Scientific rationale
- Ketogenic diets may affect insulin sensitivity, adiposity, fatigue pathways, oxidative stress, and inflammatory signalling.
- Any dietary effect is layered on top of immunological disease biology, rehabilitation, sleep, mood, and medication.
Research snapshot
- Recent diet trials and meta-analyses suggest feasibility and possible benefits for fatigue, quality of life, body composition, and metabolic markers.
- Evidence is not sufficient to claim prevention of relapses, MRI activity, or disability progression.
Clinical frame
- Dietary work can be part of a broader lifestyle plan, but disease-modifying treatment decisions remain neurological decisions.
- Monitoring matters when patients have weight loss, lipid changes, bowel symptoms, pregnancy plans, or high training loads.
Open questions
- Which dietary pattern is most sustainable in relapsing and progressive MS?
- Can trials connect patient-reported benefits with MRI, immunological, and neurofilament outcomes?
Selected evidence
- Fasting, ketogenic, and anti-inflammatory diets in multiple sclerosis: final results of the NAMS trial Neurological Research and Practice, 2025
- Phase II study of ketogenic diets in relapsing multiple sclerosis Journal of Neurology, Neurosurgery & Psychiatry, 2022
- Dietary interventions in multiple sclerosis: a network meta-analysis PubMed record, 2024
- Serum neurofilament light chain in relapsing multiple sclerosis patients on a ketogenic diet Multiple Sclerosis Journal, 2023
- Impact of a ketogenic diet on sleep quality in people with relapsing multiple sclerosis Multiple Sclerosis and Related Disorders, 2024
- Ketogenic diet in modulating inflammation in multiple sclerosis: systematic review and meta-analysis Nutrients, 2025
- Exploring the ketogenic diet as adjunctive therapy in multiple sclerosis Nutrients, 2025