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I just learned that there are trials going on about ketogenic diet and MS. Apparently the first trial at the Charité Hospital Berlin showed significant benefits from this diet.

Here's the study: https://www.researchgate.net/publicatio ... lled_trial

An article about it in German: http://dmsg.de/multiple-sklerose-news/i ... g&anr=5821

A video interview in English: https://www.youtube.com/watch?v=RqPPmX9zYUU

Another article about the potential of a ketogenic diet: http://www.hindawi.com/journals/msi/2015/681289/, it concludes that "The ketogenic diet has the potential to treat the neurodegenerative component of progressive MS "

I know this is probably hard to reconcile this with the findings of Dr. Swank, but first of all we are evidence based, aren't we? ;)

Can a super-diet be developed that provides both mechanisms of action?

Cheers,
Reto
Thank you for so much for posting this, Rete. It can only be for the good that researchers re-examine long-held assumptions and the finding that diet (albeit not one that seems immediately compatible with the OMS regime!) can make a positive difference to progressive MS is really interesting.

Unfortunately a 'phone line fault means we have barely any internet access at the moment so I am not able to read up about a ketogenic diet (my impression is it is low carbohydrate?) but I look forward to exploring this topic when I have proper access to cyberspace again.

Thanks again!

Jette
The Gut Microbiome is KEY to optimal health.
The OMS site & forum are brilliant! Thanks, everyone! :D
Dear Reto,
this pilot study on ketogenic diet (by the team of Prof. Dr. Friedemann Paul and Dr. Marcus Bock at the Charité in Berlin) first stirred much interest among my German friends with MS, when preliminary results were published in a TV programme (in the TV health show “Visite” on the German channel NDR) in September 2013 (no longer available on the NDR-website). Three of my MS friends were so impressed by the improvements in walking that one participant of the study reported in front of the camera that they decided to switch to the ketogenic diet. I myself was very impressed at that time, too — and felt made extremely uncertain in my choice of diet (I had been for 6 months on the OMS diet at that time).
In my confusion, I wrote long letters to the Charité scientists and to the OMS team, asking a couple of questions. I received answers from both, that did not sort out my problem for me, but helped me to form my own personal decision, when I pondered the following points:

1. The Charité study was only a pilot study of a duration of only sixth months. (In contrast, Dr. Swank had observed his patients for 34 years.)
2. The Charité study had only a small number of participants: 60 persons with MS, of which they put 20 in the control group (who did not change their diet), 20 in the group that fasted intermittently and 20 in the ketogenic diet group. Thus, the reported benefits of the ketogenic diet emerged in the rather small sample of only 20 persons.
3. The results of the ketogenic diet group were compared to the results of the control group who ate “Mischkost ohne Ernährungsveränderung”, that is: an omnivore diet without dietary changes — more or less, I would say, “standard western diet”, which can not be considered healthy for anybody. In contrast, the participants of the ketogenic diet group were encouraged to eat mountains of vegetables (A friend showed me a one-week meal plan: many veggies with each meal of the day!) and to include flaxseed oil and oily fish in their diet. In my view, it is possible, that any positive result in the ketogenic diet group – in comparison to the poorly eating control group – might be due to veggies and flaxseed oil in comparison to “standard western diet”. I would have liked to see a comparison between a ketogenic diet group and a group following Swank or OMS! Only in such a study design one would be able to determine whether ketogenic diet can offer any advantage over OMS. Personally, I would like to know whether ketogenic diet can beat OMS diet, not whether it can beat an unhealthy “standard western diet”.
4. Ketogenic diet is so extremely carb-reduced, that it is probably automatically an almost gluten-free diet, even if gluten was not strictly or intentionally removed from the diet (as one the Charité scientists wrote me). I wonder whether it might be possible that the good results of the ketogenic diet group were also due to some latent gluten sensitivity in some of the participants (unbeknown to themselves), who during the study may have profited much from eating gluten-free – and pushed the average result into the improvement zone.
5. The impact of the three forms of diet on the participants was measured at the Charité by “MS-54 self assessment questionnaires” and by testing the blood lipid profiles. I do not want to dismiss self assessment questionnaires as unreliable or non-scientific, but in such a small study I would have liked so see also some more objective measuring like taking the time a participant needs to walk a distance or measuring walking distances, measuring concentration time spans and so on.

My personal resumée of these points is that the evidence for the benefit of the ketogenic diet for people with MS, and especially the evidence that ketogenic diet might work better than OMS, is yet much too scanty to induce me to switch to the ketogenic diet – and to forego the benefits of OMS for this experiment, because one thing seems to be very clear to me:
You will not be able to reconcile OMS and ketogenic diet to each other or combine and unite them to one diet which meets the criteria of both!
On ketogenic diet you need to eat 80% of your daily calories in the form of fat. The rest are some proteins and mountains of veggies with almost no calories. And you will eat almost no carbs. If we think e. g. of a caloric need of 2,000 calories per day, this would mean that you would have to eat 1,600 calories in form of fat. Even if you chose to use only flaxseed oil to meet this fat-intake requirement, the 178 ml flaxseed oil, which you would then consume, would contain around 17,3 g sat fats — far more than we on OMS should aim at.

The Charité will set up a larger trial (and of longer duration) which is due to start at the end of 2016. They will probably – and to my great regret – not compare the ketogenic diet against Swank’s diet or OMS, because they do not view Swank or OMS as evidence-based or established standard diets for MS. Literally, they told me: “Herr Swank und die anderen genannten Kollegen [sc. Jelinek] schulden einen wissenschaftlichen Beleg ihrer Ernährung bis heute.” which roughly translates to: “Dr. Swank and the other doctors mentioned [i. e. George Jelinek] have not yet provided scientific evidence for their diets.” – a statement which I do not agree with.

Let’s wait and see what the Charité (or other scientists) will come up with in a couple of years! As yet I think the best available evidence is on the side of OMS, and I am determined to stick to OMS.

I am absolutely confident that George Jelinek and the OMS team will revise their recommendations, if in the future truly sound evidence for another diet will emerge.

Hope, this helps!
Best regards
Zoë
Thank you for sharing.
My take would be it is a diet to aim at the popular fads, low carbs and no restriction on fat. It is not something I feel any urge to find out more on .
Just a reminder of this thought provoking study. It is unlikely that you would want to take on any high fat diets after reading it. See what you think.


https://overcomingms.org/news-research/ ... t-disease/
Dx 1992 OMS 25-2-09
I am really grateful to Reto for bringing attention to the ketogenic diet. Ketones and the ketogenic diet is something I suspect we will be hearing more about in years to come. The diet has proved spectacularly successful as a treatment for children with otherwise hard-to-control epilepsy and as Reto points out, researchers are now exploring whether there is potential for a ketogenic diet (KD) to play a role in treating other neurological conditions, including Alzheimer's, Parkinsons and MS (1). What appears particularly exciting is that doctors have observed children remaining seizure-free during two years on the diet, and continuing to be free of seizures even after the diet and anti-consvulsant medicine was discontinued. So maybe KD has the ability to 're-boot' the brain?

The website http://www.ketogenic-diet-resource.com (created by a dietician with a Master's degree in Applied Clinical Nutrition) explains that:

"the restriction of carbohydrate is key to the KD diet. When carbohydrate foods (sugar and starch) are digested, they are broken down into blood sugar (glucose) in the body. The more carbs we eat, the more glucose is created. If we reduce carb intake and instead eat more fat and proteins, it causes our internal metabolic pathways to switch from burning sugar to burning fat. This switch produces ketone bodies while at the same time reducing blood sugar and insulin levels."

The heart, muscle and brain come to rely on fats to fuel themselves (humans developed the ability to burn ketones as fuel as an adaptation for periods when other food was unavailable) and the body enters a state of nutritional ketosis. As the article by Stafstrom & Rho (1) outlines, there is growing research evidence that this state of nutritional ketosis has the capacity to protect neurological pathways and even reverse neurogeneration (damaged myelin in the case of MS).

The 2015 article in 'Multiple Sclerosis International' (2) to which Reto provided a link reviews the research evidence for a ketogenic diet being effective for treating progressive MS. The authors also question the long held assumption that inflammation comes first and leads to the neurological damage, instead putting forward the idea that it is the neurological damage that leads to the inflammation. Their rationale for this is that there is increasing observation of neurological degeneration even when there is no inflammation.

Reading this, I was struck by the recollection of a post I read on on this forum just a few weeks ago: the writer had been for an interval scan and was told there was no evidence of inflammation. Why then, she had asked, was her walking continuing to deteriorate? The medical practitioner had given what sounded like rather a vague reply along the lines of 'there must be some inflammation somewhere'.

The thought that the neurological damage is continuing to take place even though the inflammation is being controlled (by keeping saturated fats to the minimum possible, as per the OMS guidelines) makes me, at any rate, keen to explore whether it would be possible to combine any of the (neuroprotective) KD components with OMS..

Zoë provides a brilliant summary and critique of the Charité pilot study and I can only agree with her conclusion that it would not be possible to combine OMS with the KD diet followed in the Charité study. Given the many thousands of people who have derived huge benefits from following the OMS guidelines it is not at all tempting to abandon OMS for the unknown territory of KD, either. As Reto says, it would be ideal to come up with superdiet that combined the two! The Charlie Foundation (http://www.charliefoundation.org), who treat children with epilepsy, do distinguish different levels of KD, with the classic ketonic diet having a 4:1 or 3:1 ratio of fat to non-fat (protein and carbohydrate) and a modified ketogenic diet having a fat to non-fat ratios of 2:1 and 1:1.

It might be interesting to explore whether any of these modified KD ratios would a) be likely to have any therapeutic effect and b) be compatible with OMS? There are already many forum contributors who choose to avoid or minimise sugar, and I - for one - could doubtless do to watch my carbohydrate intake (it is very easy to reach for the cereal, bread or pasta, especially when the energy levels are low . . .).

For anyone wishing to explore KD in more detail, http://www.ketogenic-diet-resource.com has a wealth of information to offer and http://ketodietapp.com/Blog/page/Start-Here has comprehensive lists of KD foods, a food pyramid, meal plans (including ones for vegans), recipes etc.

All this worrying about food almost makes one want to fast. Which actually, is another way of achieving ketosis . . .

Bon appetit to one and all!

Jette


1) Carl E. Stafstrom and Jong M. Rho, 'The Ketogenic Diet as a Treatment Paradigm for Diverse Neurological Disorders', Frontiers in Pharmacolgy, April 2012 - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321471/
(2) Mithu Storoni and Gordon T. Plant, 'Review Article: The Therapeutic Potential of the Ketogenic Diet in Treating Multiple Sclerosis', "Multiple Sclerosis International", Vol. 15 - http://dx.doi.org/10.1155/2015/681289
The Gut Microbiome is KEY to optimal health.
The OMS site & forum are brilliant! Thanks, everyone! :D
Thank you very much for your replies.

Zoe, its great that you got that additional information from the Charité researchers. Its a bit harsh to say that there is no scientific evidence for the Swank diet, there seems to be at least enough to warrant further studies. Personally I'm not so convinced that it was the actual reduction of saturated fats that cause the improvements observed by Swank, if I'm not mistaken no other study could confirm this effect. It seems to me, that it might well be that it was the change in the ration of the polyunsaturated acids (more omega-3, less arachidonic acids) that came along with the diet that caused the effect and not the actual reduction in saturated fats.

Jette, thanks for the further informations. Yes fasting would be the easiest, unfortunately I'm underweight already so that isn't really a good option for me. I also haven't had any inflammation for the almost 4 year I've been on OMS diet (and the part I was most strict about was the sat-fats) but quite some worsening of my walking abilities. This makes me reevaluate my diet and think that the effective aspects of the OMS diet might lie in the intersections it has with other diets that seem to be effective. I'll definitively have a look at the resources you provide.

Cheers,
Reto
Reto,

Sorry to hear your walking abilities have gone in reverse. It sounds like you are doing whatever you can in terms of diet to reverse that path and I applaud and support your efforts. George recently wrote a fantastic blog for the website and closed with this paragraph which may be applicable to your situation:

"Everyone has their own individual journey in recovering from MS. We are here to help on that journey, but there are many paths to true health. How you establish your own path and what you explore is up to you. At OMS we believe we provide strong evidence-based guidance about a generic path that will help most people, but we welcome everybody with MS whether recovering or not, and hope your input into our organisation can help all the others on their journeys. We wish you all long, healthy and happy lives."

Your search for diet-related answers are interesting, but I also wonder if you have embraced the OMS program in its entirety. In other words, are you also getting enough exercise and meditating on a regular basis - two key components to the OMS lifestyle?

I'm happy to meet with you anytime and offer whatever support I can... Perhaps just a chat would be useful...

All the best,
Jack
Diagnosis: Jul 2009
OMS: Jan 2010
Hi there guys,

It was really great to read all your thoughtful comments on this. I would love to get your thoughts on this.

I have been reading more and more on the importance of the microbiota and having the right diversity of microbes, antibiotic use resulting in having a poor microbiome and the links with autism, AI, obesity and treatments such as faecal transplants. This included a study that marks the difference in the micribiata of MS patients when compared with healthy control patients:
https://www.sciencedaily.com/releases/2 ... 130221.htm

I also came across this program http://becomeawellnesschampion.com/ and have been listening to some of the videos on the site and on the facebook page. The website isn't a great one and I don't love the way the lady Pam presents the information itself. But I was wondering about the program itself.

It implicates dysbiosis, bad microbes and silent infections (fungi, yeast e.g. candida types) as the root cause of MS and some other AI diseases and promotes a nutritious ketogenic diet, mixed with a healthy lifestyle, removal of toxins and infections as the way to overcome these diseases.

It seems to suggest that inflammation is a symptom of the underlying infection. The ketogenic diet works because it starves/kills the fungus/yeast which need glucose (from carbs).

It made me wonder about whether the OMS program may be helping by removing inflammation but not treating some underlying cause (e.g. infection) which is why you can remove inflammation but still have disease progression.

I'm definitely not a research scientist but it feels like there may be some interesting links here.... what do you all think?

This study about fungus in the microbiome is also interesting:
https://www.sciencedaily.com/releases/2 ... 151435.htm
Diagnosed 2013
OMS retreat Feb 2016
Tecfidera
My own worry with starving candida is it might then cause it to change to the mycelium variant and be even harder to rid. I do feel gut health is important and would love a quick fix to create a perfect balance of flora.
I already don't consume refined/unrefined sugar or bread or pasta as choose to be wheat free.
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