Researchers at U.Va. Health recently discovered that a ketogenic diet benefits patients with multiple sclerosis by reducing levels of fatigue and depression as well as improving overall quality of life.
Multiple sclerosis, a debilitating disease in which the immune system starts attacking the brain and spinal cord by eroding the protective covering — myelin sheaths — on neurons, has significant effects on energy, physical functioning and mental health.
Looking for ways to combat this, Asst. Neurology Prof. Nicholas Brenton spearheaded new research exploring how a modified Atkins diet — a less restrictive form of a ketogenic diet — has the potential to be a new standard of care for MS patients.
For almost a century, ketogenic diets have been lauded as a treatment for epilepsy, but their application to other conditions has only recently been explored. There is currently early stage research being done regarding illnesses like Alzheimer's in relation to ketogenic diets in mouse and rat models.
Brenton came up with the concept due to his personal background as an epileptologist, combined with inspiration from a 2012 study that tested how rats with multiple sclerosis reacted to a ketogenic diet. With promising results, the study convinced Brenton to consider applying the idea to human patients with multiple sclerosis.
Third-year College student Candace Moore, who works in a separate but related lab run by Asst. Biology Prof. John Campbell, has experience with the ways neurons can majorly affect one’s appetite. The Campbell Lab’s research in brain-food relations supports, more generally, the idea that diets can be used as treatment. Diseases often change the levels of nutrients and necessary concentrations within the body, and adjusting food intake can be beneficial to combating and sustaining healthy functioning.
“[I have learned that] diet affects [multiple sclerosis] more because MS is a disease that really targets the immune system,” Moore said.
However, there were other factors to take into account. Ketogenic diets have been linked to fatigue, especially in their initial stages, so it was important for Brenton to help his patients combat this and other side effects of ketosis — a state in which the body tends to burn fat instead of carbohydrates — induced by such diets.
“Nobody at the time had looked at this diet and MS mostly because of how restrictive [ketogenic diets are],” Brenton said.
To conduct this study, Brenton’s team first conducted a small trial on approximately 20 patients who were willing to try a dietary change in hope to help their multiple sclerosis. U.Va. Health Nutritionist Diana Lehner-Gulotta conducted an introductory meeting with each of the patients, informing them of the process for testing and teaching them ways to adhere to the very limited diet.
“[The patients] would have an initial visit with me that typically lasted about an hour, where I would give them education about the modified Atkins diet and what kinds of foods they could and couldn't eat,” Lehner-Gulotta said.
The patients sat through an initial series of tests to establish their baseline energy levels and then were given blood tests monthly to monitor physical changes throughout the study. Over the six-month period, the researchers found that the dietary change related to a decrease in depression and fatigue in patients using the Beck Depression Inventory and a Modified Fatigue Impact Scale.
The short-term six-month timeline for the diet left behind lingering questions.
“I think that all of these diets require better study to really determine the precise benefits and risks that MS patients may have when [taking on a ketogenic diet] long-term,” Brenton said.
Due to the small scale of the original study, the team has since conducted a larger study with a larger participant pool. This larger study enrolled 65 subjects. It aimed to provide a more accurate dataset as well as create a stronger confidence in the replicability of the study — and it supported the above results.
A key concern for future research is the potential deficiencies caused by a long-term modified Atkins diet. Due to the very narrow scope of the diet, there is potential for nutritional deficiencies ranging from magnesium to Vitamin A. Currently, patients are being overseen by clinical staff and dietary staff to ensure that this does not occur.
“I think we're interested to see whether in the future a more liberal form of this diet might have just as positive effects just because this diet is really restrictive, and it does have side effects,” Lehner-Gulotta said.
Since this research represents the first study on ketogenic diets for multiple sclerosis, many milestones still remain to establish ketogenic — or other — diets as standards of care for multiple sclerosis.
“We don't know if it's the ketosis or if it's low carbs right now [that] are what it is about the diets that may help so I would be more inclined to study first what we've been studying and then to back off and try more lenient or less restrictive diets that are in the same scope. ” Brenton said.
CORRECTION: A previous version of this article stated that the pilot study of 20 subjects reflected the most up-to-date research conducted by Brenton’s team. It has since been updated to indicate that a more recent larger study of 65 subjects represents the strongest support for these findings. The article has also been updated to reflect the fact that the inspiration for the article was based in a 2015 paper – not a 2012 paper – focusing on rats with multiple sclerosis.
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