Ketogenic Diet as a Strategy for Improved Wellness and Reduced Disability in Relapsing Multiple Sclerosis
J. Nicholas Brenton1, Diana Lehner-Gulotta1, Emma Woolbright1, Rachael Coleman1, Mark Conaway1, Brenda Banwell2, A. G. Christina Bergqvist2, Myla Goldman3
1University of Virginia, 2The Children's Hospital of Philadelphia, 3Virginia Commonwealth University

Assess the safety and tolerability of a ketogenic diet (KD) in patients with relapsing MS and secondarily explore the impact on patient-reported, laboratory and clinical outcome metrics.

Dietary changes impact human physiology and immune function and have potential as therapeutic strategies in MS. Ketogenic diets mimic a fasting state and have been shown to impact immune regulation.

65 subjects with relapsing MS enrolled into a 6-month prospective KD intervention. Adherence to diet was monitored with the use of daily urine ketone testing. At baseline, patient-reported fatigue, depression and quality of life scores were obtained in addition to fasting adipokines and pertinent MS-related clinical outcome metrics. Baseline study metrics were repeated at 3 and/or 6 months on KD.


83% adhered to the KD for the full study period. Subjects exhibited reductions in fat mass from baseline to 6 months on-diet (41.3 ± 16.1 vs 32.0 ± 14.1 kg, p<0.001) and a significant decline in fatigue and depression scores. MS quality of life physical (67 ± 16 vs 79 ± 12, p<0.001) and mental (71 ± 17 vs 82 ± 11, p<0.001) composite scores improved on diet. Improvements were noted in EDSS scores (2.3 ± 0.9 vs 1.9 ± 1.1, p<0.001), 6-minute walk (1631 ± 302 vs 1733 ± 330 feet, p<0.001), and 9-hole peg test (21.5 ± 3.6 vs 20.3 ± 3.7 seconds, p<0.001). Fasting serum leptin was lower (25.5 ± 15.7 vs 14.0 ± 11.7 ng/mL, p<0.001) and adiponectin was higher at 6 months on KD (11.4 ± 7.8 vs 13.5 ± 8.4 mcg/mL, p=0.002). 

KDs are safe and tolerable over a 6-month study period and yield improvements in body composition,  fatigue, depression, quality of life, and neurologic disability in persons living with relapsing MS. KDs induce a reduction in pro-inflammatory adipokines and an elevation in anti-inflammatory adipokines.