Multiple sclerosis is an inflammatory auto-immune disease that affects the central nervous system.
Impaired glucose metabolism, decreased insulin sensitivity, disruptions in the gut microbiome, chronic inflammation, and mitochondrial dysfunction are all linked to multiple sclerosis.
The ketogenic diet has been shown to improve glucose metabolism, improve insulin sensitivity, improve gut microbiome diversity, reduce inflammation, produce ketone bodies that function as antioxidants, and improve mitochondrial functioning, leading researchers to believe that there might be something to the idea of multiple sclerosis and keto in that the ketogenic diet may function as powerful nutritional therapy for M.S. patients.
We are starting off 2020 with promising new research on potential therapies for the ketogenic diet. On January 2nd, Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study was published in the journal Trials. While this clinical trial has not concluded (the study began in May 2017 and is expected to continue recruitment until March 2020), the researchers provide comping evidence for why they believe a ketogenic diet will be superior to a standard diet in limiting disease progression of multiple sclerosis (M.S.). Let’s break down this paper to understand why and how a ketogenic diet may be beneficial for M.S. patients.
Multiple Sclerosis (M.S.) is a common inflammatory autoimmune disease that affects the central nervous system. In this disease, the immune system attacks the myelin sheath (the protective outer layering that covers nerves).
Decreased myelin sheath leads to disrupted neuron signaling and communication deficiencies between the brain and the rest of the body. There is no cure for M.S., but nutritional therapies have been shown to decrease disease progression and improve the overall quality of life.
Since M.S. is an inflammatory disease, and the ketogenic diet has been shown to improve inflammatory markers, the hypothesis is that patients with M.S. who follow a ketogenic diet will experience reductions in inflammation and thus reduce symptoms.
Additionally, increases in pro-inflammatory cytokines (specifically IL-17) have been observed in M.S. patients, which has been shown to cause insulin resistance and impaired glucose metabolism. Furthermore, cerebral glucose hypometabolism (decreased glucose metabolism in the brain) has been observed in M.S. patients due to neuronal mitochondrial dysfunction.
Moreover, changes in the gut microbiome have been linked to autoimmune conditions like M.S. but, both the ketogenic diet and fasting have been shown to improve gut microbiota diversity. Since the ketogenic diet has been shown to reduce inflammation, produce ketone bodies that function as antioxidants, improve gut microbiome diversity, and improve insulin sensitivity and glucose metabolism, researchers hypothesized that the ketogenic diet may act as a potent nutritional therapy for multiple sclerosis.
One hundred and eleven patients will M.S. will be randomly assigned to one of three dietary interventions: a standard low-fat and predominantly vegetarian diet (as recommended by the German Nutrition Society), a fasting diet consisting of 14-hour daily fasts and a 7-day fast every 6 months, or a ketogenic diet restricted to 20-40g of carbohydrates per day. 
Multiple Sclerosis and Keto: Final Thoughts
While the results have not been published, this study shows tremendous promise. It is the first large clinical study to look at the effects of nutritional therapies for M.S. over an extended period of time. Once the full study has been published, we will post an in-depth break down of their findings.
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