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If you live with multiple sclerosis (MS), you’ve probably noticed that everyone online seems to have a
“miracle MS diet” often with a smiling before-and-after photo and absolutely no mention of how hard it
is to give up bread. One of the buzziest eating plans right now is the keto diet for MS:
a very low-carbohydrate, high-fat way of eating that pushes your body into burning fat for fuel.

But catchy TikToks aside, what does the science actually say? Can a ketogenic diet really
improve MS symptoms like fatigue, brain fog, and mood or even change the course of the disease? Or is it
just another overhyped wellness trend with extra bacon?

In this deep dive, we’ll walk through what research has found so far about the keto diet and multiple
sclerosis, where the evidence is promising, where it’s still shaky, and what to keep in mind if you’re
considering trying keto as a complementary approach always alongside, not instead of, your neurologist’s
treatment plan.

Important: This article is for general information and education only. It’s not medical advice and can’t replace a conversation with your own healthcare team.

MS and Diet: Why Food Is Suddenly a Big Deal

MS is a chronic autoimmune disease where the immune system attacks the myelin coating that protects nerve
fibers in the brain and spinal cord. That damage disrupts nerve signaling and leads to symptoms like
fatigue, numbness, vision changes, spasticity, and mobility problems.

Medications that modify the immune response are still the foundation of MS treatment. But over the last
decade, researchers have become increasingly interested in how lifestyle factors especially diet, weight,
and metabolic health may influence inflammation, symptoms, and quality of life.

Observational studies suggest that obesity and insulin resistance are linked with worse disability and
more inflammation in MS, likely through pathways involving inflammatory cytokines like IL-6 and IL-17.
That’s one reason diets that improve metabolic markers including the ketogenic diet have drawn so much
attention.

What Exactly Is a Ketogenic Diet?

A ketogenic diet is a very low-carb, high-fat eating pattern that shifts the body from
burning glucose (sugar) to burning fat and producing ketone bodies for energy. In classic medical keto,
about 70–80% of calories come from fat, 10–20% from protein, and only about 5–10% from carbohydrates.

In MS research, participants typically follow a relatively strict version of keto often limiting carbs
to under 20 grams per day (think: the carbs in one banana… for the entire day).
That usually means:

• Lots of oils, avocados, nuts, seeds, eggs, cheese, and fatty fish
• Plenty of non-starchy vegetables (leafy greens, broccoli, cauliflower)
• Very little fruit, grains, beans, or starchy vegetables
• No sugar-sweetened foods or drinks

When carbs are that low, insulin levels drop and the liver produces ketone bodies (like beta-hydroxybutyrate).
These ketones can fuel the brain and may also have anti-inflammatory and neuroprotective effects at least
in animal models of MS and other neurodegenerative diseases.

What the Research Says So Far About Keto and MS

Small Clinical Trials Show Symptom and Quality-of-Life Gains

Human research on the keto diet in MS is still relatively new and mostly involves small, short-term studies.
But several trials have reported encouraging results.

One of the most cited studies is a phase II, six-month trial in people with relapsing MS
led by Dr. J. Nicholas Brenton at the University of Virginia. About 65 participants followed a ketogenic
diet for six months, with daily urine ketone testing to confirm adherence. Roughly 83% stuck with the diet
for the entire study period, which is impressive given how restrictive keto can be.

The results were eye-catching:

• Participants had significant reductions in fat mass and body weight.
• Self-reported fatigue and depression scores dropped by nearly 50% on average.
• Physical and mental quality-of-life scores improved over the six months.

Disability scores (like the Expanded Disability Status Scale, or EDSS) showed slight improvement in some
ketogenic and fasting-mimicking diet groups in related research, though the changes were modest and not yet
definitive.

A systematic review published in 2025 concluded that ketogenic diets for MS appear
generally safe and tolerable in the short term and may improve fatigue, mood, and quality
of life, but the overall evidence quality is still low to moderate due to small sample sizes and limited
follow-up.

Mechanisms: Why Keto Might Help in MS

Keto isn’t just about weight loss although weight loss and better metabolic health can help reduce
systemic inflammation. Researchers are also interested in several potential neurobiological
mechanisms:

• Anti-inflammatory effects: Animal models of MS show that ketogenic diets can dampen
  inflammatory pathways and reduce levels of pro-inflammatory cytokines associated with demyelination.
• Better mitochondrial function: Ketones may support more efficient energy production in
  neurons and glial cells, which could be helpful in a disease where energy failure and oxidative stress
  contribute to damage.
• Glutamate regulation: A 2023 review suggested that ketone bodies may help normalize
  glutamate signaling by improving metabolic health and reducing obesity-related inflammation potentially
  influencing disability and emotional symptoms like anxiety and depression.
• Metabolic risk factor improvements: Keto often improves insulin resistance, triglycerides,
  and other metabolic markers that are linked to worse outcomes in MS and other inflammatory diseases.

Put simply, keto is being explored not just as a “diet,” but as a form of metabolic therapy
that might support the brain and immune system.

Important Limits: What We Don’t Know Yet

Before we crown the ketogenic diet the official MS diet, there are some big caveats:

• Most trials have been small (dozens, not hundreds of people).
• Many have been open-label and uncontrolled meaning no comparison group on a different
  diet or standard eating pattern.
• Follow-up is usually short (3–6 months), so we don’t know how keto affects MS over
  years or decades.
• There’s currently no strong evidence that keto reduces relapse rates, MRI lesion load,
  or long-term disability compared to other balanced, anti-inflammatory diets.

Major organizations, including the National MS Society and American Society for Nutrition, emphasize that
there isn’t enough evidence yet to recommend a specific diet keto, Swank, Wahls, or otherwise as a
proven way to change the underlying course of MS.

Potential Benefits of Keto for People With MS

That said, the early research and many real-world experiences highlight several areas where a
keto diet for MS may help some people.

Less Fatigue (and Possibly Less Brain Fog)

Fatigue is one of the most disabling MS symptoms, and it doesn’t always respond well to medication.
In multiple studies, people on ketogenic or ketone-focused diets reported meaningful reductions in
fatigue scores, sometimes by about half.

Because ketones are a more efficient fuel than glucose for some brain cells, researchers think that
metabolic “smoothing” of energy supply plus reduced inflammation may explain some of these fatigue
improvements.

Mood and Quality-of-Life Improvements

In the UVA phase II trial, participants not only felt less tired; they also reported lower
depression scores and better mental and physical quality of life.
Other trials of ketogenic or fasting-mimicking diets in MS also describe better self-reported well-being
and daily functioning.

Is that because of ketones themselves, the structure of being in a trial, weight loss, or feeling more in
control of the disease? Probably a mix of all of the above which is exactly why larger, controlled
studies are needed.

Weight Loss and Metabolic Health

Many participants in MS keto studies lost significant amounts of fat mass, which may
reduce systemic inflammation and improve mobility, especially if extra weight was worsening joint or
fatigue issues.

For people with MS who also have obesity, prediabetes, or metabolic syndrome, a structured ketogenic
diet (done with medical supervision) may be one way to improve overall health which indirectly supports
the brain and immune system.

Risks, Side Effects, and Who Should Be Careful

The keto diet is powerful, but it’s definitely not harmless and it’s not right for everyone with MS.

In a 2022 study of keto in relapsing MS summarized by the MS Trust, most people tolerated the diet over
six months, but side effects were common, especially in the first few weeks.
These included:

• Constipation
• Diarrhea or nausea
• “Keto flu” symptoms like headache and fatigue
• Occasional acne or mood changes

The American Academy of Neurology has also cautioned that keto diets may carry risks like
kidney stones, digestive problems, and nutrient deficiencies, especially when followed
long term or without professional guidance.

Extra caution (or a different diet) may be needed if you:

• Have a history of kidney disease, pancreatitis, or severe liver disease
• Are underweight or have trouble maintaining your weight
• Have an eating disorder or a history of disordered eating
• Are pregnant, breastfeeding, or planning pregnancy
• Take certain medications that affect kidneys or metabolism

That’s why any ketogenic diet for MS should be done with a neurologist and a registered
dietitian, not just a random app and a bag of almond flour.

If You’re Considering Keto for MS: Research-Informed Tips

Thinking about trying a ketogenic diet for MS symptoms like fatigue or brain fog? Here are some
practical principles based on what studies have actually done and what experts recommend.

1. Start With Your Neurologist (and a Dietitian)

Bring up keto at your next MS appointment. Ask:

• Is keto safe for me given my meds, history, and current symptoms?
• Are there lab tests we should do before and during the diet (lipids, kidney function, etc.)?
• Can you refer me to a dietitian who understands MS and therapeutic diets?

Importantly, no study has asked people to stop disease-modifying MS medications to try
keto. The diet is being explored as an add-on, not a replacement.

2. Aim for Whole-Food Keto, Not “Cheese-and-Bacon Keto”

Most MS-focused research encourages a nutrient-dense version of keto that includes:

• Non-starchy vegetables at most meals
• Healthy fats (olive oil, avocado, nuts, seeds)
• Fatty fish and moderate-fat protein sources
• Limited processed meats and ultra-processed foods

This lines up with broader MS diet research showing benefits from patterns rich in fruits, vegetables,
and minimally processed foods, whether that’s keto, the Wahls protocol, Swank, or a Mediterranean-style
approach.

3. Monitor Symptoms, Not Just the Scale

Because many people try keto hoping to reduce MS fatigue, mood issues, or cognitive fog,
it’s smart to track these alongside weight and lab tests.

Some people keep a simple weekly log of:

• Fatigue (0–10)
• Depression/anxiety (0–10)
• Mobility or balance issues
• Sleep quality

If your quality of life isn’t improving after a few months or if you feel worse that’s useful data
to bring back to your care team.

4. Think Long-Term Sustainability

The toughest question isn’t “Can I try keto for six months?” but “Can I live with some version of this
for years?” Some people end up transitioning from strict keto to a more moderate low-carb or
Mediterranean-style plan once symptoms improve or weight stabilizes.

The National MS Society emphasizes that whatever MS diet you choose should be one you can maintain
safely in the long run, while still leaving room for joy, social life, and the occasional slice
of birthday cake.

How Keto Compares With Other MS Diets

Keto isn’t the only game in town. Other popular MS diets include:

• Swank diet: A low–saturated-fat plan (≤15 g/day) emphasizing fish, whole grains, and
  low-fat dairy. Early observational work suggested better long-term outcomes in people who followed it,
  but the evidence is older and not from modern randomized trials.
• Wahls protocol: A modified Paleo-style diet with high vegetable intake, especially leafy
  greens and colorful produce, plus elimination of gluten and dairy in some versions. Trials show reduced
  fatigue and better quality of life, similar in magnitude to Swank.

A key theme across Swank, Wahls, and ketogenic diets is fewer ultra-processed foods and more
nutrient-dense whole foods. That may be just as important as any specific macro ratio.

For now, no diet including keto has enough evidence to be declared “the best MS diet.” Instead, the
goal is to find an eating pattern that supports your energy, mood, metabolic health, and overall
lifestyle, in partnership with your healthcare team.

Key Takeaways: Keto and MS in Plain Language

• Early research shows that a keto diet for MS may reduce fatigue, improve depression
  scores, and boost quality of life in the short term for some people.
• Animal studies and reviews suggest ketones may have anti-inflammatory and neuroprotective effects, and
  improving metabolic health seems helpful in MS overall.
• However, human trials are still small and short, and we don’t yet know if keto changes
  relapse rates, MRI lesions, or long-term disability.
• Keto can cause side effects and isn’t appropriate for everyone, so it should only be tried with medical
  supervision and never as a replacement for disease-modifying MS therapies.
• Keto is best viewed as one possible complementary strategy within a bigger plan that
  includes medication, movement, sleep, stress management, and social support.

Real-World Experiences With Keto and MS: What People Notice

Research papers tell one side of the story. Lived experience tells another. While everyone’s journey with
multiple sclerosis is different, many people who experiment with a ketogenic diet for MS describe a
similar pattern of ups and downs.

The first week often feels… rough. Imagine switching from being a “carb engine” to a “fat engine” overnight.
Some people report classic “keto flu” symptoms: headaches, crankiness, and a sense that their brain has
temporarily been replaced with cotton wool. For someone who already battles MS fatigue, that can feel like
a bad trade at first.

Then, if the diet is well structured and hydration and electrolytes are on point, things may shift. Many
people say that their energy becomes more stable throughout the day. Instead of the sharp
post-lunch crash, they describe a “smooth and steady” feeling. Some notice that their legs still get tired
on stairs, but the overwhelming need to collapse on the couch afterward isn’t as intense.

Mood changes are another common theme. While depression and anxiety are complex and never just about food,
a number of people report feeling slightly more emotionally resilient on keto less “dragged down” by
the day-to-day grind of living with MS. Others are more neutral: they don’t feel dramatically different
mentally, but they appreciate the sense of having something concrete they can do to support
their health.

Socially, keto can be tricky. Work events, family gatherings, and holidays revolve around carbs the
lasagna, the birthday cake, the holiday cookies. People who stick with the diet long term often talk about
developing a toolkit: learning to bring a keto-friendly dish to gatherings, eating a solid meal before
going out, or simply deciding in advance whether a particular occasion is worth a small, planned deviation.
The goal shifts from “perfect keto 24/7” to “consistent enough to feel the benefits without feeling socially
isolated.”

Another big lesson from real-world experience is the importance of flexibility over time.
Some people start with strict keto tracking macros carefully, measuring portions, testing ketones and
then gradually transition to a less rigid, but still lower-carb, style of eating once they understand how
their body responds. Others realize that keto is simply not their match: maybe their cholesterol climbs,
their GI system protests, or the mental load of tracking every gram of carbohydrate becomes a stressor in
its own right.

Perhaps the most valuable takeaway from these lived experiences is that diet is just one piece of the MS
puzzle. People who feel best tend to combine nutrition changes with other supportive habits: gentle but
consistent movement, prioritizing sleep, pacing their energy, and keeping a strong relationship with their
neurology team. Keto may be one helpful lever but it works best alongside many others.

If you’re curious about trying a ketogenic diet for MS, it can help to view it as an experiment,
not a life sentence. With the guidance of your neurologist and a dietitian, you can set clear goals
(for example, “Does my fatigue improve over three months?”), make a plan, and then honestly evaluate how
you feel. If keto brings noticeable improvements and you can live with it, it may earn a place in your
long-term toolkit. If not, that’s valuable information too and there are plenty of other evidence-informed
nutrition strategies to explore.