Ketogenic Diet Reduces Depression, Improves Quality of Life in Multiple Sclerosis

James Nicholas Brenton, MD

Preliminary study results released ahead of the 2022 American Academy of Neurology (AAN) Annual Meeting, April 2-7, in Seattle, Washington, show that the ketogenic diet may be safe for patients with multiple sclerosis (MS). Data further suggest that those with MS on the diet may experience less fatigue and depression, while also reporting improved quality of life.¹

A total of 65 patients with relapsing–remitting MS were enrolled in the study and were then instructed to consume a ketogenic diet for 6 months. Investigators, including James Nicholas Brenton, MD, assistant professor, division of pediatric neurology, department of neurology, the University of Virginia, in Charlottesville, measured adherence via daily urine tests, which measured ketones. At study completion, 83% of participants adhered to the diet for the full study period.

At the start of the diet, at 3 months, and at 6 months, participants completed tests and surveys to measure disability and quality of life. Data suggest that participants had less body fat after 6 months, as well as a decline in fatigue and depression scores.

When surveyed about quality of life, participants were asked about their energy levels over recent weeks and whether they’ve felt happy or downhearted and blue. Patients were scored between 0 and 100, with higher scores indicating better physical and mental health. Prior to the study, patients had an average physician health score of 67 and an average mental health score of 71, compared with average scores of 79 and 82, respectively, at study completion.

Additionally, scores improved on a common MS disease progression test, with patients scored between 0 and 10, with 1 representing no disability, 2 minimal disability, and 3 moderate disability but still able to walk. Patients averaged a score of 2.3 at the beginning of the study, compared with 1.9 at the end. On the 6-Minute Walk Test, patients also improved, walking an average of 1631 feet at baseline and 1733 feet at study completion. When analyzing patient blood samples, investigators also observed improvements in levels of inflammatory markers.

“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,” Brenton said in a statement.¹ “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."

Participants were instructed to consume 2 to 3 ketogenic meals every day, with 1 to 2 services of low-carbohydrate foods, such as eggs, fish, or meat. These were accompanied by 2-4 tablespoons of fat, such as butter, oil, avocado, ghee, or heavy cream, and 1-2 cups of nonstarchy vegetables. While staying within the maximum daily carbohydrate intake of 20 g, patients were permitted to have snacks.

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“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," Brenton added in a statement.¹ “A ketogenic diet helps lower blood sugar levels in people with type 2 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.”

Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health and the ZiMS Foundation, the study also had a limitation. This was noted by investigators as a lack of a control group of patients with MS who consumed regular or nonketogenic diets.

While there is no evidence that a particular diet can prevent, treat, or cure MS, additional research efforts have suggested dietary adjustments may be beneficial for this patient population. New 36-month findings from the WAVES randomized trial were presented at the Americas Committee for Treatment and Research in Multiple Sclerosis (ACTRIMS) Forum 2022, February 24-26, in West Palm Beach, Florida, with data suggesting that individuals with RRMS had reductions in weight and cholesterol after utilizing either Swank of Wahls diets. Furthermore, these approaches may be even more beneficial for those with elevated weight or cholesterol.²

Lead author Tyler Ticomb, PhD, RDN, IFMCP, post-doctoral scholar, Wahls UIHC Clinical Research Lab, University of Iowa, presented findings, following his previously reported data on the initial 12 weeks of the study at the 2021 Annual Meeting of the Consortium of Multiple Sclerosis Centers (CMSC), October 25-28, in Orlando, Florida. Similar to what was previously observed, patients in both groups demonstrated statistically significant reductions in total cholesterol, low-density lipoprotein (LDL), body weight, and body mass index at the 12- and 24-week time points. In the Swank group, investigators recorded mean fasting insulin levels of 4.84 (±0.47) and 5.05 (±0.63) at those periods (P <.0001 for both), a significant decrease from 8.84 (±1.56) at baseline. As for those in the Wahls group, the insulin values did not change from 6.52 (±0.83) at baseline.

REFERENCE
1. Ketogenic diet may reduce disability, improve quality of life in people with MS. News release. American Academy of Neurology. March 1, 2022. Accessed March 3, 2022. https://www.prnewswire.com/news-releases/ketogenic-diet-may-reduce-disability-improve-quality-of-life-in-people-with-ms-301493387.html
2. Titcomb TJ, Eyck PT, Rubenstein L, Snetselaar LG, Wahls TL. Impact of Swank and Wahls diets on metabolic health among individuals with relapsing remitting MS: a secondary analysis of the WAVES trial. Presented at: ACTRIMS Forum 2022; February 24-26; West Palm Beach, Florida. Abstract P099.