- A preliminary study has found that participants with relapsing-remitting multiple sclerosis (MS) who followed a ketogenic diet for 6 months experienced improvements in fatigue, mood, and the quality of life.
- The study also demonstrated improvements in walking distance, disability, and finger dexterity.
- Still, determining the potential for a keto diet to be a complementary MS treatment will require further research.
MS is a chronic neurological disease that affects nearly 2.3 million adults globally. At least two to three times as many women have MS, compared with men. At present, there is no cure.
In a person with MS, the body’s immune system mistakenly attacks the insulation around nerves, which is called myelin. This insulation helps nerves efficiently transmit electrical impulses.
Some people with MS experience mild symptoms with little or no impairment, but for most people with MS, symptoms worsen over time, eventually leading to varying degrees of disability.
Disease-modifying treatments can suppress the immune response that characterizes MS. This can reduce the number and severity of attacks and delay progression. Still, not everyone responds to this treatment.
Insulin resistance and inflammation
Recent research indicates that a ketogenic diet, which is low in carbohydrates and high in fat, might benefit people with MS.
Decreased carbohydrate consumption reduces glucose and insulin levels. This causes the body to produce ketones from fats, and ketones serve as an alternative fuel source.
Previous studies have suggested that ketones may aid in the regeneration of demyelinated nerves and reduce inflammation. This led investigators to evaluate a keto diet’s safety, tolerability, and effects in participants with relapsing-remitting MS.
People with this condition have periods of new or worsening symptoms, which are called “exacerbations” or “relapses.” These are followed by periods of remission, when the symptoms improve or disappear.
The authors of the recent study will present their preliminary findings at the American Academy of Neurology’s 74th Annual Meeting, in Seattle.
The study included 65 participants with relapsing-remitting MS. They followed a strict modified Atkins diet for 6 months. This involved eating 2–3 ketogenic meals every day. Each meal contained a source of protein plus 2–4 tablespoons of fat and 1–2 cups of nonstarchy vegetables.
The lead author of the study, Dr. J. Nicholas Brenton, director of the Pediatric and Young Adult MS and Related Disorders Clinic and associate professor of pediatrics and neurology at the University of Virginia, told MNT:
“Participants were instructed to restrict net carbohydrates to 20 grams or less each day and encouraged to increase healthy fat intake. Adherence to the diet was monitored by daily urine tests to measure ketones, a metabolite produced by the body when it is burning fats.”
Before the study began and at 3 months, 6 months, or both, the researchers recorded participant-reported fatigue, depression, and quality of life scores. They also assessed how much MS had affected the participants’ functioning with validated tests.
The researchers also measured levels of two cytokines — adiponectin and leptin. Fatty tissue releases these cytokines, which play a role in regulating metabolism, inflammation, and obesity.
In the study, 83% of the participants complied with diet for 6 months.
Significant impact on MS measures
Overall, the participants demonstrated significant decreases in measures of fatigue and depression and increases in physical and mental quality of life after 6 months of the keto diet.
They experienced significant improvements in disability, walking, and finger dexterity at 6 months, compared with before the study began.
Also, fasting serum leptin and adiponectin measures indicated a decrease in inflammation after 6 months.
MNT spoke with Dr. Barbara Giesser, a neurologist and MS specialist at the Pacific Neuroscience Institute at Providence Saint John’s Health Center, in Santa Monica. Dr. Giesser, who was not involved in the research, said:
“This study builds on previous work in both the animal model of MS and smaller studies in people. Ketogenic diets may be of benefit in persons with MS by several mechanisms, including decreasing inflammation, reducing body fat, and/or promoting a less inflammatory gut microbiome.”
Speaking about the results, Dr. Brenton stated:
“Improvements in participant fatigue were not entirely surprising. The improvements in fine motor dexterity, quality of life, and walking speed were intriguing and provide important insights as to clinical outcome measures that can be employed in next-step comparative diet trials.”
Two sides to the coin
Speaking about the limitations of the study, Dr. Giesser explained: “The disability measure, while statistically significant, may not have been clinically meaningful. Also, as the authors point out, ketogenic diets could lead to other medical complications or nutrient deficiencies.”
She continued, “General dietary recommendations for persons with MS include eating a ‘heart-healthy’ diet. […] Any dietary regimen should be undertaken after consultation with a physician.”
Meanwhile, scientists need to conduct larger randomized controlled studies to confirm the safety and efficacy of a keto diet as an add-on treatment for MS.
“Our data do not support widespread adoption of this diet for all-comers with MS. But it does justify the need for future studies that aim to study ketogenic diets as a complementary therapeutic approach to the treatment of MS.”
– Dr. Brenton
Dr. Giesser observed, “This study further adds to the growing body of evidence-based data that indicate that lifestyle practices such as diet are an important and integral part of treating persons with MS.”
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