Patients with relapsing-remitting multiple sclerosis (MS) who adopted a high-fat, low-carbohydrate ketogenic diet saw significant improvements in their MS – including reductions in neurologic disability, fatigue and depression and heightened overall quality of life, a new study finds.

The ketogenic diet – popular for weight loss and among the fitness community – was put to the test among 65 volunteers with relapsing-remitting MS, an inflammatory disorder in which the immune system attacks the natural insulation that protects the body’s nerves in the brain and spinal cord. MS symptoms vary widely, but patients often struggle with cognition, dexterity and mobility.

In the new study, more than 80% of participants on the keto diet adhered to it for the full six-month study period. Participants lost body fat and reported significant improvements in fatigue, depression and quality of life. In addition, their performance improved on physical endurance testing, such as the six-minute walk.

“The findings from the study are exciting and serve as a testament to the dedication of our study participants and the resilience of those living with MS,” said researcher J. Nicholas Brenton, MD, an expert on MS at UVA Health. “People living with MS are highly motivated toward research that studies the link between dietary intake and MS. Our study not only demonstrates the feasibility of dietary changes in MS patients but also the potential benefits that could arise from such interventions. Given the intriguing results of this study, our team is currently looking at how the ketogenic diet impacts the immune profile of MS patients.”

About the Ketogenic Diet

The ketogenic diet mimics the body’s fasting state. To do this, it cuts carbohydrates dramatically and replaces them with healthy fats and protein. As a result, the body relies on fat as a primary energy source (as opposed to carbs/sugars). A person on a ketogenic diet, for example, might eat a hamburger with no bun and a side of brussels sprouts with bacon. The traditional side of French fries would not be allowed – while fries are high in fat, they’re also loaded with carbohydrates, which are used as sugars by the body. Consuming excess carbs would defeat the point of keto, which is to minimize the body’s sugar reserves.

Dietary changes are known to have effects on the body’s immune system. In particular, the ketogenic diet may have several benefits for immune-mediated disorders, so Brenton wanted to investigate how this diet could help patients with MS. 

He and his collaborators found that the diet had a wide array of benefits, as determined both by patient report and by laboratory and clinical tests. For example, patients on keto walked farther and faster in six minutes than they did prior to the diet. Other benefits included reductions in total body fat and enhanced fine motor speed, as well as improved fatigue, depression and quality of life scores and beneficial changes in inflammatory blood markers.

Based on the findings, the researchers conclude that the ketogenic diet is safe in the short-term and potentially effective in improving MS-related symptoms and overall quality of life.

“Our study provides evidence that a ketogenic diet is safe and beneficial, reducing some symptoms for people with MS, when used over a six-month period,” Brenton said. “Still, more research is needed as there are risks associated with these diets. It is important that people with MS consult with their healthcare provider before making any big changes to their diet, and that they be regularly monitored by a physician and registered dietitian if pursuing a true ketogenic diet.”

 A ketogenic diet, which primarily consists of foods like meat, fish, eggs, heavy cream, butter, oils and non-starchy vegetables like pea pods, carrots, broccoli and peppers, may be safe for people with multiple sclerosis (MS). That is according to a preliminary study released today, March 1, 2022, that will be presented at the American Academy of Neurology’s 74th Annual Meeting being held in person in Seattle, April 2 to 7, 2022 and virtually, April 24 to 26, 2022. The preliminary study also found people with MS may experience less fatigue and depression and report an improved quality of life while on the diet.  

“A ketogenic diet, which is high in fats, adequate in protein, and low in carbohydrates, allows the body to utilize fat as its primary source of energy instead of sugars, thus mimicking a fasting state,” said study author J. Nicholas Brenton, MD, of the University of Virginia in Charlottesville and a member of the American Academy of Neurology. “A ketogenic diet helps lower blood sugar levels in people with type II diabetes and improve seizure control in people with epilepsy. However, it has not been well-studied in people with MS. Diet changes can be an inexpensive way to improve overall health, so our study explored whether eating a ketogenic diet is safe, tolerable and beneficial for people living with MS.” 

The study enrolled 65 people diagnosed with relapsing-remitting MS. Relapsing-remitting MS is the most common form of the disease, marked by symptom flare-ups followed by periods of remission. 

Study participants consumed a ketogenic diet for six months. They were instructed to consume two to three ketogenic meals per day consisting of one to two servings of low-carbohydrate proteins such as eggs, fish or meat alongside two to four tablespoons of fat, such as butter, oil, avocado, ghee or heavy cream, and one to two cups of non-starchy vegetables such as cucumbers, leafy greens or cauliflower. Snacks were also allowed as long as participants followed the maximum daily carbohydrate allowance of 20 grams. Adherence to the diet was monitored by daily urine tests to measure ketones, a metabolite produced by the body when it is burning fats. A total of 83% of participants adhered to the diet for the full study period. 

Participants completed tests and surveys prior to the start of the diet and again at three and six months while on the diet to measure level of disability and quality of life. 

Researchers found that not only did participants have less body fat after six months, they also had a decline in fatigue and depression scores. 

On a quality-of-life survey, participants were asked questions like, “Did you have a lot of energy over recent weeks?” “Did you feel worn out?” “Have you been a happy person?” and “Have you felt downhearted and blue?” The survey provided a score for physical and mental health that can range from zero to 100, with higher scores representing better physical and mental health. Participants had an average physical health score of 67 at the start of the study compared to an average score of 79 at the end. Participants had an average mental health score of 71 at the start of the study compared to an average score of 82 at the end. 

Scores also improved on a common MS disease progression test. On a scale of zero to 10, with a score of one representing no disability, two representing minimal disability and three, moderate disability but still able to walk, average participant score at the start of the study was 2.3 compared to 1.9 at the end. On a six-minute walking test, participants walked an average of 1,631 feet at the start of the study compared to 1,733 feet at the end.  

Researchers also took blood samples and found participants had improvements in the levels of inflammatory markers in the blood. 

“Our study provides evidence that a ketogenic diet may indeed be safe and beneficial, reducing some symptoms for people with MS, when used over a six-month period,” said Brenton. “However, more research is needed because there are potential risks associated with ketogenic diets, such as kidney stones, digestive issues and nutrient deficiencies. It is important that people with MS consult with their doctor before making any big changes to their diet, and that they be regularly monitored by a physician and registered dietitian while on a ketogenic diet.” 

A limitation of the study was the lack of a control group of people with MS who consumed their regular, non-ketogenic diet. 

Dr. Daniel Kantor talks with Dr. Marcus Bahra from Charite Medical University, Berlin about the Ketogenic Diet and the impact it has on Multiple Sclerosis and Quality of Life.