Multiple Sclerosis News TodayACTRIMS 2025: Ketogenic Diet Alters Immune Cell Function

This preliminary report presents findings from a Phase 2 trial (NCT03718247) examining the effects of a modified Atkins diet (MAD), a less restrictive ketogenic approach, on immune cell function in stable relapsing-remitting MS patients. The 6-month intervention showed measurable changes in immune cell populations and metabolic profiles, suggesting dietary modification may influence disease-relevant immunological parameters.

Key Clinical Considerations

• The modified Atkins diet led to shifts toward anti-inflammatory immune profiles, including reduced pro-inflammatory gene expression in myeloid cells and increased regulatory T-cell activity
• Metabolic changes in immune cells showed a transition from glycolysis (sugar metabolism) to fatty acid oxidation, potentially altering immune cell activation states
• Previous trial results indicated improvements in physical function, quality of life, fatigue, and depression scores among the 65 participants (ages 12-55)
• The trial enrolled only stable RRMS patients, limiting generalizability to more active disease or progressive MS forms
• Long-term safety of ketogenic diets in MS patients remains unestablished, a critical consideration for clinical recommendations

Clinical Practice Impact

• Patient Communication: When discussing dietary interventions, emphasize that evidence for immune-modulating effects exists but clinical outcomes remain uncertain. Frame MAD as a potential adjunctive approach rather than a primary therapy, noting the commitment required for dietary adherence.
• Practice Integration: Consider screening appropriate stable RRMS patients for dietary modification interest, particularly those reporting fatigue, depression, or reduced quality of life. Provide proper metabolic monitoring if implementing ketogenic approaches.
• Risk Management: Monitor liver function, lipid profiles, and nutritional status in patients attempting ketogenic diets. Ensure patients maintain their disease-modifying therapies while exploring dietary interventions.
• Action Items: Develop educational materials explaining the potential benefits and limitations of ketogenic approaches in MS. Establish collaboration with registered dietitians for proper implementation support.

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