Abstract W P136: Aiding Stroke Rehabilitation with the Modified Atkins Diet: A Pilot Trial

Abstract

Introduction: The Modified Atkins Diet (MAD) is a low carbohydrate, ketogenic diet. Animal studies suggest ketogenic diets enhance functional stroke recovery by activating transcriptional programs associated with brain protection and repair. The safety of use of the MAD in the elderly stroke population is however unknown. We here expand the use of MAD in a new patient population. Setting: Inpatient Stroke Rehabilitation Unit Methods: 18 first time ischemic stroke patients were randomized to receive either the MAD or their respective regular diet. Laboratory studies were obtained upon admission and every 5 days until discharge. Functional outcome measures included the Upper Extremity Fugl Meyer Motor Score (FMMS), Functional Independence Measure (FIM) and Montreal Cognitive Assessment (MOCA). Urine was tested daily for presence of ketones. A registered dietician monitored patients daily. All patients received cholesterol-lowering medication. Results: 10 patients received the MAD and 8 respective control diets. Age, gender, and interval post stroke did not differ significantly between groups. No significant difference existed between groups in admission cognitive, motor and total FIM scores, FMMS and MOCA scores. 4 patients withdrew prematurely from the MAD group due to low palatability of a pureed diet with nectar thick liquids. No significant medical events were encountered in either group. The MAD did not induce significant changes in LDL (-13.8±29.7 vs. -7.5±19.2;p=0.59), cholesterol (-9.2±36.5 vs. -10.8±25.22;p=0.92) and glucose levels (14±28.5 vs. -0.38±20.5;p=0.4).The MAD and Control group had similar changes in total (30.9,±12.3 vs. 25.9±11.9;p=0.5), motor (18.8±14.5 vs. 18.5±13.1;p=0.62), cognitive FIM (4.5,±2.3 vs. 5±3.5;p=0.4),FMMS(15.2±5.01 vs. 17.8±11.6;p=0.65),and MOCA scores (6.2±5.2 vs. 4.6±2.96;p=0.57). Conclusion: The Modified Atkins Diet is a safe and feasible intervention to aide stroke recovery. No adverse effects on lipid and glucose profile were noted, and the diet was overall well tolerated. A larger, multi-center trial will be needed to test for efficacy. The study also highlights the advantages of the rehab setting for implementing dietary interventions post stroke and verifying compliance.