Satiating Effect of a Ketogenic Diet and Its Impact on Muscle Improvement and Oxidation State in Multiple Sclerosis Patients

Nutrients. 2019 May 23;11(5):1156. doi: 10.3390/nu11051156.


Background: It was previously established that Multiple sclerosis (MS) generates energy alterations at the mitochondrial level related to the loss of muscle mass. Ketone bodies, mainly beta-hydroxybutyrate (BHB), re-establish this energy alteration causing satiety, changes in body composition and a decrease in hormone-dependant hunger, such as ghrelin. The aim of this study was to establish possible improvements in body composition and the level of oxidation in patients with MS, by means of the satiating effect of a ketogenic diet.

Methods: A pilot study was carried out with 27 MS patients who were given a Mediterranean isocaloric and ketogenic diet for 4 months. Anthropometric measurements, as well as satiety and hunger perception (VAS scale), were taken. In addition, BHB and paraoxonase 1 (PON1), as an oxidation marker, were measured by spectrophotometric automated assays, and ghrelin was determined by an enzyme immunoassay in the serum. All measurements were taken before and after the intervention.

Results: A significant increase in satiety perception at lunch and dinner and of BHB in the blood was obtained. Hunger perception decreased significantly at lunch and dinner with similar levels of ghrelin. In addition, an important increase in lean mass and PON1 was observed. To our knowledge, this is the first study addressing improvements in body composition, oxidation state and metabolism in MS patients, based on the satiating effect of a Mediterranean isocaloric diet.

Conclusion: A ketogenic diet increases lean mass and decreases inflammation and oxidation possibly as a consequence of an increase in satiety and decrease in hunger in MS patients.

Keywords: ghrelin; ketogenic diet; multiple sclerosis; paraoxonase 1; satiety; β-hydroxybutyrate.

MeSH terms

  • 3-Hydroxybutyric Acid / blood
  • Adult
  • Aryldialkylphosphatase / blood
  • Biomarkers / blood
  • Body Composition
  • Diet, Ketogenic*
  • Diet, Mediterranean*
  • Energy Metabolism*
  • Female
  • Ghrelin / blood
  • Humans
  • Hunger
  • Male
  • Middle Aged
  • Multiple Sclerosis, Chronic Progressive / blood
  • Multiple Sclerosis, Chronic Progressive / diet therapy*
  • Multiple Sclerosis, Chronic Progressive / physiopathology
  • Multiple Sclerosis, Relapsing-Remitting / blood
  • Multiple Sclerosis, Relapsing-Remitting / diet therapy*
  • Multiple Sclerosis, Relapsing-Remitting / physiopathology
  • Muscle, Skeletal / physiopathology*
  • Oxidation-Reduction
  • Pilot Projects
  • Satiation*
  • Time Factors
  • Treatment Outcome


  • Biomarkers
  • GHRL protein, human
  • Ghrelin
  • Aryldialkylphosphatase
  • PON1 protein, human
  • 3-Hydroxybutyric Acid