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Neurological Disorders

This review by Pietrzak et al. provides an excellent review of the role of the ketogenic diet in neurological disorders encompassing the topics in this section.

  • Epilepsy
    • Epilepsy – Adults
    • Epilepsy – Children and Infants
    • Syndromes with Epilepsy and Other Features
    • Status Epilepticus
  • Neurodevelopmental 
    • Autism Spectrum Disorder
    • Areas of Overlap between ASD, ADHD, and Epilepsy
    • ADHD – Attention Deficit Hyperactivity Disorder
    • Mitochondrial Diseases
  • Neurodegenerative
    • Reviews
    • Trials/Studies
    • Case Studies
    • Alzheimer’s Disease
    • Amyotrophic Lateral Sclerosis (ALS)
    • Parkinson’s Disease
    • Multiple Sclerosis
    • Media Links
  • Neurology – Other 
    • Brain Injury/Neurotrauma
    • Migraine/Headache
    • Media Links

Epilepsy

  1. Liu H, Yang Y, Wang Y, et al. Ketogenic diet for treatment of intractable epilepsy in adults: A meta-analysis of observational studies. Epilepsia Open. 2018;3(1):9-17. doi:10.1002/epi4.12098 
  2. van Berkel AA, IJff DM, Verkuyl JM. Cognitive benefits of the ketogenic diet in patients with epilepsy: A systematic overview. Epilepsy Behav. 2018;87:69-77. doi:10.1016/j.yebeh.2018.06.004 
  3. Ye F, Li X-J, Jiang W-L, Sun H-B, Liu J. Efficacy of and Patient Compliance with a Ketogenic Diet in Adults with Intractable Epilepsy: A Meta-Analysis. Journal of Clinical Neurology. 2015;11(1):26-31. doi:10.3988/jcn.2015.11.1.26 
  4. Nei M, Ngo L, Sirven JI, Sperling MR. Ketogenic diet in adolescents and adults with epilepsy. Seizure – European Journal of Epilepsy. 2014;23(6):439-442. doi:10.1016/j.seizure.2014.02.015 
  5. Shah LM, Turner Z, Bessone SK, Winesett SP, Stanfield A, Kossoff EH. How often is antiseizure drug-free ketogenic diet therapy achieved? Epilepsy Behav. 2019;93:29-31.  doi:10.1016/j.yebeh.2019.01.042 
  6. Sadeghifar F, Penry VB. Mechanisms and Uses of Dietary Therapy as a Teatment for Epilepsy: A Review. Glob Adv Health Med. 2019;8. doi:10.1177/2164956119874784 
  7. Wells J, Swaminathan A, Paseka J, Hanson C. Efficacy and Safety of a Ketogenic Diet in Children and Adolescents with Refractory Epilepsy—A Review. Nutrients. 2020;12(6):1809. doi:10.3390/nu12061809
  8. Zarnowska IM. Therapeutic Use of the Ketogenic Diet in Refractory Epilepsy: What We Know and What Still Needs to Be Learned. Nutrients. 2020;12(9):2616. doi:10.3390/nu12092616
  9. Verrotti A, Iapadre G, Di Francesco L, Zagaroli L, Farello G. Diet in the Treatment of Epilepsy: What We Know So Far. Nutrients. 2020;12(9):2645. doi:10.3390/nu12092645
  10. Hettiarachchi D, Lakmal K, Dissanayake VHW. A Concise Review of Ketogenic Dietary Interventions in the Management of Rare Diseases. Journal of Nutrition and Metabolism. doi:https://doi.org/10.1155/2021/6685581
  11. Felton EA, Henry-Barron BJ, Jan AK, et al. The Feasibility and Tolerability of Medium Chain Triglycerides in Women with a Catamenial Seizure Pattern on the Modified Atkins Diet. Nutrients. 2021;13(7):2261. doi:10.3390/nu13072261
  12. Husari KS, Cervenka MC. Ketogenic Diet Therapy for the Treatment of Post-encephalitic and Autoimmune-Associated Epilepsies. Front Neurol. 2021;12:624202. doi:10.3389/fneur.2021.624202
  13. Natasha E Schoeler, M.O. (2021) ‘K.Vita: a feasibility study of a blend of medium chain triglycerides to manage drug-resistant epilepsy’, Brain Communications, 3(4). doi:10.1093/braincomms/fcab160.
  14. Louw EJTM van der, Williams TJ, Henry-Barron BJ, et al. Ketogenic diet therapy for epilepsy during pregnancy: A case series. Seizure – European Journal of Epilepsy. 2017;45:198-201. doi:10.1016/j.seizure.2016.12.019
  15. Han FY, Conboy-Schmidt L, Rybachuk G, et al. Dietary medium chain triglycerides for management of epilepsy: New data from human, dog, and rodent studies. Epilepsia. n/a(n/a). doi:10.1111/epi.16972

Epilepsy - Children and Infants

  1. Sourbron J, Klinkenberg S, van Kuijk SMJ, et al. Ketogenic diet for the treatment of pediatric epilepsy: review and meta-analysis. Childs Nerv Syst. Published online March 16, 2020. doi:10.1007/s00381-020-04578-7
  2. Lyons L, Schoeler NE, Langan D, Cross JH. Use of ketogenic diet therapy in infants with epilepsy: A systematic review and meta-analysis. Epilepsia. n/a(n/a). doi:10.1111/epi.16543
  3. Liu XY, Chen J, Zhu M, et al. Three and Six Months of Ketogenic Diet for Intractable Childhood Epilepsy: A Systematic Review and Meta-Analysis. Front Neurol. 2019;10:244. doi:10.3389/fneur.2019.00244 
  4. Cai Q-Y, Zhou Z-J, Luo R, et al. Safety and tolerability of the ketogenic diet used for the treatment of refractory childhood epilepsy: a systematic review of published prospective studies. World J Pediatr. 2017;13(6):528-536. doi:10.1007/s12519-017-0053-2 
  5. Kim SH, Shaw A, Blackford R, et al. The ketogenic diet in children 3 years of age or younger: A 10-year single-center experience. Scientific Reports. 2019;9(1):8736. doi:10.1038/s41598-019-45147-6
  6. Luz IR, Pereira C, Garcia P, et al. Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre. Acta Médica Portuguesa. 2019;32(12):760-766. doi:10.20344/amp.12184  PDF
  7. Dressler A, Trimmel-Schwahofer P. The ketogenic diet for infants: How long can you go? Epilepsy Res. 2020;164:106339. doi:10.1016/j.eplepsyres.2020.106339 ABSTRACT
  8. Wirrell E, Eckert S, Wong-Kisiel L, Payne E, Nickels K. Ketogenic Diet Therapy in Infants: Efficacy and Tolerability. Pediatr Neurol. 2018;82:13-18. doi:10.1016/j.pediatrneurol.2017.10.018
  9. Sharma S, Goel S, Kapoor D, et al. Evaluation of the Modified Atkins Diet for the Treatment of Epileptic Spasms Refractory to Hormonal Therapy: A Randomized Controlled Trial. J Child Neurol. Published online April 9, 2021:8830738211004747. doi:10.1177/08830738211004747
  10. Gogou, M., Pujar, S., Nemani, T., Chiang, C., Simpson, Z., Hardy, I., Schoeler, N., Cross, J.H., Eltze, C., 2022. Antiseizure medication reduction and withdrawal in children with drug-resistant epilepsy after starting the ketogenic diet. Dev Med Child Neurol. doi.org/10.1111/dmcn.15377 (younger starting age a/w more success)
  11. Zhang J, Chen G, Wang J, et al. Efficacy of the ketogenic diet on ACTH- or corticosteroid-resistant infantile spasm: a multicentre prospective control study. Epileptic Disord. Published online March 26, 2021. doi:10.1684/epd.2021.1256
  12. Ruiz-Herrero J, Cañedo-Villarroya E, Pérez-Sebastián I, Bernardino-Cuesta B, Pedrón-Giner C. Efficacy and safety of ketogenic dietary theraphies in infancy. A single-center experience in 42 infants less than two years of age. Seizure. 2021;92:106-111. doi:10.1016/j.seizure.2021.08.018
  13. Lin K-L, Lin J-J, Wang H-S. Application of ketogenic diets for pediatric neurocritical care. Biomedical Journal. Published online July 5, 2020. doi:10.1016/j.bj.2020.02.002
  14. Singh RK, Joshi SM, Potter DM, Leber SM, Carlson MD, Shellhaas RA. Cognitive outcomes in febrile infection-related epilepsy syndrome treated with the ketogenic diet. Pediatrics. 2014;134(5):e1431-1435. doi:10.1542/peds.2013-3106
  15. García-Peñas JJ. S.L.U 2021 Viguera Editores. Epilepsy, cognition, and the ketogenic diet: Neurología.com. doi:10.33588/rn.66S01.2017529
  16. Yang R, Wen J, Wei W, et al. Improving the effects of ketogenic diet therapy in children with drug-resistant epilepsy. Seizure. Published online October 30, 2021. doi:10.1016/j.seizure.2021.10.021
  17. Samia, P. et al. (2021) ‘Qualitative exploration of feasibility and acceptability of the modified ketogenic dietary therapy for children with drug-resistant epilepsy in Kenya’, Epilepsy & Behavior, 125. doi:10.1016/j.yebeh.2021.108362. (under-resourced)

Breastfeeding Infants

  1. Le Pichon JB, Thompson L, Gustafson M, Abdelmoity A. Initiating the ketogenic diet in infants with treatment refractory epilepsy while maintaining a breast milk diet. Seizure. 2019;69:41-43. doi:10.1016/j.seizure.2019.03.017 
  2. Tan-Smith C, Little H, Fabe J, Dickson C, Shillito P. Increase of Human Milk Fat Inducing Nutritional Ketosis in Exclusively Breastfed Infant, Brought About by Treating the Mother With Ketogenic Dietary Therapy. J Hum Lact. Published online October 5, 2021:8903344211048422. doi:10.1177/08903344211048422 ABSTRACT

Caution – there are several reports of lactation ketoacidosis occuring in the literature (see Possible Complications). For a prudent interpretation of the literature regarding breastfeeding, the link below to Dr. Andreas Eenfeldt – Diet Doctor, may be helpful – Breastfeeding on a low-carb diet – is it dangerous? Diet Doctor. 

Potential Complications/Growth

  1. Mir A, Albaradie R, Alamri A, et al. Incidence of potential adverse events during hospital‐based ketogenic diet initiation among children with drug‐resistant epilepsy. Epilepsia Open. 2020;5(4):596-604. doi:10.1002/epi4.12442 
  2. Ferraris C, Guglielmetti M, Pasca L, et al. Impact of the Ketogenic Diet on Linear Growth in Children: A Single-Center Retrospective Analysis of 34 Cases. Nutrients. 2019;11(7). doi:10.3390/nu11071442
  3. Liu Y, Wan J, Gao Z, Xu L, Kong L. Ketogenic diet and growth in Chinese infants with refractory epilepsy. Asia Pac J Clin Nutr. 2021;30(1):113-121. doi:10.6133/apjcn.202103_30(1).0014 ABSTRACT
  4. Yılmaz Ü, Nalbantoğlu Ö, Güzin Y, et al. The effect of ketogenic diet on thyroid functions in children with drug-resistant epilepsy. Neurol Sci. Published online April 12, 2021. doi:10.1007/s10072-021-05225-y ABSTRACT
  5. Santiworakul C, Chomtho K, Chomtho S. Growth and nutritional status of pediatric patients treated with the ketogenic diet. Asia Pac J Clin Nutr. 2021;30(2):231-237. doi:10.6133/apjcn.202106_30(2).0007 ABSTRACT

Status Epilepticus

  1. Schoeler NE, Simpson Z, Zhou R, Pujar S, Eltze C, Cross JH. Dietary Management of Children With Super-Refractory Status Epilepticus: A Systematic Review and Experience in a Single UK Tertiary Centre. Front Neurol. 2021;12. doi:10.3389/fneur.2021.643105
  2. Mahmoud SH, Ho‐Huang E, Buhler J. Systematic review of ketogenic diet use in adult patients with status epilepticus. Epilepsia Open. 2020;5(1):10-21. doi:10.1002/epi4.12370
  3. Williams TJ, Cervenka MC. The role for ketogenic diets in epilepsy and status epilepticus in adults. Clin Neurophysiol Pract. 2017;2:154-160. doi:10.1016/j.cnp.2017.06.001
  4. Katz JB, Owusu K, Nussbaum I, et al. Pearls and Pitfalls of Introducing Ketogenic Diet in Adult Status Epilepticus: A Practical Guide for the Intensivist. Journal of Clinical Medicine. 2021;10(4):881. doi:10.3390/jcm10040881
  5. Noviawaty I, Olaru E, Rondello C, Fitzsimmons B, Raghavan M. Clinical Reasoning: Ketogenic diet in adult super-refractory status epilepticus. Neurology. Published online February 27, 2020:10.1212/WNL.0000000000009137. doi:10.1212/WNL.0000000000009137
  6. Anand S, Vibhute AS, Das A, Pandey S, Paliwal VK. Ketogenic Diet for Super-refractory Status Epilepticus: A Case Series and Review of Literature. Ann Indian Acad Neurol. 2021;24(1):111-115. doi:10.4103/aian.AIAN_170_20
  7. Allen CM, Hall CA, Cox NE, Ryan H, De Beer T, O’Donoghue MF. Adjunctive use of the ketogenic diet in a young adult with UBE2A deficiency syndrome and super refractory status epilepticus. Epilepsy & Behavior Reports. Published online May 7, 2021:100456. doi:10.1016/j.ebr.2021.100456

Neurodevelopmental

  1. Dipti Kapoor DG. Emerging Role of the Ketogenic Dietary Therapies beyond Epilepsy in Child Neurology. Annals of Indian Academy of Neurology. 2021;24(4):470. doi:10.4103/aian.AIAN_20_21
  2. Oyarzabal A  a , Musokhranova Ua , Barros LFb , García-Cazorla A. Energy metabolism in childhood neurodevelopmental disorders. EBioMedicine. 2021;69. doi:10.1016/j.ebiom.2021.103474 
  3. Zhu DN, Li P, Wang J, et al. [Prospective study of ketogenic diet in treatment of children with global developmental delay]. Chinese Journal of Contemporary Pediatrics. 2017;19(10):1038. doi:10.7499/j.issn.1008-8830.2017.10.002
  4. Staretz-Chacham O, Pode-Shakked B, Kristal E, et al. The Effects of a Ketogenic Diet on Patients with Dihydrolipoamide Dehydrogenase Deficiency. Nutrients. 2021;13(10):3523. doi:10.3390/nu13103523 
  5. Maiorana A, Caviglia S, Greco B, et al. Ketogenic diet as elective treatment in patients with drug-unresponsive hyperinsulinemic hypoglycemia caused by glucokinase mutations. Orphanet J Rare Dis. 2021;16(1):424. doi:10.1186/s13023-021-02045-3
  6. Delaunay-Vagliasindi S, Seneff S, Coro S & Campbell-McBride N (2021) GAPS Nutritional Protocol as a treatment for PANDAS: A case study. J Orthomol Med. 36(3) 
  7. Madhoun AA, Alnaser F, Melhem M, Nizam R, Al-Dabbous T, Al-Mulla F. Ketogenic diet attenuates cerebellar atrophy progression in a subject with a biallelic variant at the ATAD3A locus. The Application of Clinical Genetics. doi:10.2147/TACG.S194204 
  8. Ünalp, A., Köse, M., Karaoğlu, P., Güzin, Y., Yılmaz, Ü., 2022. A rare case of hypomyelinating leukodystrophy-14 benefiting from ketogenic diet therapy. Turk J Pediatr 64, 747–753. doi.org/10.24953/turkjped.2021.1662
  9. Inui T, Wada Y, Shibuya M, et al. Intravenous ketogenic diet therapy for neonatal-onset pyruvate dehydrogenase complex deficiency. Brain Dev. Published online December 1, 2021:S0387-7604(21)00210-2. doi:10.1016/j.braindev.2021.11.005 ABSTRACT
  10.  

The evidence base for therapeutic carbohydrate restriction in ASD and ADHD is currently weak but lines of evidence from epilepsy and mitochondrial disease studies, mechanisms, and co-morbidity between conditions, point to a potential benefit of a TCR approach.

Autism Spectrum Disorder

‘At present, there is strong evidence that mitochondrial and metabolic dysfunction may underlie the complex pathophysiology of ASD’ Cheng et al

  1. Castro K, Faccioli LS, Baronio D, Gottfried C, Perry IS, dos Santos Riesgo R. Effect of a ketogenic diet on autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders. 2015;20:31-38. doi:10.1016/j.rasd.2015.08.005 ABSTRACT
  2. Lee RWY, Corley MJ, Pang A, et al. A modified ketogenic gluten-free diet with MCT improves behavior in children with autism spectrum disorder. Physiol Behav. 2018;188:205-211. doi:10.1016/j.physbeh.2018.02.006   PDF 
  3. Varesio C, Grumi S, Zanaboni MP, et al. Ketogenic Dietary Therapies in Patients with Autism Spectrum Disorder: Facts or Fads? A Scoping Review and a Proposal for a Shared Protocol. Nutrients. 2021;13(6):2057. doi:10.3390/nu13062057
  4. Li Q, Liang J, Fu N, Han Y, Qin J. A Ketogenic Diet and the Treatment of Autism Spectrum Disorder. Front Pediatr. 2021;9. doi:10.3389/fped.2021.650624
  5. El-Rashidy O, El-Baz F, El-Gendy Y, Khalaf R, Reda D, Saad K. Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metab Brain Dis. 2017;32(6):1935-1941. doi:10.1007/s11011-017-0088-z   PDF
  6. Frye RE. Mitochondrial Dysfunction in Autism Spectrum Disorder: Unique Abnormalities and Targeted Treatments. Seminars in Pediatric Neurology. 2020;35:100829. doi:10.1016/j.spen.2020.100829
  7. Żarnowska I, Chrapko B, Gwizda G, Nocuń A, Mitosek-Szewczyk K, Gasior M. Therapeutic use of carbohydrate-restricted diets in an autistic child; a case report of clinical and 18FDG PET findings. Metab Brain Dis. 2018;33(4):1187-1192. doi:10.1007/s11011-018-0219-1
  8. Evangeliou A, Vlachonikolis I, Mihailidou H, et al. Application of a Ketogenic Diet in Children With Autistic Behavior: Pilot Study. J Child Neurol. 2003;18(2):113-118. doi:10.1177/08830738030180020501 ABSTRACT 
  9. Herbert MR, Buckley JA. Autism and Dietary Therapy: Case Report and Review of the Literature. J Child Neurol. 2013;28(8):975-982. doi:10.1177/0883073813488668 ABSTRACT
  10. Kawicka A, Regulska-Ilow B. How nutritional status, diet and dietary supplements can affect autism. A review. Rocz Panstw Zakl Hig. 2013;64(1):1-12. PMID: 23789306   PDF
  11. Napoli E, Dueñas N, Giulivi C. Potential Therapeutic Use of the Ketogenic Diet in Autism Spectrum Disorders. Front Pediatr. 2014;2. doi:10.3389/fped.2014.00069
  12. Âbele S, Meija L, Folkmanis V, Tzivian L. Specific Carbohydrate Diet (SCD/GAPS) and Dietary Supplements for Children with Autistic Spectrum Disorder – PROCEEDINGS OF THE LATVIAN ACADEMY OF SCIENCES. Section B,Vol. 75 (2021), No. 6 (735), pp. 417–425.ProQuest (2021). doi: 10.2478/prolas-2021-0062
  13. Manco M, Guerrera S, Ravà L, et al. Cross-sectional investigation of insulin resistance in youths with autism spectrum disorder. Any role for reduced brain glucose metabolism? Translational Psychiatry. 2021;11(1):1-8. doi:10.1038/s41398-021-01345-3
  14. Chieh AY, Bryant BM, Kim JW, Li L. Systematic review investigating the relationship between autism spectrum disorder and metabolic dysfunction. Research in Autism Spectrum Disorders. 2021;86:101821. doi:10.1016/j.rasd.2021.101821 ABSTRACT
  15. Cannon Homaei, S. et al. (2021) ‘ADHD symptoms in neurometabolic diseases: Underlying mechanisms and clinical implications’, Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2021.11.012
  16. AlQassmi, A., AlOtiabi, M. and AlRabeeah, F. (2021) ‘A Case Report: An Approach to Recognize a Role in Ketogenic Diet Response in Autism with Positive CHD8’, Recent Developments in Medicine and Medical Research Vol. 9, pp. 17–22. doi:10.9734/bpi/rdmmr/v9/4654F. ABSTRACT

Areas of Overlap between ASD, ADHD, and Epilepsy

ASD and ADHD can be co-morbid. They share common features in presentation and pathophysiology that include mitochondrial dysfunctions, genetics, and the microbiome.  Allergies, food sensitivities, and fussy eating are common. The Gluten-free/Casein-free dietary approach is used in both  ASD and ADHD with some success (see 1. and 2. below). When compared to the gluten-free casein-free diet, the ketogenic diet showed additional benefits (see 3. below).

  1. Ly V, Bottelier M, Hoekstra PJ, Arias Vasquez A, Buitelaar JK, Rommelse NN. Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2017;26(9):1067-1079. doi:10.1007/s00787-017-0959-1
  2. Alamri ES. Efficacy of gluten- and casein-free diets on autism spectrum disorders in children. Saudi Med J. 2020;41(10):1041-1046. doi:10.15537/smj.2020.10.25308
  3. El-Rashidy O, El-Baz F, El-Gendy Y, Khalaf R, Reda D, Saad K. Ketogenic diet versus gluten free casein free diet in autistic children: a case-control study. Metab Brain Dis. 2017;32(6):1935-1941. doi:10.1007/s11011-017-0088-z   PDF 

Behavioural improvements seen in epilepsy (can be co-morbid) and ASD patients indicate that further research investigating the impact of a ketogenic diet on behaviour in ADHD may be warranted.

  1. IJff DM, Postulart D, Lambrechts DAJE, et al. Cognitive and behavioral impact of the ketogenic diet in children and adolescents with refractory epilepsy: A randomized controlled trial. Epilepsy Behav. 2016;60:153-157. doi:10.1016/j.yebeh.2016.04.033 ABSTRACT
  2. Luz IR, Pereira C, Garcia P, et al. Ketogenic Diet for Refractory Childhood Epilepsy: Beyond Seizures Control, the Experience of a Portuguese Pediatric Centre. Acta Médica Portuguesa. 2019;32(12):760-766. doi:10.20344/amp.12184  PDF

ADHD - Attention Deficit Hyperactivity Disorder

There are a significant number of diet related studies for ADHD that lack consensus. Variations in the dietary approaches yield mixed results. Though none specifically use a low-carbohydrate approach, common themes include exclusion protocols and/or the removal of sugars/gluten/casein(dairy) which has many features in common with the therapeutic carbohydrate restriction approach. 

Some of these results may also be influenced by different causal subtypes of ADHD where food choices may affect some more than others. 

The totality of evidence suggests the potential benefits of an elimination diet (e.g. the few foods or oligoantigenic diet) in ADHD . With any dietary approach, nutritional sufficiency and the exclusion of ultra-processed food should be considered the first step.

  1. Pelsser LM, Frankena K, Toorman J, Pereira RR. Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLOS ONE. 2017;12(1):e0169277. doi:10.1371/journal.pone.0169277
  2. San Mauro Martin I, Sanz Rojo S, González Cosano L, Conty de la Campa R, Garicano Vilar E, Blumenfeld Olivares JA. Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: A randomised clinical trial. Neurologia (Engl Ed). Published online December 26, 2019:S0213-4853(19)30132-X. doi:10.1016/j.nrl.2019.09.007 
  3. Bosch A, Bierens M, de Wit AG, et al. A two arm randomized controlled trial comparing the short and long term effects of an elimination diet and a healthy diet in children with ADHD (TRACE study). Rationale, study design and methods. BMC Psychiatry. 2020;20(1):262. doi:10.1186/s12888-020-02576-2
  4. Pelsser LMJ, Frankena K, Toorman J, Savelkoul HFJ, Pereira RR, Buitelaar JK. A randomised controlled trial into the effects of food on ADHD. Eur Child Adolesc Psychiatry. 2009;18(1):12-19. doi:10.1007/s00787-008-0695-7  PDF 

Mitochondrial Disease

  1. Zweers H, van Wegberg AMJ, Janssen MCH, Wortmann SB. Ketogenic diet for mitochondrial disease: a systematic review on efficacy and safety. Orphanet Journal of Rare Diseases. 2021;16(1):295. doi:10.1186/s13023-021-01927-w
  2. Qu C, Keijer J, Adjobo-Hermans MJW, et al. The ketogenic diet as a therapeutic intervention strategy in mitochondrial disease. The International Journal of Biochemistry & Cell Biology. Published online July 21, 2021:106050. doi:10.1016/j.biocel.2021.106050
  3. Koňaříková E, Marković A, Korandová Z, Houštěk J, Mráček T. Current progress in the therapeutic options for mitochondrial disorders. Physiol Res. 2020 Nov 2. Epub ahead of print. PMID: 33129249.    PDF
  4. Huang, L., Li, H., Zhong, J., Yang, L., Chen, G., Wang, D., Zheng, G., Han, H., Han, X., Long, Y., Wang, X., Liang, J., Yu, M., Shen, X., Fan, M., Fang, F., Liao, J., Sun, D., 2022. Efficacy and Safety of the Ketogenic Diet for Mitochondrial Disease With Epilepsy: A Prospective, Open-labeled, Controlled Study. Front Neurol 13, 880944. doi.org/10.3389/fneur.2022.880944
  5. Murofushi Y, Hayakawa I, Abe Y, et al. Ketogenic Diet for KARS-Related Mitochondrial Dysfunction and Progressive Leukodystrophy. Neuropediatrics. Published online August 26, 2021. doi:10.1055/s-0041-1732446
  6. Numata-Uematsu Y, Uematsu M, Yamamoto T, et al. Leigh syndrome-like MRI changes in a patient with biallelic HPDL variants treated with ketogenic diet. Molecular Genetics and Metabolism Reports. 2021;29:100800. doi:10.1016/j.ymgmr.2021.100800
  7. Marina AD, Leiendecker B, Roesch S, Wortmann SB. Ketogenic diet for treating alopecia in BCS1l-related mitochondrial disease (Bjornstad syndrome). JIMD Reports. 2020;53(1):10-11. doi:10.1002/jmd2.12109 
  8. Madhoun AA, Alnaser F, Melhem M, Nizam R, Al-Dabbous T, Al-Mulla F. Ketogenic diet attenuates cerebellar atrophy progression in a subject with a biallelic variant at the ATAD3A locus. The Application of Clinical Genetics. doi:10.2147/TACG.S194204 
  9. Nadeau, E. et al. (2020) ‘Self-initiated lifestyle interventions lead to potential insight into an effective, alternative, non-surgical therapy for mitochondrial disease associated multiple symmetric lipomatosis’, Mitochondrion, 52, pp. 183–189. doi:10.1016/j.mito.2020.03.009.
  10. Wesół-Kucharska, D. (2022) ‘The Effectiveness of the Ketogenic Diet for Leigh Syndrome with Cardiomiopathy’(sic), 8(16), p. 7. ISSN 2639-8109
 

Neurodegenerative

Reviews

  1. Gough, S.M. et al. (2021) ‘Neuroprotection by the Ketogenic Diet: Evidence and Controversies’, Frontiers in Nutrition, 8. doi:10.3389/fnut.2021.782657.
  2. Włodarek D. Role of Ketogenic Diets in Neurodegenerative Diseases (Alzheimer’s Disease and Parkinson’s Disease). Nutrients. 2019;11(1). doi:10.3390/nu11010169 
  3. Veyrat-Durebex C, Reynier P, Procaccio V, et al. How Can a Ketogenic Diet Improve Motor Function? Front Mol Neurosci. 2018;11. doi:10.3389/fnmol.2018.00015
  4. Paoli A, Bianco A, Damiani E, Bosco G. Ketogenic diet in neuromuscular and neurodegenerative diseases. Biomed Res Int. 2014;2014:474296. doi:10.1155/2014/474296

  5. Cunnane, S.C. et al. (2022) ‘Multimodal strategy to rescue the brain in mild cognitive impairment: ketogenic oral nutrition supplementation with B vitamins and aerobic exercise’, European Journal of Clinical Investigation, p. e13806. doi:10.1111/eci.13806.

  6. Yang H, Shan W, Zhu F, Wu J, Wang Q. Ketone Bodies in Neurological Diseases: Focus on Neuroprotection and Underlying Mechanisms. Front Neurol. 2019;10. doi:10.3389/fneur.2019.00585
  7. Shcherbakova, K., Schwarz, A., Apryatin, S., Karpenko, M., Trofimov, A., 2022. Supplementation of Regular Diet With Medium-Chain Triglycerides for Procognitive Effects: A Narrative Review. Front Nutr 9, 934497.doi.org/10.3389/fnut.2022.934497
  8. Vinciguerra F, Graziano M, Hagnäs M, Frittitta L, Tumminia A. Influence of the Mediterranean and Ketogenic Diets on Cognitive Status and Decline: A Narrative Review. Nutrients. 2020;12(4):1019. doi:10.3390/nu12041019
  9. Camandola S, Mattson MP. Brain metabolism in health, aging, and neurodegeneration. The EMBO Journal. 2017;36(11):1474-1492. doi:10.15252/embj.201695810
  10. Morris G, Maes M, Berk M, Carvalho AF, Puri BK. Nutritional ketosis as an intervention to relieve astrogliosis: Possible therapeutic applications in the treatment of neurodegenerative and neuroprogressive disorders. European Psychiatry. 2020;63(1). doi:10.1192/j.eurpsy.2019.13
  11. Norwitz NG, Jaramillo JG, Clarke K, Soto A. Ketotherapeutics for neurodegenerative diseases. In: Söderbom G, Esterline R, Oscarsson J, Mattson MP, eds. International Review of Neurobiology. Vol 155. Metabolic and Bioenergetic Drivers of Neurodegenerative Disease: Treating neurodegenerative diseases as metabolic diseases. Academic Press; 2020:141-168. doi: 10.1016/bs.irn.2020.02.003 
  12. Kovács Z, Brunner B, Ari C. Beneficial Effects of Exogenous Ketogenic Supplements on Aging Processes and Age-Related Neurodegenerative Diseases. Nutrients. 2021;13(7):2197. doi:10.3390/nu13072197
  13. Maiuolo J, Gliozzi M, Musolino V, et al. From Metabolic Syndrome to Neurological Diseases: Role of Autophagy. Front Cell Dev Biol. 2021;9. doi:10.3389/fcell.2021.651021 
  14. Wang, J.-H. et al. (2022) ‘The potential pharmacological mechanisms of β-hydroxybutyrate for improving cognitive functions’, Current Opinion in Pharmacology, 62, pp. 15–22. doi:10.1016/j.coph.2021.10.005.
  15. Toppala, S. et al. (2019) ‘Midlife Insulin Resistance as a Predictor for Late-Life Cognitive Function and Cerebrovascular Lesions’, Journal of Alzheimer’s Disease, 72(1), pp. 215–228. doi:10.3233/JAD-190691.

Trials/Studies

  1. Gyorkos A, Baker MH, Miutz LN, Lown DA, Jones MA, Houghton-Rahrig LD. Carbohydrate-restricted Diet and Exercise Increase Brain-derived Neurotrophic Factor and Cognitive Function: A Randomized Crossover Trial. Cureus. 11(9). doi:10.7759/cureus.5604 
  2. Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term Effects of a Very Low-Carbohydrate Diet and a Low-Fat Diet on Mood and Cognitive Function. Archives of Internal Medicine. 2009;169(20):1873-1880. doi:10.1001/archinternmed.2009.329
  3. Fortier M, Castellano C-A, St‐Pierre V, et al. A ketogenic drink improves cognition in mild cognitive impairment: Results of a 6-month RCT. Alzheimer’s & Dementia. n/a(n/a). doi:https://doi.org/10.1002/alz.12206 
  4. Roy M, Fortier M, Rheault F, et al. A ketogenic supplement improves white matter energy supply and processing speed in mild cognitive impairment. Alzheimer’s & Dementia : Translational Research & Clinical Interventions. 2021;7(1). doi:10.1002/trc2.12217
  5. Cunnane SC, Sieber CC, Swerdlow RH, Cruz-Jentoft AJ. Mild cognitive impairment: when nutrition helps brain energy rescue—a report from the EuGMS 2020 Congress. Eur Geriatr Med. Published online July 5, 2021. doi:10.1007/s41999-021-00534-z
  6. Mujica-Parodi LR, Amgalan A, Sultan SF, et al. Diet modulates brain network stability, a biomarker for brain aging, in young adults. PNAS. 2020;117(11):6170-6177. doi:10.1073/pnas.1913042117 

Case Studies

  1. Phillips MCL, Murtagh DKJ, Ziad F, Johnston SE, Moon BG. Impact of a Ketogenic Diet on Sporadic Inclusion Body Myositis: A Case Study. Front Neurol. 2020;11. doi:10.3389/fneur.2020.582402
  2. Höller A, Albrecht U, Baumgartner Sigl S, et al. Successful implementation of classical ketogenic dietary therapy in a patient with Niemann-Pick disease type C. Molecular Genetics and Metabolism Reports. 2021;27:100723. doi:10.1016/j.ymgmr.2021.100723 
  3. Fujikura Y, Sugihara H, Hatakeyama M, Oishi K, Yamanouchi K. Ketogenic diet with medium-chain triglycerides restores skeletal muscle function and pathology in a rat model of Duchenne muscular dystrophy. The FASEB Journal. 2021;35(9):e21861. doi:10.1096/fj.202100629R (Pre-clinical)

Alzheimer's Disease

Reviews, Perspectives and Mechanisms

  1. Lilamand M, Porte B, Cognat E, Hugon J, Mouton-Liger F, Paquet C. Are ketogenic diets promising for Alzheimer’s disease? A translational review. Alzheimer’s Research & Therapy. 2020;12(1):42. doi:10.1186/s13195-020-00615-4
  2. Rusek M, Pluta R, Ułamek-Kozioł M, Czuczwar SJ. Ketogenic Diet in Alzheimer’s Disease. International Journal of Molecular Sciences. 2019;20(16):3892. doi:10.3390/ijms20163892
  3. Pinto A, Bonucci A, Maggi E, Corsi M, Businaro R. Anti-Oxidant and Anti-Inflammatory Activity of Ketogenic Diet: New Perspectives for Neuroprotection in Alzheimer’s Disease. Antioxidants (Basel). 2018;7(5). doi:10.3390/antiox7050063
  4. Myette-Côté É, Soto-Mota A, Cunnane SC. Ketones – Potential to Achieve Brain Energy Rescue and Sustain Cognitive Health during Aging. British Journal of Nutrition. Published online undefined/ed:1-47. doi:10.1017/S0007114521003883   PDF
  5. Cunnane SC, Courchesne-Loyer A, Vandenberghe C, et al. Can Ketones Help Rescue Brain Fuel Supply in Later Life? Implications for Cognitive Health during Aging and the Treatment of Alzheimer’s Disease. Front Mol Neurosci. 2016;9:53. doi:10.3389/fnmol.2016.00053
  6. Więckowska-Gacek A, Mietelska-Porowska A, Wydrych M, Wojda U. Western diet as a trigger of Alzheimer’s disease: From metabolic syndrome and systemic inflammation to neuroinflammation and neurodegeneration. Ageing Research Reviews. Published online June 30, 2021:101397. doi:10.1016/j.arr.2021.101397
  7. Taylor MK, Swerdlow RH, Sullivan DK. Dietary Neuroketotherapeutics for Alzheimer’s Disease: An Evidence Update and the Potential Role for Diet Quality. Nutrients. 2019;11(8):1910. doi:10.3390/nu11081910
  8. Norwitz NG, Saif N, Ariza IE, Isaacson RS. Precision Nutrition for Alzheimer’s Prevention in ApoE4 Carriers. Nutrients. 2021;13(4). doi:10.3390/nu13041362
  9. Rhea EM, Raber J, Banks WA. ApoE and cerebral insulin: Trafficking, receptors, and resistance. Neurobiology of Disease. 2020;137:104755. doi:10.1016/j.nbd.2020.104755
  10. Berlanga-Acosta J, Guillén-Nieto G, Rodríguez-Rodríguez N, et al. Insulin Resistance at the Crossroad of Alzheimer Disease Pathology: A Review. Front Endocrinol. 2020;11. doi:10.3389/fendo.2020.560375

Trials/Case Studies

  1. Phillips MCL, Deprez LM, Mortimer GMN, et al. Randomized crossover trial of a modified ketogenic diet in Alzheimer’s disease. Alzheimer’s Research & Therapy. 2021;13(1):51. doi:10.1186/s13195-021-00783-x
  2. Ota M, Matsuo J, Ishida I, et al. Effects of a medium-chain triglyceride-based ketogenic formula on cognitive function in patients with mild-to-moderate Alzheimer’s disease. Neuroscience Letters. 2019;690:232-236. doi:10.1016/j.neulet.2018.10.048 
  3. Taylor MK, Sullivan DK, Mahnken JD, Burns JM, Swerdlow RH. Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer’s disease. Alzheimers Dement (N Y). 2017;4:28-36. doi:10.1016/j.trci.2017.11.002 
  4. Toups K, Hathaway A, Gordon D, et al. Precision Medicine Approach to Alzheimer’s Disease: Successful Proof-of-Concept Trial. medRxiv. Published online May 11, 2021:2021.05.10.21256982. doi:10.1101/2021.05.10.21256982
  5. Taylor MK, Swerdlow RH, Burns JM, Sullivan DK. An Experimental Ketogenic Diet for Alzheimer Disease Was Nutritionally Dense and Rich in Vegetables and Avocado. Curr Dev Nutr. 2019;3(4):nzz003. doi:10.1093/cdn/nzz003
  6. Krikorian R, Shidler MD, Dangelo K, Couch SC, Benoit SC, Clegg DJ. Dietary ketosis enhances memory in mild cognitive impairment. Neurobiol Aging. 2012;33(2):425.e19-425.e27. doi:10.1016/j.neurobiolaging.2010.10.006   PDF
  7. Stoykovich S, Gibas K. APOE ε4, the door to insulin-resistant dyslipidemia and brain fog? A case study. Alzheimers Dement (Amst). 2019;11:264-269. doi:10.1016/j.dadm.2019.01.009
  8. Horner S, Berger L, Gibas K. Nutritional Ketosis and photobiomodulation remediate mitochondria warding off Alzheimer’s disease in a diabetic, ApoE4+ patient with mild cognitive impairment: A case report. Photodiagnosis Photodyn Ther. Published online April 16, 2020:101777. doi:10.1016/j.pdpdt.2020.101777
  9. Newport MT, VanItallie TB, Kashiwaya Y, King MT, Veech RL. A new way to produce hyperketonemia: Use of ketone ester in a case of Alzheimer’s disease. Alzheimer’s & Dementia. 2015;11(1):99-103. doi:10.1016/j.jalz.2014.01.006    PDF

Media Links

  1. Ivor Cummins – Youtube – Ep50 Dale Bredesen MD “The End Of Alzheimer’s” – Prevention and Resolution!

Amyotrophic Lateral Sclerosis

  1. Caplliure‐Llopis J, Peralta‐Chamba T, Carrera‐Juliá S, et al. Therapeutic alternative of the ketogenic Mediterranean diet to improve mitochondrial activity in Amyotrophic Lateral Sclerosis (ALS): A Comprehensive Review. Food Sci Nutr. 2019;8(1):23-35. doi:10.1002/fsn3.1324
  2. Paganoni S, Wills A-M. High-Fat and Ketogenic Diets in Amyotrophic Lateral Sclerosis. J Child Neurol. 2013;28(8):989-992. doi:10.1177/0883073813488669   PDF 
  3. Zhao Z, Lange DJ, Voustianiouk A, et al. A ketogenic diet as a potential novel therapeutic intervention in amyotrophic lateral sclerosis. BMC Neurosci. 2006;7:29. doi:10.1186/1471-2202-7-29
     
  4. De Marchi F, Collo A, Scognamiglio A, et al. Study protocol on safety and feasibility of a normocaloric ketogenic diet in Amyotrophic Lateral Sclerosis patients. Nutrition. Published online October 23, 2021:111525. doi:10.1016/j.nut.2021.111525  ABSTRACT (ongoing trial – protocol only)

Parkinson’s Disease

  1. Krikorian R, Shidler MD, Summer SS, et al. Nutritional ketosis for mild cognitive impairment in Parkinson’s disease: A controlled pilot trial. Clinical Parkinsonism & Related Disorders. August 2019. doi:10.1016/j.prdoa.2019.07.006
  2. Phillips MCL, Murtagh DKJ, Gilbertson LJ, Asztely FJS, Lynch CDP. Low-fat versus ketogenic diet in Parkinson’s disease: A pilot randomized controlled trial. Mov Disord. 2018;33(8):1306-1314. doi:10.1002/mds.27390
  3. Tidman, M.M., White, D. and White, T. (2022) ‘Effects of an low carbohydrate/healthy fat/ketogenic diet on biomarkers of health and symptoms, anxiety and depression in Parkinson’s disease: a pilot study’, Neurodegenerative Disease Management [Preprint]. doi:10.2217/nmt-2021-0033.
  4. Norwitz NG, Dearlove DJ, Lu M, Clarke K, Dawes H, Hu MT. A Ketone Ester Drink Enhances Endurance Exercise Performance in Parkinson’s Disease. Front Neurosci. 2020;14. doi:10.3389/fnins.2020.584130
  5. Koyuncu H, Fidan V, Toktas H, Binay O, Celik H. Effect of ketogenic diet versus regular diet on voice quality of patients with Parkinson’s disease. Acta Neurol Belg. Published online September 6, 2020. doi:10.1007/s13760-020-01486-0 ABSTRACT
  6. Vanitallie, T.B. et al. (2005) ‘Treatment of Parkinson disease with diet-induced hyperketonemia: a feasibility study’, Neurology, 64(4), pp. 728–730. doi:10.1212/01.WNL.0000152046.11390.45.
  7. Norwitz NG, Hu MT, Clarke K. The Mechanisms by Which the Ketone Body D-β-Hydroxybutyrate May Improve the Multiple Cellular Pathologies of Parkinson’s Disease. Front Nutr. 2019;6. doi:10.3389/fnut.2019.00063
  8. Thickbroom GW. The therapeutic potential of ketone bodies in Parkinson’s disease. Expert Review of Neurotherapeutics. 2021;0(0):1-3. doi:10.1080/14737175.2021.1881483
  9. Jabre MG, Bejjani B-PW. Treatment of Parkinson disease with diet-induced hyperketonemia: A feasibility study.  doi:org/10.1212/01.WNL.0000152046.11390.45 PDF Comment 
  10. Neth BJ, Bauer BA, Benarroch EE, Savica R. The Role of Intermittent Fasting in Parkinson’s Disease. Front Neurol. 2021;12. doi:10.3389/fneur.2021.682184 
  11. Grammatikopoulou, M.G. et al. (2022) ‘Ketogenic therapy for Parkinson’s disease: A systematic review and synthesis without meta-analysis of animal and human trials’, Maturitas, 163, pp. 46–61. Available at: https://doi.org/10.1016/j.maturitas.2022.06.001.
  12. Souza, A.P. da S. et al. (2021) ‘Effect of Metabolic Syndrome on Parkinson’s Disease: A Systematic Review’, Clinics, 76. doi:10.6061/clinics/2021/e3379.
  13. Fiory F, Perruolo G, Cimmino I, et al. The Relevance of Insulin Action in the Dopaminergic System. Front Neurosci. 2019;13. doi:10.3389/fnins.2019.00868
  14. Boelens Keun JT, Arnoldussen IA, Vriend C, van de Rest O. Dietary Approaches to Improve Efficacy and Control Side Effects of Levodopa Therapy in Parkinson’s Disease: A Systematic Review. Advances in Nutrition. 2021;(nmab060). doi:10.1093/advances/nmab060 
  15. Choi A, Hallett M, Ehrlich D. Nutritional Ketosis in Parkinson’s Disease — a Review of Remaining Questions and Insights. Neurotherapeutics. Published online July 7, 2021. doi:10.1007/s13311-021-01067-w 
  16. Tidman, M. (2022) ‘Effects of a Ketogenic Diet on Symptoms, Biomarkers, Depression, and Anxiety in Parkinson’s Disease: A Case Study’, Cureus, 14(3). doi:10.7759/cureus.23684.
  17. Curtis, W.M., Seeds, W.A., Mattson, M.P., Bradshaw, P.C., 2022. NADPH and Mitochondrial Quality Control as Targets for a Circadian-Based Fasting and Exercise Therapy for the Treatment of Parkinson’s Disease. Cells 11, 2416. doi.org/10.3390/cells11152416
  18. Yao, C. et al. (2021) ‘Cognition, motor symptoms, and glycolipid metabolism in Parkinson’s disease with depressive symptoms’, Journal of Neural Transmission. doi:10.1007/s00702-021-02437-6 ABSTRACT

Multiple Sclerosis

  1. Bock M, Michalsen A, Paul F. Ketogenic diet and prolonged fasting improve health-related quality of life and lipid profiles in multiple sclerosis –A randomized controlled trial. In: ; 2015. PDF
  2. Vural Fidan, Handan Koyuncu, Hayal Toktas “Impact of Ketogenic Diet Versus Regular Diet on Voice Quality of Patients with Multiple Sclerosis”. Clinical Case Reports and Clinical Study, 4(4); doi: 03.2021/1.1081.  PDF
  3. Benlloch M, López-Rodríguez MM, Cuerda-Ballester M, et al. Satiating Effect of a Ketogenic Diet and Its Impact on Muscle Improvement and Oxidation State in Multiple Sclerosis Patients. Nutrients. 2019;11(5):1156. doi:10.3390/nu11051156
  4. Wahls TL, Titcomb TJ, Bisht B, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021;7(3):20552173211035400. doi:10.1177/20552173211035399

  5. Di Majo, D. et al. (2022) ‘Ketogenic and Modified Mediterranean Diet as a Tool to Counteract Neuroinflammation in Multiple Sclerosis: Nutritional Suggestions’, Nutrients, 14(12), p. 2384. Available at: https://doi.org/10.3390/nu14122384.

  6. Fanara S, Aprile M, Iacono S, et al. The Role of Nutritional Lifestyle and Physical Activity in Multiple Sclerosis Pathogenesis and Management: A Narrative Review. Nutrients. 2021;13(11):3774. doi:10.3390/nu13113774
  7. Brenton JN, Banwell B, Bergqvist AGC, et al. Pilot study of a ketogenic diet in relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(4):e565. doi:10.1212/NXI.0000000000000565
  8. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18. doi:10.2147/DNND.S116949
  9. Bock M, Karber M, Kuhn H. Ketogenic diets attenuate cyclooxygenase and lipoxygenase gene expression in multiple sclerosis. EBioMedicine. 2018;36:293-303. doi:10.1016/j.ebiom.2018.08.057
  10. Swidsinski A, Dörffel Y, Loening-Baucke V, et al. Reduced Mass and Diversity of the Colonic Microbiome in Patients with Multiple Sclerosis and Their Improvement with Ketogenic Diet. Front Microbiol. 2017;8. doi:10.3389/fmicb.2017.01141
  11. Lee JE, Bisht B, Hall MJ, et al. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. Journal of the American College of Nutrition. 2017;36(3):150-168. doi:10.1080/07315724.2016.1255160
  12. Fellows Maxwell K, Wahls T, Browne RW, et al. Lipid profile is associated with decreased fatigue in individuals with progressive multiple sclerosis following a diet-based intervention: Results from a pilot study. PLoS One. 2019;14(6). doi:10.1371/journal.pone.0218075
  13. Choi IY, Piccio L, Childress P, et al. Diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms. Cell Rep. 2016;15(10):2136-2146. doi:10.1016/j.celrep.2016.05.009
  14. Storoni M, Plant GT. The Therapeutic Potential of the Ketogenic Diet in Treating Progressive Multiple Sclerosis. Multiple Sclerosis International. 2015. doi:10.1155/2015/681289
  15. Nathan J, Khedekar Kale D, Naik VD, Thakker F, Bailur S. Dietary Therapy in Secondary Progressive Multiple Sclerosis: A Case Report. Cureus. 2019;11(8):e5341. doi:10.7759/cureus.5341
  16. Wahls TL, Chenard CA, Snetselaar LG. Review of Two Popular Eating Plans within the Multiple Sclerosis Community: Low Saturated Fat and Modified Paleolithic. Nutrients. 2019;11(2). doi:10.3390/nu11020352
  17. Maric G, Lalic K, Pekmezovic T, et al. Could the performance of oral glucose tolerance test contribute to the brain health-focused care in multiple sclerosis? Multiple Sclerosis and Related Disorders. 2020;46:102536. doi:10.1016/j.msard.2020.102536 ABSTRACT
  18. Bahr LS, Bock M, Liebscher D, et al. Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study. Trials. 2020;21(1):3. doi:10.1186/s13063-019-3928-9 – Valuable background discussion
  19. Morales-Suarez-Varela M, Collado Sánchez E, Peraita-Costa I, Llopis-Morales A, Soriano JM. Intermittent Fasting and the Possible Benefits in Obesity, Diabetes, and Multiple Sclerosis: A Systematic Review of Randomized Clinical Trials. Nutrients. 2021;13(9):3179. doi:10.3390/nu13093179
  20. Titcomb TJ, Brooks L, Smith KL, et al. Change in Micronutrient Intake among People with Relapsing-Remitting Multiple Sclerosis Adapting the Swank and Wahls Diets: An Analysis of Weighed Food Records. Nutrients. 2021;13(10):3507. doi:10.3390/nu13103507

Media Links

  1. Dr Tommy Wood/Ragnar – Multiple Sclerosis – Meðferðaúræði við MS – YouTube (In English)

Neurology - Other

  1. Stafstrom CE, Rho JM. The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders. Front Pharmacol. 2012;3. doi:10.3389/fphar.2012.00059 
  2. Ruskin DN, Masino SA. The Nervous System and Metabolic Dysregulation: Emerging Evidence Converges on Ketogenic Diet Therapy. Front Neurosci. 2012;6. doi:10.3389/fnins.2012.00033
  3. Tavarez T, Roehl K, Koffman L. Nutrition in the Neurocritical Care Unit: a New Frontier. Curr Treat Options Neurol. 2021;23(5). doi:10.1007/s11940-021-00670-8
  4. Lin K-L, Lin J-J, Wang H-S. Application of ketogenic diets for pediatric neurocritical care. Biomedical Journal. 2020;43(3):218. doi:10.1016/j.bj.2020.02.002
  5. Kwon HE, Kim HD. Recent aspects of ketogenic diet in neurological disorders. Acta Epileptologica. 2021;3(1):21. doi:10.1186/s42494-021-00053-1
  6. Watt C, Sanchez-Rangel E, Hwang JJ. Glycemic Variability and CNS Inflammation: Reviewing the Connection. Nutrients. 2020;12(12):3906. doi:10.3390/nu12123906
  7. Coleman K, Phillips J, Sciarini M, Stubbs B, Jackson O, Kernagis D. A Metabolic Intervention for Improving Human Cognitive Performance During Hypoxia. Aerosp Med Hum Perform. 2021;92(7):556-562. doi:10.3357/AMHP.5767.2021
  8. Valente M, Del Negro I, Bagatto D, et al. Clinical and magnetic resonance study of a case of subacute sclerosing panencephalitis treated with ketogenic diet. BMJ Neurol Open. 2021;3(2):e000176. doi:10.1136/bmjno-2021-000176
  9. Nathan J, Khedekar Kale D, Naik VD, Thakker F, Bailur S. Substantial Remission in Subacute Sclerosing Panencephalitis by Following the Ketogenic Diet: A Case Report. Cureus. 2019;11(8):e5485. doi:10.7759/cureus.5485
  10. Ulate-Campos A, Fons C, Artuch R, et al. Alternating Hemiplegia of Childhood With a de Novo Mutation in ATP1A3 and Changes in SLC2A1 Responsive to a Ketogenic Diet. Pediatric Neurology. 2014;50(4):377-379. doi:10.1016/j.pediatrneurol.2013.11.017
  11. Roubergue A, Philibert B, Gautier A, et al. Excellent Response to a Ketogenic Diet in a Patient with Alternating Hemiplegia of Childhood. JIMD Rep. 2014;15:7-12. doi:10.1007/8904_2013_292

Brain Injury/Neurotrauma

Systematic Reviews, Meta-Analyses and other reviews

  1. Gambardella I, Ascione R, D’Agostino DP, et al. Neuroprotection of Ketosis in Acute Injury of the Mammalian Central Nervous System: a Meta-Analysis. Journal of Neurochemistry. n/a(n/a). doi:https://doi.org/10.1111/jnc.15341 
  2. Gough, S.M. et al. (2021) ‘Neuroprotection by the Ketogenic Diet: Evidence and Controversies’, Frontiers in Nutrition, 8. doi:10.3389/fnut.2021.782657.
  3. Daines, S.A. (2021) ‘The Therapeutic Potential and Limitations of Ketones in Traumatic Brain Injury’, Frontiers in Neurology, 12. doi:10.3389/fneur.2021.723148
  4. White H, Heffernan AJ, Worrall S, Grunsfeld A, Thomas M. A Systematic Review of Intravenous β-Hydroxybutyrate Use in Humans – A Promising Future Therapy? Frontiers in Medicine. 2021;8. doi:10.3389/fmed.2021.740374 
  5. White H, Venkatesh B. Clinical review: Ketones and brain injury. Critical Care. 2011;15(2):219. doi:10.1186/cc10020
  6. Prins M. DIET, KETONES AND NEUROTRAUMA. Epilepsia. 2008;49(Suppl 8):111-113. doi:10.1111/j.1528-1167.2008.01852.x 
  7. Prins ML, Matsumoto JH. The collective therapeutic potential of cerebral ketone metabolism in traumatic brain injury. J Lipid Res. 2014;55(12):2450-2457. doi:10.1194/jlr.R046706 
  8. Shaafi S, Mahmoudi J, Pashapour A, Farhoudi M, Sadigh-eteghad S, Akbari H. Ketogenic Diet Provides Neuroprotective Effects against Ischemic Stroke Neuronal Damages. Adv Pharm Bull. 2014;4(Suppl 2):479-481. doi:10.5681/apb.2014.071      PDF 
  9. Yarar-Fisher C, Li J, Womack ED, et al. Ketogenic regimens for acute neurotraumatic events. Curr Opin Biotechnol. 2021;70:68-74. doi:10.1016/j.copbio.2020.12.009 ABSTRACT
  10. Arora N, Mehta TR. Role of the ketogenic diet in acute neurological diseases. Clinical Neurology and Neurosurgery. 2020;192:105727. doi:10.1016/j.clineuro.2020.105727
  11. Stubbs BJ, Koutnik AP, Volek JS, Newman JC. From bedside to battlefield: intersection of ketone body mechanisms in geroscience with military resilience. GeroScience. Published online October 2, 2020. doi:10.1007/s11357-020-00277-y 
  12. Maalouf M, Rho JM, Mattson MP. The neuroprotective properties of calorie restriction, the ketogenic diet, and ketone bodies. Brain Research Reviews. 2009;59(2):293-315. doi:10.1016/j.brainresrev.2008.09.002    PDF 
  13. Krakovski, M.A., Arora, N., Jain, S., Glover, J., Dombrowski, K., Hernandez, B., Yadav, H., Sarma, A.K., 2022. Diet-microbiome-gut-brain nexus in acute and chronic brain injury. Front Neurosci 16, 1002266. doi.org/10.3389/fnins.2022.1002266
  14. Eller, O.C., Willits, A.B., Young, E.E., Baumbauer, K.M., 2022. Pharmacological and non-pharmacological therapeutic interventions for the treatment of spinal cord injury-induced pain. Front Pain Res (Lausanne) 3, 991736. doi.org/10.3389/fpain.2022.991736

Trials/Studies

  1. Li J, McLain A, Morrow C, Gower B, Yarar C. Utilizing a Low-Carbohydrate/High-Protein Diet to Improve Metabolic Health in Individuals With Spinal Cord Injury. Current Developments in Nutrition. 2021;5(Supplement_2):510-510. doi:10.1093/cdn/nzab041_025 
  2. Rippee MA, Chen J, Taylor MK. The Ketogenic Diet in the Treatment of Post-concussion Syndrome—A Feasibility Study. Front Nutr. 2020;7. doi:10.3389/fnut.2020.00160 
  3. White H, Venkatesh B, Jones M, Kruger PS, Walsham J, Fuentes H. Inducing ketogenesis via an enteral formulation in patients with acute brain injury:a phase II study. Neurological Research. 2020;0(0):1-11. doi:10.1080/01616412.2019.1709743
  4. Yarar-Fisher C, Kulkarni A, Li J, et al. Evaluation of a ketogenic diet for improvement of neurological recovery in individuals with acute spinal cord injury: a pilot, randomized safety and feasibility trial. Spinal Cord Ser Cases. 2018;4:88. doi:10.1038/s41394-018-0121-4 
  5. Arora, N. et al. (2022) ‘Phase I single center trial of ketogenic diet for adults with traumatic brain injury’, Clinical Nutrition ESPEN, 47, pp. 339–345. doi:10.1016/j.clnesp.2021.11.015.
  6. Zheng, J. et al. (2021) ‘Safety of Every-Other-Day Fasting in the Treatment of Spinal Cord Injury: A Randomized Controlled Trial’, American Journal of Physical Medicine & Rehabilitation, 100(12), pp. 1184–1189. doi:10.1097/PHM.0000000000001727 ABSTRACT
  7. Demirel A, Li J, Morrow C, et al. Evaluation of a ketogenic diet for improvement of neurological recovery in individuals with acute spinal cord injury: study protocol for a randomized controlled trial. Trials. 2020;21(1):372. doi:10.1186/s13063-020-04273-7 – useful background/discussion
  8. Chang Y, Kim CK, Kim M-K, Seo W-K, Oh K. Insulin resistance may affect the functional recovery of acute ischemic stroke in non-diabetic patients. Published online March 15, 2020. doi:10.21203/rs.3.rs-17241/v1
  9. Solinsky R, Betancourt L, Schmidt-Read M, et al. Acute Spinal Cord Injury is Associated with Prevalent Cardiometabolic Risk Factors. Arch Phys Med Rehabil. Published online May 29, 2021. doi:10.1016/j.apmr.2021.04.022 ABSTRACT
  10. D’Agostino CA, Zippert M, D’Agostino DP. Neuroregeneration improved by ketones. The FASEB Journal. 2018;32(S1):545.9-545.9. doi:10.1096/fasebj.2018.32.1_supplement.545.9 (Pre-clinical) ABSTRACT

Paediatric Neurotrauma

  1. Wood TR, Stubbs BJ, Juul SE. Exogenous Ketone Bodies as Promising Neuroprotective Agents for Developmental Brain Injury. Dev Neurosci. May 2019:1-12. doi:10.1159/000499563 
  2. Lin K-L, Lin J-J, Wang H-S. Application of ketogenic diets for pediatric neurocritical care. Biomedical Journal. Published online July 5, 2020. doi:10.1016/j.bj.2020.02.002

Case Studies

  1. Lu W, Gu W, He J, Wu C. A case report of the ketogenic diet for severe cerebral complications after ependymoma operation. Chinese Journal of Applied Clinical Pediatrics. Published online 2021:543-545. 
  2. Maiorana A, Manganozzi L, Barbetti F, et al. Ketogenic diet in a patient with congenital hyperinsulinism: a novel approach to prevent brain damage. Orphanet J Rare Dis. 2015;10. doi:10.1186/s13023-015-0342-6

Migraine/Headache

Reviews and mechanisms

  1. Jibril, A.T., Shab-Bidar, S., Djafarian, K., Iddrisu, M., Kwartemaah, I.S.O., Yelarge, A., 2022. Effect of Major Dietary Interventions on Migraine: a Systematic Review of Randomized Control Trials. SN Compr. Clin. Med. 4, 185.doi.org/10.1007/s42399-022-01270-6 
  2. Lorenzo CD, Ballerini G, Barbanti P, et al. Position Paper on the Applications of Ketogenic Diets in Patients with Headache: Consensus Statement. Published online April 30, 2021. doi:10.20944/preprints202104.0794.v1   PDF
  3. Di Lorenzo C, Ballerini G, Barbanti P, et al. Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations. Nutrients. 2021;13(7):2307. doi:10.3390/nu13072307
  4. Hindiyeh NA, Zhang N, Farrar M, Banerjee P, Lombard L, Aurora SK. The Role of Diet and Nutrition in Migraine Triggers and Treatment: A Systematic Literature Review. Headache. 2020;60(7):1300-1316. doi:10.1111/head.13836
  5. Caminha MC, Moreira AB, Matheus FC, et al. Efficacy and tolerability of the ketogenic diet and its variations for preventing migraine in adolescents and adults: a systematic review. Nutrition Reviews. 2021;(nuab080). doi:10.1093/nutrit/nuab080 ABSTRACT
  6. Gross EC, Klement RJ, Schoenen J, D’Agostino DP, Fischer D. Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention. Nutrients. 2019;11(4). doi:10.3390/nu11040811
  7. Papetti L, Moavero R, Ferilli MAN, et al. Truths and Myths in Pediatric Migraine and Nutrition. Nutrients. 2021;13(8):2714. doi:10.3390/nu13082714
  8. Razeghi Jahromi S, Ghorbani Z, Martelletti P, Lampl C, Togha M, On behalf of the School of Advanced Studies of the European Headache Federation (EHF-SAS). Association of diet and headache. The Journal of Headache and Pain. 2019;20(1):106. doi:10.1186/s10194-019-1057-1
  9. Raucci U, Boni A, Evangelisti M, et al. Lifestyle Modifications to Help Prevent Headache at a Developmental Age. Front Neurol. 2021;11. doi:10.3389/fneur.2020.618375
  10. Barbanti P, Fofi L, Aurilia C, Egeo G, Caprio M. Ketogenic diet in migraine: rationale, findings and perspectives. Neurol Sci. 2017;38(1):111-115. doi:10.1007/s10072-017-2889-6 ABSTRACT
  11. Grech, O., Sassani, M., Terwindt, G., Lavery, G.G., Mollan, S.P., Sinclair, A.J., 2022. Alterations in metabolic flux in migraine and the translational relevance. The Journal of Headache and Pain 23. doi.org/10.1186/s10194-022-01494-w
  12. Martins-Oliveira M, Tavares I, Goadsby PJ. Was it something I ate? Understanding the bidirectional interaction of migraine and appetite neural circuits. Brain Research. Published online August 21, 2021:147629. doi:10.1016/j.brainres.2021.147629

Trials/Studies

  1. Di Lorenzo C, Pinto A, Ienca R, et al. A Randomized Double-Blind, Cross-Over Trial of very Low-Calorie Diet in Overweight Migraine Patients: A Possible Role for Ketones? Nutrients. 2019;11(8):1742. doi:10.3390/nu11081742 
  2. Haslam RL, Bezzina A, Herbert J, Spratt N, Rollo ME, Collins CE. Can Ketogenic Diet Therapy Improve Migraine Frequency, Severity and Duration? Healthcare. 2021;9(9):1105. doi:10.3390/healthcare9091105
  3. Bongiovanni D, Benedetto C, Corvisieri S, et al. Effectiveness of ketogenic diet in treatment of patients with refractory chronic migraine. Neurol Sci. Published online February 1, 2021. doi:10.1007/s10072-021-05078-5 ABSTRACT
  4.  Lovati, C., d’Alessandro, C.M., Ventura, S.D., Muzio, F., Pantoni, L., 2022. Ketogenic diet in refractory migraine: possible efficacy and role of ketone bodies-a pilot experience. Neurol Sci. doi.10.1007/s10072-022-06311-5 ABSTRACT
  5. Di Lorenzo C, Coppola G, Bracaglia M, et al. A ketogenic diet normalizes interictal cortical but not subcortical responsivity in migraineurs. BMC Neurol. 2019;19(1):136. doi:10.1186/s12883-019-1351-1    PDF
  6. Cannataro R, Perri M, Caroleo MC, Gallelli L, Sarro GD, Cione E. Modulation of MicroRNAs Linked to Pain-migraine by Ketogenic Diet (P14-007-19). Current Developments in Nutrition. 2019;3(Supplement_1):nzz052.P14-007-19. doi:10.1093/cdn/nzz052.P14-007-19    PDF
  7. Di Lorenzo C, Coppola G, Bracaglia M, et al. Cortical functional correlates of responsiveness to short-lasting preventive intervention with ketogenic diet in migraine: a multimodal evoked potentials study. J Headache Pain. 2016;17. doi:10.1186/s10194-016-0650-9
  8. Di Lorenzo C, Coppola G, Di Lenola D, et al. Efficacy of Modified Atkins Ketogenic Diet in Chronic Cluster Headache: An Open-Label, Single-Arm, Clinical Trial. Front Neurol. 2018;9:64. doi:10.3389/fneur.2018.00064
  9. Valente, M., Garbo, R., Filippi, F., Antonutti, A., Ceccarini, V., Tereshko, Y., Di Lorenzo, C., Gigli, G.L., 2022. Migraine Prevention through Ketogenic Diet: More than Body Mass Composition Changes. J Clin Med 11, 4946. doi.org/10.3390/jcm11174946
  10.  
  11. Lorenzo CD, Coppola G, Sirianni G, Pierelli F. Short term improvement of migraine headaches during ketogenic diet: a prospective observational study in a dietician clinical setting. 2017.PDF
  12. Farkas MK, Mak E, Richter E, Farkas V. EHMTI-0336. Metabolic diet therapy in the prophylactic treatment of migraine headache in adolescents by using ketogenic diet. 2014. PDF
  13. Di Lorenzo C, Coppola G, Sirianni G, et al. Migraine improvement during short lasting ketogenesis: a proof-of-concept study. Eur J Neurol. 2015;22(1):170-177. doi:10.1111/ene.12550
  14. Cavestro C, Rosatello A, Micca G, et al. Insulin metabolism is altered in migraineurs: a new pathogenic mechanism for migraine? Headache. 2007;47(10):1436-1442. doi:10.1111/j.1526-4610.2007.00719.x ABSTRACT
  15. Putananickal N, Gross EC, Orsini A-L, et al. Efficacy and safety of exogenous beta-hydroxybutyrate for preventive treatment in episodic migraine: A single-centred, randomised, placebo-controlled, double-blind crossover trial. Cephalalgia. Published online September 20, 2021:3331024211043792. doi:10.1177/03331024211043792

Media Links

  1. Podcast LCM. Low Carb MD Podcast – Episode 135: Dr. Josh Turknett. Google Podcasts.

Updated 01 November 2022

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Latest Update: 01 March 2023