{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T03:38:25Z","timestamp":1790048305147,"version":"4.0.1"},"reference-count":27,"publisher":"Akademiai Kiado Zrt.","issue":"2","license":[{"start":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T00:00:00Z","timestamp":1697155200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["EuJMI"],"published-print":{"date-parts":[[2023,10,13]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Multiple sclerosis (MS) is a chronic autoimmune disease of the central nervous system (CNS) characterized by inflammation and neurodegeneration. Current research suggests that diet may influence disease course, severity of symptoms, and quality of life in MS patients. The ketogenic diet (KD) has been used for more than a century as a therapeutic approach for various medical conditions. It was originally developed in the 1920s as a treatment option for epilepsy, and especially in the last 30 years, has gained popularity for its potential benefits in a variety of neurological conditions other than epilepsy. This prompted us to perform a literature survey regarding the effect of KD on the onset and progression of MS. The here reviewed 15 original research articles including <jats:italic>in vitro<\/jats:italic>, preclinical, and\u00a0clinical studies provide evidence for the safety and feasibility of the KD in MS, showing potential neuroprotective effects and positive impacts on cellular metabolism and disease outcome. Since the literature is limited and most studies were conducted with low numbers of MS patients and rather exploratory in nature, further studies with larger cohorts are needed to gain a better understanding of the mechanisms by which the improvements of the MS disease course are achieved.<\/jats:p>","DOI":"10.1556\/1886.2023.00020","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T08:26:05Z","timestamp":1693815965000},"page":"29-36","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":14,"title":["The impact of ketogenic diet on the onset and progression of multiple sclerosis"],"prefix":"10.1556","volume":"13","author":[{"given":"Jurij D.","family":"Brockhoff","sequence":"first","affiliation":[{"name":"Gastrointestinal Microbiology Research Group, Institute of Microbiology, Infectious Diseases and Immunology, Charit\u00e9 - University Medicine Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Bereswill","sequence":"additional","affiliation":[{"name":"Gastrointestinal Microbiology Research Group, Institute of Microbiology, Infectious Diseases and Immunology, Charit\u00e9 - University Medicine Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6399-651X","authenticated-orcid":true,"given":"Markus M.","family":"Heimesaat","sequence":"additional","affiliation":[{"name":"Gastrointestinal Microbiology Research Group, Institute of Microbiology, Infectious Diseases and Immunology, Charit\u00e9 - University Medicine Berlin, corporate member of Freie Universit\u00e4t Berlin, Humboldt-Universit\u00e4t zu Berlin, and Berlin Institute of Health, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"14","key":"B1","series-title":"Mult Scler","first-page":"1816","article-title":"Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition","author":"Walton C","year":"2020","unstructured":"Walton C, King R, Rechtman L, Kaye W, Leray E, Marrie RA, et\u00a0al. Rising prevalence of multiple sclerosis worldwide: insights from the Atlas of MS, third edition. Mult Scler. 2020;26(14):1816\u201321."},{"issue":"4","key":"B2","series-title":"Clin Med (Lond)","first-page":"380","article-title":"Clinical presentation and diagnosis of multiple sclerosis","volume":"20","author":"Ford H","year":"2020","unstructured":"Ford H. Clinical presentation and diagnosis of multiple sclerosis. Clin Med (Lond) 2020;20(4):380\u20133."},{"key":"B3","series-title":"Types of MS","author":"National Multiple Sclerosis Society","unstructured":"National Multiple Sclerosis Society. Types of MS. Available from: https:\/\/www.nationalmssociety.org\/What-is-MS\/Types-of-MS."},{"issue":"1","key":"B4","series-title":"Epilepsia","first-page":"31","article-title":"Clinical aspects of the ketogenic diet","volume":"48","author":"Hartman AL","year":"2007","unstructured":"Hartman AL, Vining EP. Clinical aspects of the ketogenic diet. Epilepsia. 2007;48(1):31\u201342."},{"issue":"Suppl 8","key":"B5","series-title":"Epilepsia","first-page":"3","article-title":"History of the ketogenic diet","volume":"49","author":"Wheless JW","year":"2008","unstructured":"Wheless JW. History of the ketogenic diet. Epilepsia. 2008;49 Suppl 8:3\u20135."},{"issue":"1","key":"B6","series-title":"Signal Transduct Target Ther","first-page":"11","article-title":"Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations","volume":"7","author":"Zhu H","year":"2022","unstructured":"Zhu H, Bi D, Zhang Y, Kong C, Du J, Wu X, et\u00a0al. Ketogenic diet for human diseases: the underlying mechanisms and potential for clinical implementations. Signal Transduct Target Ther. 2022;7(1):11."},{"issue":"6","key":"B7","series-title":"J Clin Invest","first-page":"892","article-title":"D-beta-hydroxybutyrate rescues mitochondrial respiration and mitigates features of Parkinson disease","volume":"112","author":"Tieu K","year":"2003","unstructured":"Tieu K, Perier C, Caspersen C, Teismann P, Wu DC, Yan SD, et\u00a0al. D-beta-hydroxybutyrate rescues mitochondrial respiration and mitigates features of Parkinson disease. J Clin Invest. 2003;112(6):892\u2013901."},{"issue":"7","key":"B8","series-title":"PLoS One","article-title":"2-Deoxy-D-glucose treatment induces ketogenesis, sustains mitochondrial function, and reduces pathology in female mouse model of Alzheimer's disease","volume":"6","author":"Yao J","year":"2011","unstructured":"Yao J, Chen S, Mao Z, Cadenas E, Brinton RD. 2-Deoxy-D-glucose treatment induces ketogenesis, sustains mitochondrial function, and reduces pathology in female mouse model of Alzheimer's disease. PLoS One. 2011;6(7):e21788."},{"issue":"10","key":"B9","series-title":"Cell Rep","first-page":"2136","article-title":"A diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms","volume":"15","author":"Choi IY","year":"2016","unstructured":"Choi IY, Piccio L, Childress P, Bollman B, Ghosh A, Brandhorst S, et\u00a0al. A diet mimicking fasting promotes regeneration and reduces autoimmunity and multiple sclerosis symptoms. Cell Rep. 2016;15(10):2136\u201346."},{"key":"B10","series-title":"Front Neurol","article-title":"Dietary protection against the visual and motor deficits induced by experimental autoimmune encephalomyelitis","volume":"14","author":"Zyla-Jackson K","year":"2023","unstructured":"Zyla-Jackson K, Walton DA, Plafker KS, Kovats S, Georgescu C, Brush RS, et\u00a0al. Dietary protection against the visual and motor deficits induced by experimental autoimmune encephalomyelitis. Front Neurol. 2023;14:1113954."},{"issue":"5","key":"B11","series-title":"PLoS One","article-title":"Inflammation-mediated memory dysfunction and effects of a ketogenic diet in a murine model of multiple sclerosis","volume":"7","author":"Kim DY","year":"2012","unstructured":"Kim DY, Hao J, Liu R, Turner G, Shi FD, Rho JM. Inflammation-mediated memory dysfunction and effects of a ketogenic diet in a murine model of multiple sclerosis. PLoS One. 2012;7(5):e35476."},{"issue":"37","key":"B12","series-title":"Sci Adv","article-title":"Ketogenic diet uncovers differential metabolic plasticity of brain cells","volume":"8","author":"Duking T","year":"2022","unstructured":"Duking T, Spieth L, Berghoff SA, Piepkorn L, Schmidke AM, Mitkovski M, et\u00a0al. Ketogenic diet uncovers differential metabolic plasticity of brain cells. Sci Adv. 2022;8(37):eabo7639."},{"key":"B13","series-title":"Front Aging Neurosci","article-title":"Effect of beta-hydroxybutyrate on behavioral alterations, molecular and morphological changes in CNS of multiple sclerosis mouse model","volume":"14","author":"Sun W","year":"2022","unstructured":"Sun W, Wen M, Liu M, Wang Q, Liu Q, Li L, et\u00a0al. Effect of beta-hydroxybutyrate on behavioral alterations, molecular and morphological changes in CNS of multiple sclerosis mouse model. Front Aging Neurosci. 2022;14:1075161."},{"issue":"40","key":"B14","series-title":"J Agric Food Chem","first-page":"11215","article-title":"Cuprizone-induced demyelination in mouse Hippocampus is alleviated by ketogenic diet","volume":"68","author":"Liu C","year":"2020","unstructured":"Liu C, Zhang N, Zhang R, Jin L, Petridis AK, Loers G, et\u00a0al. Cuprizone-induced demyelination in mouse Hippocampus is alleviated by ketogenic diet. J Agric Food Chem. 2020;68(40):11215\u201328."},{"issue":"8","key":"B15","series-title":"Cureus","article-title":"Dietary therapy in secondary progressive multiple sclerosis: a case report","volume":"11","author":"Nathan J","year":"2019","unstructured":"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."},{"issue":"4","key":"B16","series-title":"Neurol Neuroimmunol Neuroinflamm","first-page":"e565","article-title":"Pilot study of a ketogenic diet in relapsing-remitting MS","volume":"6","author":"Brenton JN","year":"2019","unstructured":"Brenton JN, Banwell B, Bergqvist AGC, Lehner-Gulotta D, Gampper L, Leytham E, et\u00a0al. Pilot study of a ketogenic diet in relapsing-remitting MS. Neurol Neuroimmunol Neuroinflamm. 2019;6(4):e565."},{"issue":"2","key":"B17","series-title":"Am J Occup Ther","first-page":"77","article-title":"Hand strength and dexterity","volume":"25","author":"Kellor M","year":"1971","unstructured":"Kellor M, Frost J, Silberberg N, Iversen I, Cummings R. Hand strength and dexterity. Am J Occup Ther. 1971;25(2):77\u201383."},{"issue":"6","key":"B18","series-title":"J Neurol Neurosurg Psychiatry","first-page":"637","article-title":"Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits","volume":"93","author":"Brenton JN","year":"2022","unstructured":"Brenton JN, Lehner-Gulotta D, Woolbright E, Banwell B, Bergqvist AGC, Chen S, et\u00a0al. Phase II study of ketogenic diets in relapsing multiple sclerosis: safety, tolerability and potential clinical benefits. J Neurol Neurosurg Psychiatry. 2022;93(6):637\u201344."},{"issue":"1","key":"B19","series-title":"J Am Coll Nutr","first-page":"13","article-title":"A modified MCT-based ketogenic diet increases plasma beta-hydroxybutyrate but has less effect on fatigue and quality of life in people with multiple sclerosis compared to a modified paleolithic diet: a waitlist-controlled, randomized pilot study","volume":"40","author":"Lee JE","year":"2021","unstructured":"Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A modified MCT-based ketogenic diet increases plasma beta-hydroxybutyrate but has less effect on fatigue and quality of life in people with multiple sclerosis compared to a modified paleolithic diet: a waitlist-controlled, randomized pilot study. J Am Coll Nutr. 2021;40(1):13\u201325."},{"key":"B20","series-title":"Front Microbiol","first-page":"1141","article-title":"Reduced mass and diversity of the colonic microbiome in patients with multiple sclerosis and their improvement with ketogenic diet","volume":"8","author":"Swidsinski A","year":"2017","unstructured":"Swidsinski A, Dorffel Y, Loening-Baucke V, Gille C, Goktas O, Reisshauer A, et\u00a0al. Reduced mass and diversity of the colonic microbiome in patients with multiple sclerosis and their improvement with ketogenic diet. Front Microbiol. 2017;8:1141."},{"key":"B21","series-title":"EBioMedicine","first-page":"293","article-title":"Ketogenic diets attenuate cyclooxygenase and lipoxygenase gene expression in multiple sclerosis","volume":"36","author":"Bock M","year":"2018","unstructured":"Bock M, Karber M, Kuhn H. Ketogenic diets attenuate cyclooxygenase and lipoxygenase gene expression in multiple sclerosis. EBioMedicine. 2018;36:293\u2013303."},{"issue":"1","key":"B22","series-title":"Neurol Neuroimmunol Neuroinflamm","article-title":"Impact of dietary intervention on serum neurofilament light chain in multiple sclerosis","volume":"9","author":"Bock M","year":"2022","unstructured":"Bock M, Steffen F, Zipp F, Bittner S. Impact of dietary intervention on serum neurofilament light chain in multiple sclerosis. Neurol Neuroimmunol Neuroinflamm. 2022;9(1)."},{"key":"B23","series-title":"Mult Scler Relat Disord","article-title":"Serum neurofilament light chain in relapsing multiple sclerosis patients on a ketogenic diet","volume":"73","author":"Oh U","year":"2023","unstructured":"Oh U, Woolbright E, Lehner-Gulotta D, Coleman R, Conaway M, Goldman MD, et\u00a0al. Serum neurofilament light chain in relapsing multiple sclerosis patients on a ketogenic diet. Mult Scler Relat Disord. 2023;73:104670."},{"issue":"4","key":"B24","series-title":"Int J Mol Sci","article-title":"The ketogenic diet and neuroinflammation: the action of beta-hydroxybutyrate in a microglial cell line","volume":"24","author":"Polito R","year":"2023","unstructured":"Polito R, La Torre ME, Moscatelli F, Cibelli G, Valenzano A, Panaro MA, et\u00a0al. The ketogenic diet and neuroinflammation: the action of beta-hydroxybutyrate in a microglial cell line. Int J Mol Sci. 2023;24(4)."},{"issue":"19","key":"B25","series-title":"Cell Rep","first-page":"3467","article-title":"Gut microbiome of multiple sclerosis patients and paired household healthy controls reveal associations with disease risk and course","volume":"185","author":"Zhou X","year":"2022","unstructured":"Zhou X, Baumann R, Gao X, Mendoza M, Singh S, Sand IK, et\u00a0al. Gut microbiome of multiple sclerosis patients and paired household healthy controls reveal associations with disease risk and course. Cell Rep. 2022;185(19):3467\u201386.e16."},{"issue":"6","key":"B26","series-title":"Ann Neurol","first-page":"1195","article-title":"Gut microbiome in progressive multiple sclerosis","volume":"89","author":"Cox LM","year":"2021","unstructured":"Cox LM, Maghzi AH, Liu S, Tankou SK, Dhang FH, Willocq V, et\u00a0al. Gut microbiome in progressive multiple sclerosis. Ann Neurol. 2021;89(6):1195\u2013211."},{"issue":"1","key":"B27","series-title":"Trials","first-page":"3","article-title":"Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study","volume":"21","author":"Bahr LS","year":"2020","unstructured":"Bahr LS, Bock M, Liebscher D, Bellmann-Strobl J, Franz L, Pruss A, et\u00a0al. Ketogenic diet and fasting diet as Nutritional Approaches in Multiple Sclerosis (NAMS): protocol of a randomized controlled study. Trials. 2020;21(1):3."}],"container-title":["European Journal of Microbiology and Immunology"],"original-title":[],"link":[{"URL":"https:\/\/akjournals.com\/view\/journals\/1886\/13\/2\/article-p29.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/1886\/13\/2\/article-p29.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/1886\/13\/2\/article-p29.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T11:51:28Z","timestamp":1697197888000},"score":1,"resource":{"primary":{"URL":"https:\/\/akjournals.com\/view\/journals\/1886\/13\/2\/article-p29.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,13]]},"references-count":27,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.1556\/1886.2023.00020","relation":{},"ISSN":["2062-509X","2062-8633"],"issn-type":[{"value":"2062-509X","type":"print"},{"value":"2062-8633","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,13]]}}}