Highlights
- •Ketogenic diets are safe in MS patients with sustained, low NfL levels while on diet.
- •Those with greater evidence of serologic ketosis exhibit greater improvement in NfL.
- •Reduction in serum bicarbonate on ketogenic diet directly correlates with NfL level.
Abstract
Background
Ketogenic diets have anti-inflammatory and neuroprotective properties which make these
diets an attractive complimentary treatment approach for patients living with multiple
sclerosis (MS). The objective of this study was to assess the impact of ketogenic
diets on neurofilament light chain (NfL), a biomarker of neuroaxonal injury.
Methods
Thirty-nine subjects with relapsing MS completed a 6-month ketogenic diet intervention.
NfL levels were assayed at both baseline (pre-diet) and 6-months on-diet. In addition,
ketogenic diet study participants were compared to a cohort (n = 31) of historical, untreated MS controls.
Results
Baseline (pre-diet) mean NfL was 5.45 pg/ml (95% CI 4.59 - 6.31). After 6 months on
ketogenic diet, mean NfL was not significantly changed (5.49 pg/ml; 95% CI 4.82 -
6.19). Compared to untreated MS controls (mean 15.17 pg/ml), NfL levels for the ketogenic
diet cohort were relatively low. MS subjects with higher levels of ketosis (as measured
by serum beta-hydroxybutyrate) exhibited greater reductions in NfL between baseline
and 6-months on ketogenic diet.
Conclusions
Ketogenic diets do not worsen biomarkers of neurodegeneration in relapsing MS patients,
with stable, low levels of NfL observed throughout the diet intervention. Subjects
with greater biomarkers of ketosis experienced a higher degree of improvement in serum
NfL.
Clinical trial identifier
NCT03718247 – “Utilization of the Ketogenic Diet in Patients with Relapsing-Remitting
MS” https://clinicaltrials.gov/ct2/show/NCT03718247.
Keywords
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Article info
Publication history
Published online: March 25, 2023
Accepted:
March 25,
2023
Received in revised form:
March 22,
2023
Received:
November 23,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
