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July 2019; 6 (4) ArticleOpen Access

Pilot study of a ketogenic diet in relapsing-remitting MS

J. Nicholas Brenton, Brenda Banwell, A.G. Christina Bergqvist, Diana Lehner-Gulotta, Lauren Gampper, Emily Leytham, Rachael Coleman, Myla D. Goldman
First published April 12, 2019, DOI: https://doi.org/10.1212/NXI.0000000000000565
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Abstract

Objective To assess the safety and tolerability of a modified Atkins diet (KDMAD), a type of ketogenic diet (KD), in subjects with relapsing MS while exploring potential benefits of KDs in MS.

Methods Twenty subjects with relapsing MS enrolled into a 6-month, single-arm, open-label study of the KDMAD. Adherence to KDMAD was objectively monitored by daily urine ketone testing. Fatigue and depression scores and fasting adipokines were obtained at baseline and on diet. Brain MRI was obtained at baseline and 6 months. Intention to treat was used for primary data analysis, and a per-protocol approach was used for secondary analysis.

Results No subject experienced worsening disease on diet. Nineteen subjects (95%) adhered to KDMAD for 3 months and 15 (75%) adhered for 6 months. Anthropometric improvements were noted on KDMAD, with reductions in body mass index and total fat mass (p < 0.0001). Fatigue (p = 0.002) and depression scores (p = 0.003) were improved. Serologic leptin was significantly lower at 3 months (p < 0.0001) on diet.

Conclusions KDMAD is safe, feasible to study, and well tolerated in subjects with relapsing MS. KDMAD improves fatigue and depression while also promoting weight loss and reducing serologic proinflammatory adipokines.

Classification of evidence The study is rated Class IV because of the absence of a non-KD control group.

Glossary

BDI=
Beck Depression Inventory;
BHB=
beta-hydroxybutyrate;
BMI=
body mass index;
EAE=
experimental autoimmune encephalitis;
EDSS=
Expanded Disability Status Scale;
KD=
ketogenic diet;
MIFS=
Modified Fatigue Impact Scale;
PASAT=
Paced Auditory Serial Addition Test;
RRMS=
relapsing-remitting MS;
SDMT=
Symbol Digit Modalities Test

Footnotes

  • Funding information and disclosures are provided at the end of the article. Full disclosure form information provided by the authors is available with the full text of this article at Neurology.org/NN.

  • The Article Processing Charge was funded by the ziMS Foundation.

  • Class of Evidence: NPub.org/coe

  • Received December 9, 2018.
  • Accepted in final form March 5, 2019.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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