Lee Jennifer E, Titcomb Tyler J, Bisht Babita, Rubenstein Linda M, Louison Rebecca, Wahls Terry L
Department of Psychology, Mount Mercy University, Cedar Rapids, Iowa, USA.
College of Nursing, The University of Iowa, Iowa City, Iowa, USA.
J Am Coll Nutr. 2021 Jan;40(1):13-25. doi: 10.1080/07315724.2020.1734988. Epub 2020 Mar 26.
To investigate the feasibility of a modified MCT-based ketogenic diet and its impact on plasma β-hydroxybutyrate and MS outcomes compared to a modified Paleolithic diet and usual diet in people with Multiple Sclerosis (MS).
Fifteen individuals with MS were randomized to 3 groups: 1) modified Paleolithic diet (Paleo; = 6); 2) medium-chain triglyceride (MCT)-based ketogenic diet that included coconut as a fat source (Keto; = 5); or 3) usual diet (Control; = 4). Participants had blood drawn every 4 weeks to monitor nutritional ketosis. Participants completed 4-day weighed food records, measures of disability, fatigue, quality of life (QoL), cognitive function, and physical function at baseline and 12-weeks.
Macronutrient intake significantly shifted toward a ratio indicative of a ketogenic diet in the Keto group at 12 weeks. Similarly, plasma β-hydroxybutyrate indicated nutritional ketosis in the Keto group, whereas neither macronutrient intake nor plasma β-hydroxybutyrate indicated nutritional ketosis in the Paleo and Control groups. The Paleo group had significant within group reductions in fatigue scores and maintained cognitive function scores compared to the Control group. The Keto group had significant reductions in fasting glucose and insulin compared to baseline values; however, no clinical outcomes significantly changed.
Participants consuming the MCT-based ketogenic diet achieved nutritional ketosis; however, it was not associated with significant clinical improvement in this study whereas the modified Paleolithic diet was associated with significant clinical improvements. Larger randomized controlled trials are needed to determine the safety and efficacy of the modified Paleolithic and MCT-based ketogenic diets on MS.
在多发性硬化症（MS）患者中，研究改良的中链甘油三酯（MCT）生酮饮食的可行性及其与改良的旧石器饮食和常规饮食相比对血浆β-羟基丁酸酯和MS结局的影响。
15名MS患者被随机分为3组：1）改良的旧石器饮食组（旧石器组；n = 6）；2）以中链甘油三酯（MCT）为生酮饮食且以椰子为脂肪来源的组（生酮组；n = 5）；或3）常规饮食组（对照组；n = 4）。参与者每4周采血以监测营养性酮症。参与者在基线和12周时完成了为期4天的称重食物记录、残疾程度、疲劳程度、生活质量（QoL）、认知功能和身体功能测量。
在12周时，生酮组的常量营养素摄入量显著转向生酮饮食的比例。同样，生酮组的血浆β-羟基丁酸酯表明存在营养性酮症；而旧石器组和对照组的常量营养素摄入量和血浆β-羟基丁酸酯均未表明存在营养性酮症。与对照组相比，旧石器组组内疲劳评分显著降低，认知功能评分保持不变。与基线值相比，生酮组的空腹血糖和胰岛素显著降低；然而，没有临床结局有显著变化。
食用基于MCT的生酮饮食的参与者实现了营养性酮症；然而，在本研究中这与显著临床改善无关，而改良旧石器饮食与显著临床改善有关。需要更大规模随机对照试验来确定改良旧石器饮食和基于MCT的生酮饮食对MS的安全性和疗效。
