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A Keto Diet May Be Helpful For MS Symptom Management — But We Need More Research
![Terry Wahls, M.D. Terry Wahls, M.D.](https://mindbodygreen-res.cloudinary.com/image/upload/c_fill,g_auto,w_50,h_50,q_auto,f_auto,fl_lossy/usr/DrTerryWahlsNew.jpg)
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"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?
Scientists are now studying how the ketogenic diet—which is low-carbohydrate, moderate-protein, and high in fat—might affect those with MS. Here are the early findings:
The promise of high-fat, low-carb eating plans for those with MS
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.
That's why I'm in the process of recruiting for such a two-year study. It will compare a modified Paleolithic elimination diet and a time-restricted ketogenic diet to a usual diet (control). In the Efficacy of Diet on Quality of Life in Multiple Sclerosis study, we will help people improve their nutrition to investigate the impact of diet on fatigue and quality of life.
Want to get involved in this research?
What type of diet to follow if you have 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.
The current research shows that the best diets for reducing fatigue and improving quality of life are the Mediterranean and Paleolithic diets. Here are the key elements of these eating plans:
Mediterranean:
- Encourages more vegetables and fruits, whole grains, legumes, fish, nuts, and seeds
- Reduces or eliminates added sugars, processed foods, fast foods, white breads, and white rice
Modified Paleolithic:
- Encourages more vegetables (target is 6 to 9 servings), 6 to 12 ounces of meat or fish, fermented foods, nuts, and seeds
- Excludes gluten-containing grains, dairy, and eggs
- Reduces or eliminates added sugars, processed foods, fast foods, and grains
The takeaway
I tell my students and postdoctoral research scholars that changing the standard of care takes 30 years. I am 15 years into this journey. Eventually, I hope to see that those with MS are always told that their diet matters and are encouraged to make food choices that will help them manage their disease course. For that to happen we need more published, peer-reviewed scientific studies—and I look forward to continuing to help fill this gap.
![Terry Wahls, M.D. Terry Wahls, M.D.](https://mindbodygreen-res.cloudinary.com/image/upload/c_fill,g_auto,w_100,h_100,q_auto,f_auto,fl_lossy/usr/DrTerryWahlsNew.jpg)
Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and board-certified internal medicine physician. She conducts clinical trials, testing the efficacy of diet and lifestyle changes in the setting of autoimmunity.
In 2018 she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contributions in research, clinical care and patient advocacy. In addition, Dr. Wahls has secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain and now pedals her bike to work each day.
She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles (paperback), and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Learn more about the current study Efficacy of Diet on Quality of Life in Multiple Sclerosis. Pick up a one-page handout for the Wahls™ Diet. Follow her on Instagram @drterrywahls, and on Facebook/Twitter at @TerryWahls. Sign up to receive her weekly research updates.
More from the author:
The 5-Step Guide To Diagnose Your Gut Problems
Check out Rid Yourself Of Stomach Pain & Achieve Optimal Digestion
More from the author:
The 5-Step Guide To Diagnose Your Gut Problems
Check out Rid Yourself Of Stomach Pain & Achieve Optimal Digestion
![Terry Wahls, M.D. Terry Wahls, M.D.](https://mindbodygreen-res.cloudinary.com/image/upload/c_fill,g_auto,w_100,h_100,q_auto,f_auto,fl_lossy/usr/DrTerryWahlsNew.jpg)
Dr. Terry Wahls is an Institute for Functional Medicine Certified Practitioner and board-certified internal medicine physician. She conducts clinical trials, testing the efficacy of diet and lifestyle changes in the setting of autoimmunity.
In 2018 she was awarded the Institute for Functional Medicine’s Linus Pauling Award for her contributions in research, clinical care and patient advocacy. In addition, Dr. Wahls has secondary progressive multiple sclerosis, which confined her to a tilt-recline wheelchair for four years. Dr. Wahls restored her health using a diet and lifestyle program she designed specifically for her brain and now pedals her bike to work each day.
She is the author of The Wahls Protocol: How I Beat Progressive MS Using Paleo Principles and Functional Medicine, The Wahls Protocol: A Radical New Way to Treat All Chronic Autoimmune Conditions Using Paleo Principles (paperback), and the cookbook The Wahls Protocol Cooking for Life: The Revolutionary Modern Paleo Plan to Treat All Chronic Autoimmune Conditions. Learn more about the current study Efficacy of Diet on Quality of Life in Multiple Sclerosis. Pick up a one-page handout for the Wahls™ Diet. Follow her on Instagram @drterrywahls, and on Facebook/Twitter at @TerryWahls. Sign up to receive her weekly research updates.
9 Sources
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10243296/
- https://pubmed.ncbi.nlm.nih.gov/36257717/
- https://pubmed.ncbi.nlm.nih.gov/35807749/
- https://pubmed.ncbi.nlm.nih.gov/35855338/
- https://pubmed.ncbi.nlm.nih.gov/35418509/
- https://pubmed.ncbi.nlm.nih.gov/24476345/
- https://pubmed.ncbi.nlm.nih.gov/28394724/
- https://pubmed.ncbi.nlm.nih.gov/37148578/
- https://pubmed.ncbi.nlm.nih.gov/32213121/
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