Abstract
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.
Highlights
Multiple sclerosis (MS) is a neurodegenerative disease of an autoimmune nature that produces inflammation and demyelination on the sheath of neurons, altering energy activity of axonsNutrients 2019, 11, 1156; doi:10.3390/nu11051156 www.mdpi.com/journal/nutrientsNutrients 2019, 11, 1156 on a mitochondrial level [1,2,3]
Ketogenic diets could cause changes in the way the brain’s energy levels are used, increasing the medium-chain triglycerides (MCT)1 and MCT4 transporters and decreasing the glucose transporter 1 (GLUT1) transporter, which are responsible for transporting ketone bodies and glucose, respectively, through the blood-brain barrier (BBB), especially in the hippocampus and the prefrontal cortex [10], regions which are deteriorated in MS patients [11,12]
This study analysed a sample of 27 MS patients with a comparable proportion of patients of the different types of MS accepted at present and a mean age of 44.56 years (Table 1)
Summary
Multiple sclerosis (MS) is a neurodegenerative disease of an autoimmune nature that produces inflammation and demyelination on the sheath of neurons, altering energy activity of axonsNutrients 2019, 11, 1156; doi:10.3390/nu11051156 www.mdpi.com/journal/nutrientsNutrients 2019, 11, 1156 on a mitochondrial level [1,2,3]. Some of the physical consequences include muscle loss or changes [4,5], directly associated with a deterioration in the complex I enzyme of the mitochondrial respiratory chain [4]. Ketone bodies have neuroprotective effects in energy alterations at a mitochondrial level which have been demonstrated in several neurological disorders, such as epilepsy [6,7], Parkinson’s disease [8]. 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. 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
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