A ketogenic diet is one that is high in fat, moderate in protein and low in carbohydrates. Animal studies have suggested that it may be beneficial in multiple sclerosis, but little is known about whether a ketogenic diet is suitable for people with MS. This study, carried out by American researchers, tested whether people with MS would tolerate a ketogenic diet and how it might affect them.
65 people with stable relapsing remitting MS were asked to follow a ketogenic diet (a modified Atkins diet) for 6 months.
About one in four participants had no side effects from the diet. Those that did experience side effects, most often reported them during the first two weeks and improved after that. The most common side effects attributed to the ketogenic diet were constipation (43%), diarrhoea (18%), nausea (9%), weight gain (9%), fatigue (5%), worsened depression or anxiety (5%), and acne (5%). Changes in the timing and heaviness of periods were reported by 27% of female participants.
The ketogenic diet led to significant improvements in body fat composition, fatigue, depression, quality of life and levels of disability. The researchers conclude that the results warrant further larger scale studies of ketogenic diets in people with MS but warn against following a ketogenic diet outside of a clinical trial and without medical supervision.
A ketogenic diet is one that is high in fat, moderate in protein and low in carbohydrates. Consuming very low amounts of carbohydrate changes your metabolism so that your body becomes more efficient at burning fat for energy (rather than carbohydrates), which in turn causes the formation of chemicals called ketones as a by-product.
The keto diet has been used as a treatment for childhood epilepsy and following the diet may help people with type 2 diabetes lower their blood sugars, possibly by encouraging weight loss. Animal studies have suggested that it may be beneficial in multiple sclerosis, but little is known about whether a ketogenic diet is suitable for people with MS. This study, carried out by American researchers, tested whether people with MS would tolerate a ketogenic diet and how it might affect them.
How this study was carried out
65 people with stable relapsing remitting MS were asked to follow a ketogenic diet (a modified Atkins diet) for 6 months. At the beginning of the study, a dietician gave advice on what to eat and regularly met with participants to troubleshoot any problems. Each day, participants tested their urine for levels of ketones to monitor how well they were following the diet.
Clinical measures were taken before starting the diet, during and at the end of the study, including EDSS, body measurements (height, weight, waist circumference and body fat composition), cognition, walking (distance walked in 6 minutes), arm and hand dexterity (9-hole peg test). Participants also wore an accelerometer to measure levels of activity.
Participants completed questionnaires to assess depression, fatigue, and their physical and mental quality of life before and after completing the study.
Based on daily urine ketones tests, 83% of the participants were considered to have maintained a ketogenic diet. Two participants withdrew from the study due to digestive side effects from the diet, including nausea and loss of appetite.
The main aim of the study was to find out if people with MS would tolerate a ketogenic diet. About one in four participants did not experience any side effects from the diet. Of those that did experience side effects, these were most often reported during the first two weeks and improved after that. The most common side effects attributed to the ketogenic diet were constipation (43%), diarrhoea (18%), nausea (9%), weight gain (9%), fatigue (5%), worsened depression or anxiety (5%), and acne (5%). Changes in the timing and heaviness of periods were reported by 27% of female participants.
Significant improvements were seen in EDSS, walking and manual dexterity. Body mass index (BMI, a ratio of weight to height) and other measures of body fat decreased significantly over the six-month study. However, there was no change in activity levels, as measured by an accelerometer.
Participants showed a nearly 50% improvement in self-reported fatigue and depression. Quality of life scores for physical and mental health also improved significantly.
The results indicate that a ketogenic diet is safe and tolerable for people with relapsing remitting MS over a six-month period. The diet leads to improvements in body composition, fatigue, depression, quality of life and levels of disability. The researchers consider that the results warrant further larger scale studies of ketogenic diets as a complementary treatment for MS.
The study did not include a matched group on a standard or another weight-loss diet, making it difficult to assess whether simply losing weight or just taking part in the study might have led to some of the improvements. In addition, the study was limited to people with stable relapsing remitting MS and results may not be the same for people with active relapsing remitting or progressive MS.
The researchers also warn against following a ketogenic diet outside of a clinical trial and without medical supervision. They point out that participants were carefully monitored by a trained dietitian and had regular blood tests and neurological examinations. Possible risks of a long-term, unmonitored ketogenic diet include kidney stones, unhealthy levels of lipids such as cholesterol in the blood and nutrient deficiencies.
Brenton JN et al.
Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits.
Journal of Neurology Neurosurgery & Psychiatry 2022 Apr 13: jnnp-2022-329074. [Epub ahead of print].
Many people are interested in the potential to manage their MS through diet. This is a controversial topic and opinions range from denying any benefit to claims that particular diets can effectively cure MS. Several dietary approaches to managing MS have been proposed, usually as a part of a wider programme of lifestyle changes.
While research into diet and multiple sclerosis has been limited, there has been considerable research into a healthy diet for other condition. Following a healthy, balanced diet which is low in fat and includes plenty of fruit and vegetables is important for maintaining general health and reducing the risk of developing other conditions such as heart disease, stroke and diabetes. Your GP or MS nurse can give you advice on how to achieve and maintain a healthy weight through diet and exercise.
Our A-Z pages give a comprehensive overview of diet and MS and include tips on preparing and eating meals.
