brain health and metabolism suggests that addressing metabolic dysfunction can improve symptoms of neurological conditions like autism.
4. The ketogenic diet, which is already used for epilepsy, appears promising for improving energy supply and neurotransmitter balance and counteracting oxidative stress.
5. Research and surveys show that the diet may improve social interaction, cognitive functioning, and conditions that often co-occur such as epilepsy and depression.
6. Following the ketogenic diet can be challenging, especially for people with autism, due to sensitivity to tastes and textures of food and the effort required to maintain the diet.
7. Well-informed loved ones, personal guidance, and monitoring are needed for successfully following the diet.

Autism and nutrition: Does the ketogenic diet offer perspective? English version of this article

1. What is autism spectrum disorder

Autism spectrum disorder (autism) is a lifelong condition that affects how the brain processes information. People with autism often have challenges in social interactions, communication, and behavior, as well as unique ways of moving and perceiving the world around them.

In addition to these challenges, many people with autism also experience other health problems such as epilepsy, gastrointestinal complaints, and mental health conditions such as anxiety and depression. Most people with autism have average to high intelligence. An estimated 30 percent have an intellectual disability (Autisme.nl/what is autism).

Can Ketogenic Therapy Help Autism and Mental Health? YouTube video in conversation with Eline DeKeyster and Dr Brett Scher of the Metabolic Mind Podcast

2. How common is autism?

Approximately 1 to 2 percent of people in the Netherlands, more than 200,000 people, have autism. The number of people affected by autism — such as parents, siblings, partners, teachers, and caregivers — is many times greater (Autisme.nl).

The number of autism cases in the Netherlands appears to have increased over the past decades. In the 1980s, the prevalence was still estimated at about 0.5 percent (Van der Gaag, 2018). The rise in prevalence may also be due to changes in definitions or diagnostic tools for autism (Zeidan et al., 2022).

3. Reduced quality of life and societal consequences

People with autism often experience a lower quality of life than others, which is visible in aspects such as social relationships, independence, and access to work. They may have fewer friendships, difficulty maintaining employment, or challenges with daily tasks such as financial administration or obtaining the right support.

The quality of life of people with autism typically does not improve as they get older. Although some individuals may experience modest improvements in specific areas, such as sensory issues or behavior, the overall trajectory often remains characterized by challenges regarding independence, work, and social relationships (van Heijst, 2015).

Only 25 percent of adults with autism have paid employment (Holwerda, 2012). Meanwhile, family members of people with autism often face emotional, social, and financial challenges. They may experience stress and anxiety due to care responsibilities, concerns about the future, and difficulty finding adequate support or services.

4. Current treatments for autism

The classical treatment methods for autism focus on behavioral interventions and medical treatments. Their effectiveness is limited.

• Behavioral therapy focuses on the core symptoms of autism and on speech and language therapy to improve articulation and communication. The effect is greatest when therapy is applied early in development (Hyman et al., 2020).
• Pharmacological treatment is aimed at symptom reduction and treating conditions that often occur in people with autism, rather than the causes of autism. Many of the medications used have side effects, many of which are metabolic in nature, such as weight gain, increased appetite, and gastrointestinal problems (Aishworiya et al., 2022).

5. An alternative approach for autism: metabolic psychiatry

Given the limited improvements that current treatment options achieve in the quality of life of people with autism, there is ample reason to investigate a different approach: metabolic psychiatry.

5.1 What is metabolic psychiatry?

Metabolic psychiatry is a relatively new approach within psychiatry that focuses on the role of metabolism in mental disorders. The premise is that disturbances in metabolism (such as insulin resistance, mitochondrial dysfunction, and inflammation) contribute to psychiatric conditions such as depression, bipolar disorder, and schizophrenia. By improving metabolism — for example through nutrition, exercise, and other lifestyle interventions — mental health can be positively influenced.

The word ‘metabolic’ refers to metabolism, the way the body generates and uses energy. This process includes the burning of sugars and fats, the regulation of hormones such as insulin, and the functioning of mitochondria (the energy centers of cells). A well-functioning metabolism ensures stable energy supply and prevents inflammation and damage to brain cells.

5.2 Why could metabolic psychiatry work?

• Brain disorders appear to be linked to metabolic dysfunction. There is much evidence that various psychiatric and neurological conditions are related to metabolic disorders. The relationship also appears to exist with autism.
• Metabolic conditions are treatable. Metabolic disorders can be effectively treated with lifestyle interventions, especially through a change in diet: from the current Western diet (rich in ultra-processed food and refined carbohydrates) to a diet based on natural food with lower carbohydrate intake.

That it could work does not mean it is immediately proven that improving metabolism automatically leads to better outcomes for brain disorders. To find evidence, it is necessary to study the available research.

In-depth: Webinar Metabolic Psychiatry

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6. Metabolic dysfunction

Our metabolism consists of processes that convert nutrients such as carbohydrates, fats, and proteins into the energy and building blocks that our body needs. When there is metabolic dysfunction, these normal metabolic processes are disrupted. This can lead to conditions such as type 2 diabetes, cardiovascular disease, and obesity.

The Interheart study from 2004 showed that 90 percent of heart attacks are caused by lifestyle factors such as abnormal blood fat values, smoking, high blood pressure, diabetes, obesity, psychosocial factors, diet, and exercise (Yusuf, 2004).

Metabolic dysfunction can result from insulin resistance and chronic low-grade inflammation.

• Insulin resistance means that body cells become less sensitive to the hormone insulin, causing blood sugar levels to become disrupted. Blood sugar level is the amount of glucose (sugar) in the blood. Glucose serves as the main energy source for the body and especially the brain.
• Chronic low-grade inflammation means that the immune system remains constantly slightly activated, without clear symptoms (Asensi, 2023). This is a problem because chronic low-grade inflammation increases the risk of insulin resistance, diabetes, cardiovascular disease, neurological conditions, and psychiatric complaints.

A major cause of both insulin resistance and low-grade inflammation is the Western eating pattern. This consists largely of ultra-processed foods (accounting for 61 percent of calorie intake of adults and even 75 percent of children) and quickly digestible carbohydrates.

Examples of ultra-processed foods are soft drinks, cookies, sauces, and ready-made meals — in short, almost everything in the supermarket with a branded package. Quickly digestible carbohydrates are found in white bread, pasta, white rice, and fruit juices.

Metabolic dysfunction: how lifestyle can make the difference.

Reversing insulin resistance and type 2 diabetes with lifestyle

Ultra-processed food: more than half of our diet and deadly

7. Metabolic psychiatry for autism

The brain consumes an enormous amount of energy. Although it represents only 2 percent of body weight, it consumes 20 percent of total energy. Metabolism is thus crucial for brain function. That is why metabolic psychiatry is gaining interest.

Why might metabolic psychiatry also be promising for the treatment of autism?

7.1 Various brain disorders often occur together

Research shows that people with a mental disorder are 2 to 48 times more likely to have a second mental disorder, depending on the type of disorder and the time since the first diagnosis (Plana-Ripoll, 2019). For example:

• People with epilepsy are three to six times more likely to develop an anxiety disorder (Kanner, 2011).
• People with depression are twice as likely to develop Alzheimer’s disease (Ownby, 2006).

Such an association is also seen with autism, where individuals more often experience epilepsy and psychiatric conditions such as depression.

7.2 Brain disorders that occur together may have a shared cause

When two conditions often occur together, scientists suspect that there may be a common cause. Think, for example, of a stuffy nose and sore throat: these are not separate diseases, but symptoms of a shared cause such as a cold virus.

With brain disorders, when multiple conditions occur simultaneously, research is conducted to determine whether genetic factors, environmental factors, or metabolic dysfunctions could be underlying causes.

Identifying the root cause of a condition enables more effective treatments. The fact that two conditions occur together does not automatically mean they have a shared cause; sometimes the relationship is more complex.

But if there is a shared cause, what could it be?

Healthy nutrition for brain disorders; 2 diets that work

7.3 Brain disorders are often linked to metabolic health problems

Brain disorders are not only interconnected but can also be associated with metabolic ill health.

The brain, like the heart and liver, is an organ. When metabolic dysfunction occurs, it can also disrupt brain function. Examples pointing to this connection include:

• People with obesity have a 60-70 percent higher risk of developing epilepsy (Gao, 2008).
• People with diabetes are two to three times as likely to experience depression (Semenkovich, 2015).

It is important to emphasize that an association does not automatically mean that one causes the other. The underlying mechanisms of the connection between metabolic dysfunction and brain disorders are still being investigated.

7.4 Autism is linked to metabolic disturbances in the brain

Research suggests that there is a connection between autism and metabolic disturbances such as disrupted energy uptake and oxidative stress.

• Disrupted energy uptake Energy for the brain is produced in the mitochondria (the body’s energy factories). When insulin resistance occurs, it can disrupt normal mitochondrial function, leading to a deficit in energy production. Efficient uptake of glucose (blood sugar) is crucial for the function and connectivity of neurons in the brain.
  In mouse research, mitochondrial dysfunction has been linked to symptoms of autism, such as repetitive behavior, social deficits, and hyperactivity. To determine the exact role of mitochondrial dysfunction in humans with autism, more research is needed (Rossignol, 2012).
• Oxidative stress Oxidative stress occurs when there is an imbalance between harmful molecules (reactive oxygen species) and antioxidants. This loss of balance can cause cell damage.
  In autism, the production of reactive oxygen species has been shown to be increased, partly due to mitochondrial dysfunction. This can contribute to brain abnormalities and symptoms of autism.

8. Metabolic interventions for autism: the ketogenic diet

A promising approach to address autism by improving brain metabolism is the ketogenic diet. The diet has been used for about a hundred years in children with epilepsy. In people with epilepsy where medications are insufficient, it can help control seizures.

The ketogenic diet affects many of the mechanisms observed in the brains of people with autism. There are (small-scale) studies demonstrating its effect.

Ketogenic diet, more than weight loss

8.1 The ketogenic diet

With a regular Western diet rich in carbohydrates (sugars and starch), the brain uses glucose as an energy source. The ketogenic diet offers an alternative. It prescribes foods high in fats and low in carbohydrates such as meat, eggs, fatty fish, avocado, olive oil, dairy products (such as full-fat yogurt), nuts and seeds, and vegetables such as broccoli, spinach, and cauliflower.

The ketogenic diet is designed to induce ketosis. Ketosis is a metabolic state in which blood ketone levels are elevated. Ketones are molecules produced in the liver through fat burning. Body cells including brain cells take up ketones, and the mitochondria in the cells use the ketones to produce energy. When ketones are available — this can happen for example during fasting or a ketogenic diet — the brain even prefers to burn ketones rather than glucose for energy production.

8.2 How the ketogenic diet can help

The ketogenic diet can be beneficial for people with autism in several ways:

• Improved energy uptake In people with autism, energy uptake is disrupted. Ketones provide an alternative energy source for the brain.
• Neurotransmitter balance In autism, there is an imbalance between the neurotransmitters GABA and glutamate (Zhao, 2022). The ketogenic diet can inhibit glutamate transporters and thus counteract the imbalance (Romano, 2017).
• Reduction of oxidative stress The ketogenic diet can help reduce oxidative stress by stimulating the production of antioxidants and lowering the amount of reactive oxygen species.
• Addressing other conditions Many people with autism suffer from other conditions such as depression and epilepsy. The ketogenic diet is proven effective in children with epilepsy and shows promising results in combating depression.

8.3 Evidence for the effectiveness of the ketogenic diet in autism

Surveys, case descriptions of individuals, and small-scale studies suggest that the ketogenic diet can counteract problems of autism such as social behavior and cognitive functions.

• Survey outcomes A survey among people following various diets for autism showed that the ketogenic diet had the greatest effect on anxiety, attention, cognition, constipation, depression, communication, lethargy, epileptic seizures, social interactions, and comprehension. The ketogenic diet, however, also had the most reported side effects compared to other diets. It should also be noted that the number of people following the diet in this study was small (21 participants). Importantly, all diets in the survey had greater impact and fewer side effects than psychiatric or anti-epileptic medication (Matthews, 2023).
• Experimental studies In addition to the survey, several experimental studies have been conducted in children following a ketogenic diet:
  • El-Rashidy, 2017 demonstrated improvements in cognition and social skills.
  • Lee, 2018 showed that social and communication skills improved.
  • Mu, 2020 reported better social communication, interaction skills, and less anxiety and nervousness.

The studies had small sample sizes (15 to 45 participants), partly due to difficulties in setting up randomized studies in children.

8.4 Safety of the ketogenic diet

What about the safety of the ketogenic diet? Below we distinguish between children and adults:

Children
Internationally, the ketogenic diet has been recognized for more than a hundred years as a conventional therapeutic approach for medication-resistant epilepsy. In the Netherlands, the ketogenic diet is an accepted treatment for children with epilepsy (Federation of Medical Specialists, 2024). The usual treatment duration is two years, although a shorter period is preferred if the seizures stop. In children who followed the diet for a very long time (six to twelve years), complications such as growth delay and kidney stones were observed.

Adults
For adults, the ketogenic diet is generally considered safe, provided it is applied under the guidance of a nutritionist, to prevent nutritional deficiencies. However, there are some situations where the diet is not suitable:

• People with certain metabolic diseases such as rare genetic conditions that disrupt fat metabolism should avoid the diet.
• People who use certain medications, such as insulin for diabetes or lithium for bipolar disorder, may need extra supervision due to potential interactions with the diet.
• Some people experience an increase in LDL cholesterol when starting the diet. Because elevated LDL cholesterol is associated with a higher risk of cardiovascular disease, it is recommended to monitor blood fat values.

Ketosis vs ketoacidosis

People who follow the ketogenic diet are sometimes warned about ketoacidosis, because ketosis and ketoacidosis are sometimes confused. However, they are two different metabolic states:

Ketosis occurs when the body uses fat as the primary energy source with low carbohydrate intake. This leads to the production of ketones, which serve as fuel.
Ketoacidosis is a dangerous and potentially life-threatening condition in which the body produces too many ketones in the absence of insulin. This happens with uncontrolled type 1 diabetes and leads to acidification of the blood, which is harmful to organs.

A ketogenic diet creates a state of ketosis but does not cause ketoacidosis in people with a normally functioning pancreas. People with uncontrolled type 1 diabetes or insulin problems should however be careful and always consult a doctor before making major dietary changes (Westerberg, 2013).

9. Starting the ketogenic diet

For those who want to learn more about the ketogenic diet or how to start, we refer to The ultimate keto guide for beginners. There you will find:

• A description of the diet
• Information about the effects of the diet
• Explanation of ketosis and ketones and measuring them
• Nutritional information
• Suitable foods.

Guide: The ultimate keto guide for beginners

Everything you need to know to start the ketogenic diet: from basic principles and effects to practical nutritional information and suitable foods.

View the keto guide for beginners →

Recipes: Keto cooking

Looking for inspiration? Discover more than 100 low-carb recipes, from breakfast to dinner, specially compiled for the ketogenic diet.

View keto recipes →

10. Conclusion

The ketogenic diet is emerging as a promising approach to improve the symptoms and quality of life of people with autism. By targeting the metabolic dysfunctions associated with autism, such as disrupted energy metabolism and oxidative stress, the diet offers a way to address both core symptoms and related challenges, such as social interaction problems, cognitive limitations, and comorbid conditions such as epilepsy and depression.

Successful application of the ketogenic diet requires a careful, personalized approach. Important factors include educating supportive loved ones, tailoring the diet to individual sensory preferences, and using tools such as ketone meters to promote adherence.

The brain in ketosis:

Eline Dekeyster at NTR Focus on the brain on keto diet

Veelgestelde vragen

Is the ketogenic diet proven effective for autism?

The evidence is still limited but promising. Surveys and small studies show improvements in social interaction, cognitive functions, and related conditions such as epilepsy and depression. Large-scale randomized studies are still lacking.

Is the ketogenic diet safe for people with autism?

For adults, the diet is generally safe under supervision. In children, long-term use (more than two years) has been associated with possible growth delays. People with certain metabolic diseases or medication use (insulin, lithium) should be extra careful.

How can the ketogenic diet help with autism?

The diet can help through: (1) improved energy uptake in the brain via ketones as alternative fuel, (2) better balance of neurotransmitters GABA and glutamate, (3) reduction of oxidative stress, and (4) addressing related conditions such as epilepsy.

Can the ketogenic diet cure autism?

No, the ketogenic diet does not cure autism. It may potentially alleviate certain symptoms and improve quality of life. It is presented as an option to relieve specific complaints, not as a universal 'cure'. Autism is viewed by many as part of their identity.

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