Hong Kong — A high fat, low carbohydrate ketogenic diet benefited people with Parkinson's disease (PD), but so did a low fat, high carbohydrate diet, in a new pilot trial.
Both diets led to improvements in motor and nonmotor symptoms, but the patients who consumed the ketogenic diet showed greater improvements in nonmotor symptoms compared with the patients who were given the low fat diet.
Ketogenic diets have been tested in patients with various conditions, such as seizure disorders, and a small pilot study has shown benefits for migraineurs using supplements containing ketones. Preliminary evidence has suggested that manipulating the diet could have an effect on symptoms of PD, but studies have conflicted on the best fat-to-carbohydrate ratio.
Matthew Phillips, MSc, Waikato Hospital, Hamilton, New Zealand, and colleagues therefore carried out a randomized, controlled, pilot trial that compared a ketogenic diet with a low fat diet among PD patients in a hospital clinic. He described the diet plans as simple, affordable, and palatable.
He presented the results of the study during a poster tour here at the International Congress of Parkinson's Disease and Movement Disorders (MDS) 2018.
The primary outcomes measures were the within- and between-group changes in Movement Disorders Society–Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Parts 1-4 over 8 weeks.
Both groups showed improvements in their nonmotor symptoms. "The greatest between-group improvements were seen in urinary problems, pain, fatigue, daytime sleepiness, and cognitive impairment," Phillips said. "Notably, these represent some of the more disabling, less levodopa-responsive nonmotor symptoms in Parkinson's."
PD patients (n = 47) were randomly allocated about equally to consume the low fat or the ketogenic diet. Twenty patients in the former group and 18 in the latter completed the study. At baseline, patients in the ketogenic group were slightly older (mean age, 64.29 years, vs 61.48 years) and had a slightly higher mean Hoehn and Yahr score (2.13 vs 1.78) as well as slightly higher scores on the MDS-UPDRS Parts 1-4.
The groups were well matched regarding sex and other variables. Throughout the study, all patients were assessed by the same neurologist on the same weekday at the same time of day. The neurologist who conducted the assessments was blinded to the randomization.
Total calories of the diets were kept the same. The amount of protein consumed by each group was also kept the same, "which is essential because protein interferes with levodopa absorption," Phillips noted.
As expected, bedtime blood glucose levels were higher in the patients who consumed the low fat, high carbohydrate diet than in the patients who consumed the ketogenic diet. For the patients who were given the ketogenic diet, blood ketone levels were higher, averaging 1.2 mmol/L. "That is well within the range of physiological ketosis, a state in which neurons are obtaining energy from both glucose and ketones, so the neurons are sort of running like hybrid engines," he said.
For both groups, UPDRS scores were significantly decreased, but for the patients who consumed ketogenic diet, there was a greater decrease in scores on Part 1 (nonmotor daily living experiences) than was seen in the patients who consumed the low fat diet, at -4.58 ± 2.17 points (41% improvement) vs 0.99 ± 3.63 points (11% improvement) (P < .001).
https://www.medscape.com/viewarticle/903177
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