The keto diet is a popular topic among people with multiple sclerosis (MS), including many MyMSTeam members. The keto diet is high in fat and low in carbohydrates compared with a more balanced diet where carbohydrates, when broken down, are the main source of energy.
Research has shown potential benefits of the keto diet in improving MS symptoms, such as reducing fatigue and improving quality of life. However, although some people find their health improves while on the keto diet, others experience the opposite, such as worsening fatigue. For some, the benefits are enough to continue the diet, while others don’t see enough of a difference to make it worth it.
As with any diet that restricts certain food groups or limits one or more macronutrients like carbohydrates, there are risks. Diet affects people differently, and no one diet works for MS.
Read more details about the keto diet, its potential benefits and risks related to MS symptoms, and what MyMSTeam members who have tried the diet report about their experiences.
The ketogenic diet, also known as the keto diet, is a high-fat, low-carb diet. It’s called “ketogenic” because of the effect that low carbohydrate intake has on the body. When there aren’t enough carbohydrates available as an energy source, the body converts fats into molecules called ketones in a process called ketosis.
Usually, glucose that comes from the breakdown of carbohydrates is the main source of energy for the body. The American Dietary Guidelines recommend that carbohydrates make up the bulk of an adult’s diet (45 percent to 65 percent). On the keto diet, however, fats make up 55 percent to 60 percent of the diet, while carbohydrates make up only 5 percent to 10 percent. Ketones then become the main source of energy, as there are not enough carbohydrates to break down for energy.
The keto diet generally restricts starchy, carbohydrate-heavy, or sugary foods. This includes starchy vegetables like potatoes and beets as well as sugary fruits like bananas and pears.
There are different keto diets such as the classic keto diet, the medium-chain triglyceride diet, the modified Atkins diet, the low-glycemic-index treatment, and the modified ketogenic diet. You might have to try a few before deciding which one is best for you.
There are many online resources for what you can and can’t eat on the keto diet. Always check with your doctor or a nutritionist before beginning any diet, especially one as restrictive as keto. In addition, research on the keto diet and MS is limited, so keep in mind there are no guarantees it can reduce MS symptoms.
Although research suggests the keto diet has positive effects on MS, studies are limited in number, and the study populations are small or limited to animal models. Thus, there needs to be more research on the keto diet for people with MS, especially over the long term, to help establish the keto diet as a supplemental treatment for people with MS.
Diet alone can’t treat or slow MS progression. For this reason, if a diet were to be prescribed to help with MS symptoms, it would be alongside regular MS therapies, including disease-modifying therapies, medications to treat relapses, and medications to manage MS symptoms.
Nonetheless, positive findings from new research highlight the importance of continuing to investigate the potential benefits that a keto diet may have on reducing MS symptoms.
Recent research has suggested that the keto diet may benefit some people living with MS by reducing some MS symptoms. A highly cited 2022 clinical trial of 65 participants with relapsing MS found that after a six-month period on the keto diet, participants’ self-reported fatigue and depression decreased by approximately 50 percent. The same trial found that participants walked farther and faster on a six-minute walk, and their quality-of-life scores for both physical and mental health significantly increased.
Other studies have looked at the keto diet’s effect on disease progression. A 2021 clinical trial proposed to investigate whether a keto diet and fasting diet help slow MS progression. Although the results have not been published yet, the researchers stated that preclinical data suggest that a keto diet and fasting diet may influence immunity, promote remyelination, and reduce disease severity in mouse models of MS.
The potential benefits of the keto diet come from the effect of ketone bodies on the body, which have been shown to reduce oxidative stress and make inflammation less severe to improve immune cell function.
More generally, the keto diet has been studied for its effectiveness in treating autoimmune and neurological conditions. For example, the keto diet is sometimes used to treat epilepsy and is being studied for its effectiveness in treating some types of cancer.
Any restrictive diet has risks when followed over time. Some risks of being on a keto diet long term include:
Ketones can cause fatigue, which may worsen already present MS-related fatigue. In addition, constipation may worsen on the keto diet due to reduced fiber intake from restricting fiber-rich fruits, vegetables, and whole grains. Reduced intake of fruits, vegetables, and whole grains may also lead to deficiencies in important vitamins, minerals, antioxidants, and phytonutrients over time. In addition, keto diets are high in fat, especially saturated fat from animal products, which can increase the risk of heart disease because of the effects that saturated fats have on blood vessels and cholesterol.
The 2022 study that found significant improvements in MS fatigue and depression on a keto diet also found that most participants had some side effects on the diet. The most common side effect was constipation (43 percent), followed by diarrhea (18 percent), nausea (9 percent), weight gain (9 percent), fatigue (5 percent), anxiety and depression (5 percent), and acne (5 percent).
The drawbacks of following a keto diet, including risks of worsening already present conditions, emphasize the importance of making sure you have medical counsel and monitoring when trying the keto diet. In other words, a keto diet is not something to try on a whim. Speak with your neurologist if you are interested in seeing if the keto diet may help with your MS symptoms. They may be able to direct you to a nutrition specialist or a clinical trial to learn whether trying the keto diet may be right for you.
There is no one-size-fits-all approach when it comes to diets that are believed to have a positive impact on people with MS. Everyone is different, and no one diet fits everyone’s needs in managing MS symptoms. In fact, a diet may not help some people at all.
However, there is some evidence to suggest that, in addition to the keto diet, other diets like the Wahls Protocol and Swank diet may improve the quality of life of those living with MS.
The Wahls Protocol is based on the principles of the paleo diet and is focused on maximizing key nutrients for brain health. Like the keto diet, the Wahls Protocol also restricts grains. The Swank diet, however, encourages eating grains and, unlike the high-fat recommendations of keto, restricts saturated fats and red meat.
While the keto diet, Wahls protocol, and Swank diet are all different, there have been some similar findings on their impact on MS symptoms.
A 2021 study found that, on average, people with MS on either the Wahls Protocol or Swank diet experienced significant improvements in fatigue and their mental and physical quality of life. Participants on both diets saw improvements, but there were more recorded improvements on the Wahls Protocol.
Despite the positive results, this is a small sample size and there was no placebo group, so we can’t be certain that the diets helped or whether there was a placebo effect. Nonetheless, studies like these on the keto diet, Wahls Protocol, and Swank diet for people with MS highlight the potential impact that different ways of eating may have on MS symptoms. The key is finding the way of eating that makes you feel your best, and that may not turn out to be a popular diet.
MyMSTeam members’ perspectives are mixed on whether the keto diet helps them feel better. Some see a difference, while others do not.
Some members talk about their experience with keto and weight loss, which may or may not be wanted. One MyMSTeam member talked about the combination of dietary changes (keto diet and exercise) making them feel better: “I had lap-band surgery in 2013 and the weight loss plan included a keto diet. … It’s the diet and exercise that make you lose weight. And it definitely did the job. I lost 140 pounds. And I’ve kept off 120 of it since then and feel great. I’m still eating keto.” Another member had a more negative experience eating keto and losing weight: “I tried it but had difficulty staying on it, and it didn’t do anything for me. I lost weight that I couldn’t afford to lose, too.”
Some members report not feeling a difference from the keto diet. Some unwanted side effects were mentioned as well. As one MyMSTeam member wrote, “I’ve lost a lot of weight on lazy keto, and there are some delicious recipes out there. But I don’t feel any better or have any increased energy or strength.” Another said, “I did 90 days last year and really had no results. One thing they don’t tell you is that you will poop all the time. … I thought about trying again but still not sure.”
Sometimes, MyMSTeam members making dietary changes adapt the keto diet to make it work better for them. For example, some members report being on the keto diet but adapting it in some way, such as leaning more toward a paleo diet: “My daughter and I are both on the keto diet. However, I follow a more paleo diet, gluten-free. Basically, lots of vegetables, lean meat, fish, veggies, rice, etc. … I do feel a lot better when I avoid gluten, dairy, and sugar products.” Another said, “I think the main issue with keto would be the allowance of dairy. Dairy is inflammatory and always caused issues for me. If you could take the paleo parts of keto, I think it would be helpful.”
The experiences reported by MyMSTeam members highlight how the keto diet can be different for everyone. Always talk with your doctor or a dietitian first if you’re interested in trying the keto diet or another diet that may help with MS. Diets are not a treatment, but in combination with other management tips and with some adaptations, it could be that a certain diet makes you feel better in one way or another.
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