Ketogenic Diet-Based Therapy for Fatigue in Patients with Multiple Sclerosis.

Ketogenic diet significantly reduced fatigue severity in MS patients after 3 months of treatment.

• Fatigue Severity Scale scores decreased from 5.18 ± 1.02 at baseline to 4.16 ± 0.98 at 3 months (p = 0.042)
• Study enrolled 16 non-obese patients with multiple sclerosis in a single-arm open-label interventional design
• Assessments were conducted at baseline (T0), 1 month (T1), and 3 months (T3)
• Participants were described as a 'strictly selected group' prescribed KD for three months

Ketogenic diet significantly reduced daytime sleepiness as measured by the Epworth Sleepiness Scale.

• Epworth Sleepiness Scale scores decreased from 8.46 ± 3.05 at baseline to 5.64 ± 2.46 at 3 months (p < 0.001)
• This was the most statistically significant improvement observed across all outcome measures
• Assessment was conducted at T0, T1, and T3 time points over the 3-month intervention

Ketogenic diet was associated with worsened sleep quality as measured by the Pittsburgh Sleep Quality Index.

• Pittsburgh Sleep Quality Index scores increased from 5.64 ± 3.53 at baseline to 7.62 ± 2.59 at 3 months (p = 0.009)
• Higher scores on the Pittsburgh Sleep Quality Index indicate poorer sleep quality
• This finding contrasts with the improvement seen in daytime somnolence

Ketogenic diet significantly reduced depression and anxiety symptoms in MS patients.

• Depression sub-scale of DASS-21 decreased from 6.15 ± 3.81 at baseline to 3.18 ± 2.93 at 3 months (p = 0.036)
• Anxiety sub-scale of DASS-21 decreased from 5.15 ± 4.10 at baseline to 1.55 ± 1.92 at 3 months (p = 0.019)
• Both depression and anxiety improvements were statistically significant after 3 months of KD
• Mood was listed among the frequently associated symptoms of MS fatigue evaluated in this study

Ketogenic diet improved the energy sub-scale of the Multiple Sclerosis Quality of Life-54 instrument.

• Energy sub-scale of MS Quality of Life-54 improved from 37.43 ± 14.26 at baseline to 52.49 ± 12.83 at 3 months (p = 0.042)
• Higher scores on this sub-scale indicate better perceived energy and quality of life
• This improvement was consistent with the observed reduction in fatigue severity

Low-grade inflammation and energetic dysfunction were proposed as the mechanistic rationale for applying ketogenic diet to MS-related fatigue.

• Fatigue is described as 'a frequent, disabling and difficult-to-treat symptom of multiple sclerosis'
• The ketogenic diet was selected for its 'anti-inflammatory and metabolic properties'
• Low-grade inflammation and energetic dysfunction were specifically cited as proposed mechanisms underlying MS fatigue pathogenesis

The study had a small sample size and non-randomized design, limiting the generalizability of findings.

• Only 16 patients were enrolled in the study
• The design was a single-arm open-label interventional study with no control group
• Patients were described as 'carefully selected' and 'strictly selected,' indicating a highly filtered population
• Authors concluded that 'larger randomized controlled studies are needed to confirm these preliminary results'