ADHD Diet & Nutrition

Can a Ketogenic Diet Reduce ADHD Symptoms?

The low-carb, high-fat keto diet is popular for a reason: it is a powerful tool for achieving and maintaining weight loss, plus it’s shown to help patients with seizures, diabetes, and high blood pressure. So could it be used to treat ADHD symptoms naturally as well? Here’s what the science tells us to date.

A keto diet for ADHD

The Amazon Best Seller list is stacked with cookbooks dedicated to the ketogenic diet, which is equally inescapable in health magazines, talk shows, and transformation photos across Instagram. This popularity is due, in part, to studies linking a keto diet to impressive weight loss, insulin stabilization, and decreased seizures in children. Which naturally leads patients searching for non-pharmaceutical ways to reduce attention deficit hyperactivity disorder (ADHD) symptoms to ask: Can it work for ADD, too?

The short answer: Maybe. No solid research about keto and ADHD yet exists, however early indications suggest that it may reduce some symptoms.

The Keto Diet — How It Works

Like the Atkins, Paleo, and South Beach diets, a ketogenic diet is very low in carbohydrates. But unlike those diets, the keto diet is high in fats. There is no set of standard intake ratios for a keto diet, but 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), according to a diet review by the Harvard T.H. Chan School of Public Health.

With carbohydrate intake drastically reduced, a person’s body runs out of glucose stores to use for energy and so it uses dietary and stored fat instead, 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.

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The keto diet is currently most popular for its weight-loss benefits (a 2013 study from Brazilian researchers found it more effective than a conventional low-fat diet), but studies indicate it may be used to control type 2 diabetes and improve symptoms in people with mild-to-moderate Alzheimer’s disease.

The keto diet has been around for decades. In the 1920s, doctors discovered that a strict ketogenic diet could reduce, and even eliminate, seizures in children with some forms of epilepsy. Though there is no medical consensus explaining why a ketogenic diet reduces seizures, one recent study led by UCLA scientist Elaine Hsiao, Ph.D., suggests that the keto diet changes key gut bacteria that affect neurotransmitters in the brain.

Keto and ADHD

ADHD, like epilepsy, is a brain-based disorder. So could a keto diet likewise reduce ADHD symptoms? Heidi Pfeifer, R.D., LDN, a clinical dietitian specialist at Massachusetts General Hospital for Children, has seen positive evidence.

Pfeifer has spent more than 20 years treating epilepsy in children for whom medications do not work. When these children are put on a strict or liberalized version of the keto diet (40–60 grams of carbohydrates per day), ADHD symptoms improve. “We have seen improved behavior and focus with both versions independent of full seizure control,” says Pfeiffer.

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A 2001 Johns Hopkins study points to the same result. Looking at 65 children with epilepsy who were put on a ketogenic diet for one year, researchers saw “significant behavioral improvements in attention and social functioning” in the children, and a reduction in epileptic seizures.

But following a strict keto diet is not easy. In a 2010 New York Times article, writer Fred Vogelstein detailed the extreme caution that he and his wife used when carefully measuring and weighing every bit of food for their epileptic son, Sam; even a slight variation from the diet would lead to a cascade of seizures, he reported.

“For kids with ADHD, the classic ketogenic diet is really hard,” says Pfeifer. She recommends making an appointment with a registered dietitian who understands low-carb diets. To gradually transition to a low-carb, high-fat diet, “take out sugar, processed food, and foods made with white flour, dye, or additives,” Pfeiffer says. “Leave in fruits, vegetables, and whole grains — foods with high nutrient value.” This kind of eating throughout the day prevents peaks and valleys in blood glucose levels that cause the cycle of feeling energetic, then crashing with fatigue. She adds that many people who eat this way report better energy and better moods.

Downsides of the Keto Diet

Some people who go on the keto diet initially experience headaches, fatigue, irritability, nausea and difficulty sleeping — a cluster of reactions sometimes referred to as “keto flu,” according to Marcelo Campos, M.D., in a recent Harvard Medical School health blog. This is not flu at all, and the negative symptoms are usually temporary; if not, Dr. Campos advises seeing a doctor.

When staying on the diet long term, developing kidney stones is another risk, especially if adequate hydration is not maintained, Pfeifer says. Like any other treatment, following a new and restrictive diet should be done with the guidance of a doctor or knowledgeable registered dietitian. Limiting carbohydrates may limit intake of essential micronutrients, so it is important to supplement with the appropriate vitamins and minerals to avoid deficiencies. And it should be noted that most keto studies are short term; the long-term impact of a keto diet is not fully understood.

And some experts are wary. “Ketogenic diets do have evidence of helping with seizures and may reduce hyperactivity in individuals with epilepsy,” says Joel Nigg, Ph.D., author of Getting Ahead of ADHD: What Next-Generation Science Says about Treatments That Work—and How You Can Make Them Work for Your Child (#CommissionsEarned). “Beyond that, the ketogenic diet, per se, is not sufficiently studied in ADHD to support recommending it for that purpose in non-epileptic individuals.”

Abby Langer, a Toronto-based registered dietitian, and mother to a daughter with severe ADHD and anxiety, is worried that parents may unnecessarily put their child onto a keto diet: “There is zero 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,” she says. “It’s a highly restrictive diet that can impact a child’s growth and health if not done correctly. It can also establish unhealthy eating behaviors in children that may then end up as disordered eating.”

Langer is also against labeling foods as good or bad. “It’s never a good thing to tell a child that otherwise healthy foods are ‘bad or ‘off limits’ unless there is a serious, legitimate reason for avoiding those foods,” Langer says. “I don’t think ADHD qualifies as this.”

Each adult and child with ADHD is unique; for some people, more conservative steps may be effective in treating symptoms. “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 preprocessed and packaged food, or consult a dietician to undertake a hypoallergenic or restriction diet,” Nigg says. “Each of those (dietary interventions) has some modest empirical support for a subset of individuals with ADHD.”

But, he warns, “Any restriction diet should be done under dietetic or medical supervision to ensure adequate nutrition, particularly in developing children, and may also require supportive counseling since these diets are difficult to undertake.”

Keto Recipes Worth Trying

What do everyday meals look like on a keto diet? Bacon and scrambled eggs made with spinach is one popular keto breakfast. Lunch may include a tuna salad with quinoa, or a cheeseburger without the bun. Roast chicken, salmon, or steak with a side of asparagus makes for a keto dinner.

Want to know more about keto diet meals? Try any one of these kid-friendly recipes from Cristina Curp who has written several cookbooks featuring healthy keto recipes, including the new Made Whole: More Than 145 Anti-Inflammatory Keto-Paleo Recipes to Nourish You From the Inside Out. Curp says she does not follow the traditional keto macronutrient ratio. “I just stick to low-carb, high-fat real food,” she says. “My family eats the same way I do, but with the addition of some fruit and safe starches.”

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Keto Recipes to Try:

Keto Cookbooks

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5 Comments & Reviews

  1. I’ve been on the Keto diet before for about a year and a half. I was on no medication at the time, and I noticed that my attention span was AWESOME on Keto. I never had any blood sugar spikes so my emotional regulation was soo soo much easier. The other weird side effect of Keto was that I ended up feeling caffeine much more, so consumed less and felt way less manic and little anxiety. Cannot recommend keto enough. Another unintended but cool thing about being on Keto for so long is that even if I had a slip up and wanted to “cheat” I felt sugar and carbs so instantly and so intensely that it was a very good deterrent from cheating, so staying on the restricted diet was really pretty easy.

  2. I’ve had positive experiences doing keto. My mental energy and focus has improved. I also should note, I fast for around 16 hours a day. The combination of both has really helped my productivity.

  3. This comment: Langer is also against labeling foods as good or bad. “It’s never a good thing to tell a child that otherwise healthy foods are ‘bad or ‘off limits’ unless there is a serious, legitimate reason for avoiding those foods,” Langer says. “I don’t think ADHD qualifies as this.” is why there’s still diet issues in Western med.
    There’s plenty of evidence that there are bad foods for ADHD!
    I know from first hand experience that it makes a difference getting gluten and inflammitory foods out of the equation as well as with our 9 yo.
    Additionally, I switched to a keto diet and have also noticed major improvement in neurologic function when I increase fat intake over standard keto ratios. Also, in our house rice is a go to due to my wife’s allergies and if I stay off the starch of the rice that also leads to more stability. With wife’s allergies and my celiac and ADHD, we monitor/and are aware of a lot of things. The value of this is not recognized by Western med because the doc’s egos are to swollen to accept our efforts to help them…

  4. When I am on a fairly strict paleo-keto diet my symptoms almost completely disappear. Often, I only require medication for particularly difficult tasks.

  5. I am a 37 year old male andI was diagnosed with ADD at 19. I struggled all my life with focus, productivity, depression and anxiety and have been medicated for such issues since then. When I couldn’t refill my ADD meds (I am on generic Adderall) I couldn’t do anything. I am highly irritable and I’m patient. While on my meds, I would have few good days of feeling focused and productive and far more mediocre to bad days. I knew I could feel better somehow and would read an article or maybe a medical study from time to time. I never found any answers. Flash forward to today.

    I have been doing NSNG (No Sugar No Grains for over 3 years. And I can confidently say that, for whatever reason, when I am not in a state of ketosis all of my symptoms come back. My wife and I will periodically check our ketones from time to time with a blood monitoring device. An ideal state of ketosis is .07 or higher. Just this last week, I have been feeling like crap and unmotivated. It is a struggle to just finish a day at work. Two days ago I check my ketones and i was at a .03. I am now doing everything I can to increase that number in order to go back to the person I always knew I could be.

    I have several issues with Ms. Langer.

    Langer is also against labeling foods as good or bad. “It’s never a good thing to tell a child that otherwise healthy foods are ‘bad or ‘off limits’ unless there is a serious, legitimate reason for avoiding those foods,” Langer says. “I don’t think ADHD qualifies as this.”

    Does this mean that copious amounts of sugar (juice boxes, candy, cereals, flavored yogurts, etc. etc) are safe to eat all day every day? I have never heard of anyone being told that they need to eat more sugar in their diet.

    “It can also establish unhealthy eating behaviors in children that may then end up as disordered eating.”

    I ask you to show me the science that proves this. If doing something as simple as avoiding sugar and grains is helping me and my mental health, isn’t that a good reason not to consume it? If I ingest something poisonous I can get sick, or worse, die. How do I avoid that situation from happening? By not eating poisonous materials! I know how I can and will feel when I get kicked out of ketosis, therefore, I avoid foods that will make that happen. If it took something as simple as not eating something to stay alive, would you not do it? So what if I don’t want to eat donuts, cupcakes, dinner rolls, sugary cereals (which are obviously not healthy in the FIRST PLACE) daily? I feel better for not doing that. I know smoking will increase my chances of getting cancers, so, I avoid smoking to stay healthily, And that’s why I do what I do. Because I am and feel healthy physically and mentally.

    This is not a “diet”, it is a “lifestyle”! It is not restricting. I am avoiding the foods I should avoid anyway!

    I love bacon, sausage, butter, fatty steaks and other meats, avocados, nuts and seeds, nut butter, cheese, salamis, veggies, plain greek yogurt, olive oil, chicken thighs, herbs and spices. Do you know how much stuff you can make with just those ingredients?

    In short, I know I feel better when in ketosis. I have been my own guinea pig since my 20s and I have found something that IMPROVES my mental set backs and doesn’t just manage it.

    I also want to say that I never read or respond to comments in articles. I find it a waste of time. However, I am hoping that there is a parent or an individual who is wondering what else s/he can do to improve their life. I feel that this is it. A keto flu is just a few weeks and it will pass. It DOES suck. But so does detoxing from opioids and heroine, and I imagine that is far worse. The reason why we don’t have much evidence is because no one is doing studies about it. We obviously need more studies done with good science, research, testing methods and so forth. I close with a great quote…

    ‘Let thy food be thy medicine and medicine be thy food’

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