Diets improve health markers in MS, but don’t affect brain lesions
With keto diet or fasting, some benefits seen in cognition, depression
People with relapsing-remitting multiple sclerosis (RRMS) who started fasting or adopted a ketogenic diet — one low in carbs and rich in fat — for 18 months showed reductions in risk factors for heart and metabolic disease that were similar to those who followed a standard healthy diet, according to data from a clinical trial conducted in Germany.
“The results suggest beneficial effects of dietary interventions, underscoring their potential as a complementary strategy in the treatment of RRMS,” the researchers wrote.
However, sticking to these diets did not show any differences in the number of new brain lesions among patients, which was the trial’s main goal. The diets were tied to a stable disease course, the data showed.
But there were trends suggesting the ketogenic diet may support cognition, and fasting may ease symptoms of depression, according to the researchers.
The study, “Fasting, ketogenic, and anti-inflammatory diets in multiple sclerosis: a randomized controlled trial with 18-month follow-up,” was published in the journal BMC Nutrition.
While many patients are willing to incorporate dietary strategies into their care, no specific diet has yet been proven to slow disease progression in multiple sclerosis (MS).
For that reason, patients are usually advised to follow broad healthy eating guidelines — consuming plenty of fruits and vegetables, choosing whole grains and lean proteins, and limiting processed or sugary foods.
Fasting diets, which involve going without eating for several hours each day, and ketogenic diets, which cut down on carbohydrates and increase fat intake, are both believed to have anti-inflammatory effects. These diets have shown promising benefits in easing symptoms and improving quality of life in people with MS, but the evidence so far comes mainly from small studies and hasn’t been conclusive.
MS patients in trial assigned to 1 of 3 diets for 18 months
To learn more, a group of researchers from Berlin conducted a clinical trial — enrolling 105 adults with RRMS — that compared a fasting diet against a ketogenic diet and a standard healthy diet with anti-inflammatory properties.
The NAMS trial (NCT03508414), conducted at a single site in the country’s capital city, enrolled participants with active RRMS, who could continue to receive a stable dose of their disease-modifying therapy.
Over 18 months, participants were asked to follow their assigned diet and participate in 10 group sessions designed to encourage adherence, address any questions, and evaluate compliance:
- The standard healthy diet was based on German nutrition guidelines, encouraging mostly vegetarian meals and aiming for a healthy fat balance to help reduce inflammation.
- The fasting diet included a seven-day fast every six months, plus time-restricted eating on six days per week — 14 hours fasting and 10 hours eating. Participants otherwise followed the standard diet.
- The ketogenic diet limited carbohydrate intake to 20-40 grams per day while increasing fat consumption to about 70% to 80% of daily calories, mainly from plant-based sources.
After 18 months, none of the diets met the trial’s main goal of reducing the number of new brain lesions, or areas of tissue damage, the data showed. Further, no meaningful differences were seen in lesion volume.
Still, the researchers noted that the lack of new lesions across all groups after 18 months represented a favorable result, especially because participants had active disease before joining the study. Nearly half of the participants, however, were on stable DMT, which may have helped suppress new disease activity, the team noted.
Healthy eating lowered patient risk factors for heart, metabolic diseases
While the trial failed to meet its main goal, several secondary outcomes showed encouraging effects. For example, people on the fasting diet reported slight improvements in depressive symptoms after 18 months compared with people on the standard diet. Also, cognitive processing speed improved slightly in the fasting group and had a more noticeable increase in the ketogenic group, while remaining unchanged in the standard diet group.
Though in different ways, all of the diets lowered participants’ risk factors for heart and metabolic diseases. Such risk factors included body weight, body fat, certain blood fats, and blood pressure — all of which have been linked to worse disease outcomes, the researchers noted.
Overall, the findings suggest beneficial effects of dietary interventions, supporting their potential role as complementary strategies in the management of RRMS.
Hormone levels also shifted in a healthier direction, the data showed. Leptin, usually elevated in MS and associated with more severe disability, dropped in the ketogenic group, while adiponectin, which helps protect against inflammation, rose in both the ketogenic and fasting groups.
No nutrient deficiencies were observed, and all diets were safe and well tolerated, with side effects mostly mild and transient. No serious health events were linked to the interventions.
“Overall, the findings suggest beneficial effects of dietary interventions, supporting their potential role as complementary strategies in the management of RRMS,” the researchers wrote. “These results warrant further investigation in larger and more homogeneous study populations to allow for definitive conclusions.”
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