A phase II study found that a ketogenic diet was safe, tolerable, and provided clinical benefits to people with recurrent multiple sclerosis (MS).
Patients with relapsed MS enrolled in the 6-month prospective ketogenic intervention had significant reductions in fat mass and showed a nearly 50% decrease in fatigue and depression scores, reported J. Nicholas Brenton, MD, from the University of Virginia in Charlottesville, American. Annual meeting of the Academy of Neurology, held in Seattle and online.
The combined physical health and mental health scores of MS quality of life increased while participants were on the diet, and improvements were observed in the Extended Disability State Scale (EDSS) scores. Brenton added. The findings were published simultaneously in the Journal of Neurology, Neurosurgery, and Psychiatry.
A ketogenic diet is high in fat, low in carbohydrates and has adequate protein and mimics a state of nutritional fasting. It can reduce proinflammatory adipokines and increase anti-inflammatory adipokines. A ketogenic diet has been shown to improve seizure control in epilepsy, but has not been well studied in MS.
“We know that diet has the potential to affect the immune system in many ways,” Brenton told MedPage Today. “The ketogenic diet, in particular, has neuroprotective properties that may positively affect the pathobiology of MS in addition to its clinical manifestations.”
“This research is the first step in objectively demonstrating the viability of ketogenic diet studies in MS, provides an important insight into the clinical and laboratory metrics positively affected by these diets, and identifies key barriers and potential solutions for the future. clinical trials in MS diet research “. Brenton added.
The study included 65 patients with recurrent and remitting MS who followed a ketogenic diet for 6 months, which allowed a maximum daily amount of carbohydrates of 20 g. Adherence was monitored with daily urine ketone testing. Most participants (91%) were already taking vitamin D in several doses at first and were advised to continue as prescribed by their treating neurologist.
Fatigue, depression, QoL baseline scores were obtained, as well as fasting adipocins and MS-related clinical outcome metrics. These metrics were repeated at 3 and 6 months of diet.
Overall, 83% of participants adhered to the ketogenic diet for the duration of the study. The median age was 40 years and 86% were women; 63% were obese.
During the study period, the percentage of fat mass decreased from 44% to 40% of total body mass. The composite scores of physical health (67 vs 79, P <0.001) and mental health (71 vs 82, P <0.001) of the MS QoL increased.
EDSS scores improved (2.3 vs. 1.9, P <0.001), as did 6-minute walk scores (1,631 vs. 1,733 feet, P <0.001) and the nine-hole peg test. (21.5 vs. 20.3 seconds, P <0.001). Serum levels of leptin, a proinflammatory adipocin, were lower (25.5 vs 14.0 ng / ml, P <0.001), while levels of adiponectin, an anti-inflammatory adipocin, were higher (11, 4 vs. 13.5 mcg / ml, P = 0.002). ).
Among patients with MS who completed the 6-month intervention, the most common side effects were constipation (43%), diarrhea (18%), nausea (9%), weight gain (9%), and fatigue (5%). %), worsening of depression. or anxiety (5%), and acne (5%). Menstrual irregularities occurred in 27% of women. No participants showed signs of relapse.
One limitation of the study was the lack of a paired control group.
“Our study provides evidence that a ketogenic diet can be safe and beneficial, reducing some symptoms for people with MS, when used for a period of 6 months,” Brenton noted. “However, more research is needed because there are potential risks associated with ketogenic diets, such as kidney stones, digestive problems and nutrient deficiencies.”
Judy George covers neurology and neuroscience news for MedPage Today, writing about brain aging, Alzheimer’s, dementia, MS, rare diseases, epilepsy, autism, headaches, stroke, Parkinson’s, ALS, concussion, CTE, sleep, pain, and far more. Follow
Disclosures
The study was funded by the National Center for Advancing Translational Sciences through the iTHRIV Scholars program and with support from the ZiMS Foundation.
Brenton revealed research funds from the NIH and the National Institute of Neurological Disorders and Stroke.