In a 6 month trial the keto diet had significant effects, but the trial only had 65 people and you think that it would be enough. However, this number was based on number to see if the diet was tolerated. It was by most people with 83% completing 6 months

Ketogenic Diet

Brenton JN, Lehner-Gulotta D, Woolbright E, Banwell B, Bergqvist AGC, Chen S, Coleman R, Conaway M, Goldman MD. Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits. J Neurol Neurosurg Psychiatry. 2022 Apr 13:jnnp-2022-329074.

Background: Dietary changes impact human physiology and immune function and have potential as therapeutic strategies.

Objective: Assess the tolerability of a ketogenic diet (KD) in patients with relapsing multiple sclerosis (MS) and define the impact on laboratory and clinical outcome metrics.

Methods: Sixty-five subjects with relapsing MS enrolled into a 6-month prospective, intention-to-treat KD intervention. Adherence was monitored with daily urine ketone testing. At baseline, fatigue, depression and quality of life (QoL) scores were obtained in addition to fasting adipokines and MS-related clinical outcome metrics. Baseline metrics were repeated at 3 and/or 6 months on-diet.

Results: Eighty-three percent of participants adhered to the KD for the study duration. Subjects exhibited significant reductions in fat mass and showed a nearly 50% decline in self-reported fatigue and depression scores. MS QoL physical health (67±16 vs 79±12, p<0.001) and mental health (71±17 vs 82±11, p<0.001) composite scores increased on-diet. Significant improvements were noted in Expanded Disability Status Scale scores (2.3±0.9 vs 1.9±1.1, p<0.001), 6-minute walk (1631±302 vs 1733±330 ft, p<0.001) and Nine-Hole Peg Test (21.5±3.6 vs 20.3±3.7 s, p<0.001). Serum leptin was lower (25.5±15.7 vs 14.0±11.7 ng/mL, p<0.001) and adiponectin was higher (11.4±7.8 vs 13.5±8.4 µg/mL, p=0.002) on the KD.

Conclusion: KDs are safe and tolerable over a 6-month study period and yield improvements in body composition, fatigue, depression, QoL, neurological disability and adipose-related inflammation in persons living with relapsing MS.

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  • I think there also another larger study coming out soon which I believe has been completed. In Germany.

    However they have taken some of the primary and secondary outcomes out of the study for some reason.

  • Improvements with keto have been super fun for me! On exam, it’s improved vision and reduced hyperreflexia, but eliminating the need for stimulants and sleep aids is my favorite. I average about 2 more hours per day alert and functional. It was so curious to me that I used a blood meter to figure out my sweet spot, and discovered how I could manipulate numbers to better survive a relapse while I was tinkering. I hope there will be studies in the future that move away from urine testing and will show the blood ranges with the best outcomes. Mine best is quite lower than the goal range for managing seizures, but higher than for just weight loss. Thank you!

  • Why not do a trial on prolonged intermittent fasted (5-7 days low calorie diet once every 2/3 month). Such eating habits seems to have solid data from cancer research and in gerontology literature. See for example the work done with the so called fasting mimicking diet at USC.

    • You have to have the interest to do trials…I suspect our neuros have enough on their plates and then the other question is funding, who will support such a study

  • I found it interesting that going strictly low carb on the Blood Sugar Diet for six weeks produced not only a stone weight loss but that it changed my metabolism. As suggested, after the six weeks I kept on with the tweaks, but not the diet, e.g. no bread apart from occasional slice of sourdough, cauli rice and lentil pasta. Something had to have changed in those six weeks because weight has remained stable and that was five years ago. I eat pretty much anything while keeping (although not rigidly) to low carb principles. Whether it affects the MS directly or its value is in improving overall health and reducing risk of co-morbidities is another question. Let’s hope for more trials.

  • I (female, 50 with a BMI of 17,5) would love to try this but am afraid of possible weight loss. No eating disorder, allegedly my thyroid values are always within normal range but I can eat a kilo of sweets a day and not gain a gram which sounds fun but is really frustrating and keeps me from trying any strict diets that could be beneficial in managing my MS.

  • I have tried this way of eating a few times but can’t hold the focus in the long term, it gets complicated with various household food requirements/allergies/preferences and my cognition isn’t up to it. It’s a shame because I do feel better in many ways whilst on it and sugar cravings just disappear while my appetite reduces, apart from the cognition, food wise, it is very doable for me. I have recently downloaded an app in the hope it will help me to track what I am doing so fingers crossed…

  • Tried Keto for 3 months. It made me so tired and came with disability worsening as well. Of course I can’t say it’s Keto as it might be a coincidence. Now I am thinking I might needed to push beyond the 3 months. We know gut bug diversity needs longer to increase during Keto. The diet game a real mindf..k for pwMS.

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