A Keto Diet May Be Helpful For MS Symptom Management — But We Need More Research

"Is fat good or bad for you?" It's a popular question in nutrition science that is of special interest to those with multiple sclerosis (MS).

Multiple analyses1 have found that patients with MS can achieve more energy and a higher quality of life by changing the food they eat. The strongest evidence exists for the modified Paleolithic and Mediterranean diets2. Eating lots of added sugars, pastas, breads, and cereals is associated with more severe mental health symptoms3—but what about fat?

Instead of relying on carbs to power the mitochondria, those who follow the ketogenic diet rely on ketone bodies (a special type of fat) to power the mitochondria.

There is growing evidence that people with psychiatric disorders and neurologic disorders do not utilize glucose in the brain4 as effectively as people who do not have a psychiatric or neurologic disorder.

In early animal model studies of MS, the ketogenic diet was shown to reduce the severity of symptoms and/or lead to an improvement in function.

Then came the research on humans: 65 people with relapsing multiple sclerosis (MS) followed a diet that was low in carbohydrates and high in fat for six months. Notably, there was a nearly 50% reduction in fatigue severity5 and Beck depression index scores (which measures fatigue and depression) at the end of the six-month check-in compared to the baseline visit. In addition, there were significant improvements in walking endurance (measured by how far participants could walk in six minutes) and hand function (measured by moving small pegs by hand).

Though this is an exciting finding, it's important to note that this was a single-arm study—meaning that there was no comparison group. The strongest evidence for whether an intervention is helpful or harmful comes from randomized controlled studies, which haven't been done on this topic at the scale we need.

Of the handful of small randomized controlled studies on the ketogenic diet for MS, none of them were able to show that the 95% confidence interval for the reduction in fatigue or improvement in quality of life was entirely on the side of the ketogenic diet. The 95% confidence interval crossed slightly over to favor the control diet.

Likely, we need larger and longer studies to investigate how ketogenic diets can indeed reduce fatigue and improve quality of life in the setting of MS.

I have been conducting clinical research on effects of diet in people with MS since 2010. So far, I've looked into the effects of the modified Paleolithic diet, ketogenic diet, and the low-saturated fat diet. My research has consistently observed that following one of these diets can lead to reductions in fatigue6, anxiety7, and depression8, as well as improvements in quality of life9.