Ketogenic (KD) and fasting mimicking (FMD) diets have been shown to be feasible and safe in MS patients. There is clinical evidence that they might improve health-related quality of life.
In 2016 a randomized, parallel-group, three-arm pilot trial was conducted to assess the safety and feasibility of FMD or KD treatment on health-related quality of life (HRQOL) in relapsing MS patients. 60 patients were randomly assigned to a control diet, KD for 6 months (n = 20), or a single cycle of a modified human FMD for 7 days followed by a Mediterranean diet for 6 months. The FMD and KD cohorts displayed clinically meaningful improvements in the HRQOL (quality of life) summary scales at 3 months, which included the overall quality of life, change in health, a physical health composite and a mental health composite.
Choi IY, Piccio L, Childress P, Bollman B, Ghosh A, Brandhorst S, et al. A diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms. Cell Rep. 2016;15(10):2136–46.
Another pilot study which tested the safety and tolerability of a modified Atkins diet found decreased body mass index, body fat mass, fatigue and depression scores in 20 Relapsing-Remitting Multiple Sclerosis (RRMS) patients.
Brenton JN, Banwell B, Bergqvist AGC, Lehner-Gulotta D, Gampper L, Leytham E, et al. Pilot study of a ketogenic diet in relapsing–remitting MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(4):e565.
Terry Wahls is a physician from Iowa, USA who put her own MS into remission by making changes to her diet. Her story is documented in the excellent book The Wahls Protocol and an outstanding Ted Talk. Her diet protocol is a modified Paleo diet with emphasis on meat, fish, fruit and vegetables.
Dr Wahls has also done extensive research assessing the efficacy of her diet protocol in patients with MS. In a single-arm study using this dietary approach as part of a multimodal intervention, improvements in fatigue, QoL, and gait, were observed in half of a cohort with progressive MS.
Bisht B, Darling WG, Shivapour ET, et al. Multimodal intervention improves fatigue and quality of life in subjects with progressive multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis 2015; 5: 19–35.
Two small follow up randomized, controlled trials comparing the modified Paleolithic diet to usual diet demonstrated favorable outcomes for fatigue and quality of life (QoL) among individuals with progressive or RRMS.
Irish AK, Erickson CM, Wahls TL, et al. Randomized control trial evaluation of a modified paleolithic dietary intervention in the treatment of relapsing remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis 2017; 7: 1–18.
Lee JE, Titcomb TJ, Bisht B, et al. A modified MCT based ketogenic diet increases plasma betahydroxybutyrate but has less effect on fatigue and quality of life in people with multiple sclerosis compared to a modified paleolithic diet: a waitlist controlled, randomized pilot study. J Am Coll Nutr 2021; 40: 13– 13.
Dr Wahls’ most recent published study compared the Wahls protocol with the Swank diet, a low saturated fat diet historically popular with those suffering from MS. They found that adoption of both the Swank and Wahls diets were associated with reduced fatigue and improved QoL for up to 24 weeks. It is important to consider how these two diets are similar rather than how they differ. Both diets include recommendations unsaturated fats and for limited intake of highly processed foods.
Wahls TL, Titcomb TJ, Bisht B, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021;7(3):20552173211035400. doi:10.1177/20552173211035399
- Bock M, Michalsen A, Paul F. Ketogenic diet and prolonged fasting improve health-related quality of life and lipid profiles in multiple sclerosis –A randomized controlled trial. 2015. PDF
- Vural Fidan, Handan Koyuncu, Hayal Toktas Impact of ketogenic diet versus regular diet on voice quality of patients with multiple sclerosis. Clinical Case Reports and Clinical Study, 4(4); doi: 03.2021/1.1081. PDF
- Benlloch M, López-Rodríguez MM, Cuerda-Ballester M, et al. Satiating effect of a ketogenic diet and its impact on muscle improvement and oxidation state in multiple sclerosis Patients. Nutrients. 2019;11(5):1156. doi:10.3390/nu11051156
- Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18. doi:10.2147/DNND.S116949
- Bock M, Karber M, Kuhn H. Ketogenic diets attenuate cyclooxygenase and lipoxygenase gene expression in multiple sclerosis. EBioMedicine. 2018;36:293-303. doi:10.1016/j.ebiom.2018.08.057
- Swidsinski A, Dörffel Y, Loening-Baucke V, et al. Reduced Mass and Diversity of the Colonic Microbiome in Patients with Multiple Sclerosis and Their Improvement with Ketogenic Diet. Front Microbiol. 2017;8. doi:10.3389/fmicb.2017.01141
- Lee JE, Bisht B, Hall MJ, et al. A multimodal, nonpharmacologic intervention improves mood and cognitive function in people with multiple sclerosis. Journal of the American College of Nutrition. 2017;36(3):150-168. doi:10.1080/07315724.2016.1255160
- Fellows Maxwell K, Wahls T, Browne RW, et al. Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study. PLoS One. 2019;14(6). doi:10.1371/journal.pone.0218075
- Storoni M, Plant GT. The therapeutic potential of the ketogenic diet in treating progressive multiple sclerosis. Multiple Sclerosis International. 2015. doi:10.1155/2015/681289
- Nathan J, Khedekar Kale D, Naik VD, Thakker F, Bailur S. Dietary therapy in secondary progressive multiple sclerosis: A Case Report. Cureus. 2019;11(8):e5341. doi:10.7759/cureus.5341
- Wahls TL, Chenard CA, Snetselaar LG. Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients. 2019;11(2). doi:10.3390/nu11020352
- Maric G, Lalic K, Pekmezovic T, et al. Could the performance of oral glucose tolerance test contribute to the brain health-focused care in multiple sclerosis? Multiple Sclerosis and Related Disorders. 2020;46:102536. doi:10.1016/j.msard.2020.102536 ABSTRACT
- Bahr LS, Bock M, Liebscher D, et al. Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study. Trials. 2020;21(1):3. doi:10.1186/s13063-019-3928-9 – Valuable background discussion
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