Pilot study of a ketogenic diet in relapsing-remitting MS

OBJECTIVE: To assess the safety and tolerability of a modified Atkins diet (KD(MAD)), 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 KD(MAD). Adherence to KD(MAD) 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 KD(MAD) for 3 months and 15 (75%) adhered for 6 months. Anthropometric improvements were noted on KD(MAD), 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: KD(MAD) is safe, feasible to study, and well tolerated in subjects with relapsing MS. KD(MAD) 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.