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The Keto Diet and MS

Medically Reviewed by Melinda Ratini, DO, MS on April 13, 2022

The ketogenic diet, or keto, is a popular low-carb and high-fat way to lose weight. Researchers are studying the effects of keto on neurological diseases such as epilepsy, Alzheimer’s, Parkinson’s, and traumatic brain injury. Studies have shown promising results for these diseases. It may also be a safe and effective way to help manage multiple sclerosis (MS), with your doctor’s guidance.

What Is the Link Between MS and Keto?

MS is a chronic neurological disease that attacks your nerves and causes inflammation in your brain. A fatty substance called myelin protects your nerve fibers. MS causes your immune system to damage myelin. This process, called demyelination, slows down your nerve impulses. Sometimes MS also destroys the nerves themselves.

Early research shows that chemicals called ketones may help restore damaged nerves, regenerate myelin, and lower inflammation. The keto diet boosts the production of ketones by changing your body’s energy source. Normally, your body burns glucose that it gets from carbs, and converts the extra to stored sugar called glycogen.

When you cut out carbs and your body runs out of glycogen to burn, it switches over to burning stored fat. The process of burning fat without carbs triggers your body to produce ketones, which circulate throughout your body in your bloodstream. Other low-carb diets like Zone, Atkins, and South Beach work like keto by cutting carbs and raising the amount of protein and fats you eat.

Research suggests several ways ketones may work in the brain and body:

Battle oxidative stress. Oxidative stress happens when your body has lots of unstable free radicals, molecules that are toxic at high levels, and not enough antioxidants to keep them stable. This kind of imbalance is common in MS. In a small study of people with progressive MS, researchers found that antioxidants slowed down brain tissue loss. Ketones act as antioxidants by slowing down production of free radicals, activating the body’s antioxidant pathways, and directly scavenging these harmful molecules.

Raise fuel efficiency. Keto offers your body a richer fuel supply, since fat is much more energy-rich than glucose. That’s important for your cells’ mitochondria, which produce energy. Researchers believe that neurological diseases like MS happen when there is poor energy production in the mitochondria, or if they are damaged. Defective mitochondria can also make the body worse at processing glucose, and the keto diet provides another source of fuel.

Lower inflammation. Keto may ease inflammation, though how it does this is complex and not totally understood. It may reduce free radicals, which can cause inflammation. It may also turn off inflammatory genes. Keto also reduces the amount of leptin in the blood. Leptin raises inflammation and is often high in people with MS.

Heal nerve impulses in the brain. In addition to helping the body renew myelin, keto may restore healthy nerve impulses by balancing out molecules in the brain called neurotransmitters. It’s thought that in neurological diseases, there’s too much of one of these molecules, glutamate, in the spaces between brain cells. This can be toxic. By helping mitochondria work better, keto may help the body keep the right balance of glutamate.

Trigger the body’s “spring cleaning.” Another study shows that the keto diet may trigger a process called autophagy. During autophagy, the body breaks down and gets rid of old damaged cells, making room for new healthy ones. Autophagy also helps to destroy bacteria and viruses, and may even stop cells from becoming cancer cells. And autophagy may even strengthen your body’s immune system against viruses, bacteria, and cancer cells.

What Are Other Possible Benefits of the Keto Diet?

If you have MS, you may struggle with health problems related to the disease. Obesity, for example, may raise the risk of multiple sclerosis. Clinical depression, the most severe form of depression, is common in people with MS. And 80% of people with MS wrestle with crippling fatigue.

Research shows that the keto diet may improve many of these common MS symptoms. In fact, one study of 65 patients with relapsing MS shows keto improved overall wellness and disability. The study concludes with a list of the following benefits:

  • Weight loss
  • Less tiredness
  • Less depression
  • Improved physical and mental quality of life
  • Improved endurance during a short walk
  • Ability to complete a motor skills test more quickly

In early studies, scientists have also seen:

  • Improved motor function
  • Improved spatial learning and memory
  • Increased volume of the hippocampus, an area of the brain that typically shrinks with age
  • Renewed myelin

What Should You Watch Out For?

Tiredness. For people with MS who already have fatigue, a keto diet may seem less than ideal. Research shows that higher ketone levels cause fatigue, but studies show that this fatigue is worse at first and often improves over time.

Weaker bones. Research shows that people with MS have a higher risk of having osteoporosis and breaking bones. The keto diet contains relatively little calcium. Talk with your doctor about making sure you’re still getting enough calcium.

Trouble pooping. People with MS may get chronic constipation and need a diet rich in fiber to help manage it. The keto diet can be low in fiber and may make chronic constipation worse. Make sure you are eating plenty of low-carb vegetables, which are allowed and important for a healthy keto diet. This includes broccoli, asparagus, mushrooms, spinach, avocado, and green beans. Many of these have the added benefit of lowering inflammation.

Is Keto Right for Your MS?

In some people, the ketogenic way of eating improves symptoms and may lower the need for medication. But researchers are still studying the long-term effects of the keto diet on people with MS. Talk to your doctor if you’re considering it.

One early study shows that over time, keto can lead to anemia (low red blood cells) and increase your blood’s acid level. It can also raise the oxidant levels in your liver and the fat in your kidneys, causing damage to both organs.

Your best bet is to discuss the keto diet with your health care provider and work on a meal plan together.

Show Sources

SOURCES:

American Academy of Neurology: “Ketogenic Diet as a Strategy for Improved Wellness and Reduced Disability in Relapsing Multiple Sclerosis.”

Antioxidants: “Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease.”

Cleveland Clinic: “Adiponectin.”

CNS Drugs: “Osteoporosis and Multiple Sclerosis: Risk Factors, Pathophysiology, and Therapeutic Interventions.”

Epilepsia: “Ketosis and Brain Handling of Glutamate, Glutamine, and GABA.”

Frontiers in Neurology: “Ketone Bodies in Neurological Diseases: Focus on Neuroprotection and Underlying Mechanisms.”

Harvard University: “Diet Review: Ketogenic Diet for Weight Loss,” “Foods That Fight Inflammation,” “Should You Try the Keto Diet?”

International Journal of Biomedical Science: “Free Radicals, Antioxidants in Disease and Health.”

Journal of Nutrition and Metabolism: “Long-Term Ketogenic Diet Induces Metabolic Acidosis, Anemia, and Oxidative Stress in Healthy Wistar Rats.”

The Lancet Neurology: “Mechanisms of Glutamate Toxicity in Multiple Sclerosis: Biomarker and Therapeutic Opportunities.”

Mayo Clinic: “Atkins Diet: What's Behind the Claims?” “Demyelinating Disease: What Can You Do About It?”

Multiple Sclerosis International: “The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis.”

Multiple Sclerosis Journal: “Leptin Levels are Associated with Multiple Sclerosis Risk.”

National Cancer Institute: “Autophagy.”

National Multiple Sclerosis Society: “Antioxidant Lipoic Acid Reduces Brain Tissue Loss in Small Trial Involving People with Secondary-Progressive MS,” “MS Signs & Symptoms,” “The Lowdown on Low Carb,” “What is Myelin?”

Neurology: Neuroimmunology & Neuroinflammation: “Pilot Study of a Ketogenic Diet in Relapsing-Remitting MS.”

PLOS Medicine: “Obesity and Multiple Sclerosis: A Mendelian Randomization Study.”

Preventive Nutrition and Food Science: “Antioxidant and Anti-inflammatory Activities of Broccoli Florets in LPS-stimulated RAW 264.7 Cells.”

Trials: “Ketogenic Diet and Fasting Diet as Nutritional Approaches in Multiple Sclerosis (NAMS): Protocol of a Randomized Controlled Study.”

University of California, San Francisco: “How Ketogenic Diets Curb Inflammation in the Brain.”

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