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Ketone-based diets improve the disease course in MS animal models and health outcomes in different pilot studies of neurodegenerative diseases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We enrolled 105 individuals with relapsing-remitting MS (RRMS) in an 18-month, randomized, controlled study, and randomized them into (1) standard healthy diet (SD) as recommended by the German Nutrition Society, (2) fasting diet (FD) with 7-day fasts every 6 months with intermittent fasting at 6 of 7 days a week or (3) ketogenic diet (KD) with 20\u201340\u00a0g carbohydrates per day. Primary outcome was the number of new MRI lesions after 18 months in the KD and FD compared to SD and compared to baseline. Secondary outcomes included further MRI outcomes, disease biomarkers as well as metabolic, and clinical MS outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Eighty-one participants completed the study. The primary endpoint number of new T2 lesions after 18 months did not change in any of the groups (SD 0 (0-(-1)), FD 0 (2\u2009\u2212\u20090), KD 0 (2\u2009\u2212\u20090)). Secondary endpoints were analyzed exploratorily: Compared to baseline, in the FD group, Neurofilament light chain (NfL) -concentrations were lower at 9 months (-1.94 pg\/mL,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.042) and depressive symptoms improved slightly at 18 months (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.079). In the KD group, cognition improved at 18 months (symbol digit modalities test\u2009+\u20093.7,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.020). Cardiometabolic risk markers (body mass index, abdominal fat, blood lipids, adipokines, blood pressure) improved in all three groups at 9 months differently and were partially associated with clinical outcomes in the FD and KD group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The results suggest beneficial effects of dietary interventions, underscoring their potential as a complementary strategy in the treatment of RRMS. To further clarify the impact of such interventions on the disease course and patient-centered outcomes \u2014 such as cognitive function and depressive symptoms \u2014future studies with larger, more homogeneous study populations are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT03508414. Retrospectively registered on 25 April 2018.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40795-025-01156-5","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T03:19:42Z","timestamp":1755659982000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Fasting, ketogenic, and anti-inflammatory diets in multiple sclerosis: a randomized controlled trial with 18-month follow-up"],"prefix":"10.1186","volume":"11","author":[{"given":"Lina S.","family":"Bahr","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Bellmann-Strobl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela A.","family":"Koppold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebekka","family":"Rust","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanja","family":"Schmitz-H\u00fcbsch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maja","family":"Olszewska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Stadlbauer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Bock","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Scheel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Chien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Multmeier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Krannich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Michalsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedemann","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anja","family":"M\u00e4hler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"issue":"Suppl 201","key":"1156_CR1","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/ane.12843","volume":"136","author":"H Wekerle","year":"2017","unstructured":"Wekerle H. 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All research was performed in accordance with relevant guidelines\/regulations and in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants after screening to take part in the study and that pseudonymized data can be published.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Daniela A. Koppold and Andreas Michalsen are members of the steering committee of the Medical Association for Fasting and Nutrition (\u00c4GHE). They have also co-founded the Academy of Integrative Fasting (AIF), an institution for the qualification of medical staff in clinical fasting applications. 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