Research Article| Volume 73, 104670, May 2023

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Serum neurofilament light chain in relapsing multiple sclerosis patients on a ketogenic diet


      • 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.



      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.


      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.


      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.


      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”


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