Evidence map›Paper›PMID 40836308›Full record

ArticleBMC nutrition2025

Fasting, ketogenic, and anti-inflammatory diets in multiple sclerosis: a randomized controlled trial with 18-month follow-up.

Lina S Bahr, Judith Bellmann-Strobl, Daniela A Koppold, Rebekka Rust, Tanja Schmitz-Hübsch, Maja Olszewska, Jean Stadlbauer, Markus Bock, Michael Scheel, Claudia Chien and 5 more

Registry-linked trialAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC nutrition, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03508414 (Nutritional Approaches in Multiple Sclerosis), which is not on this map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03508414 naunknown statusnot on this map

Nutritional Approaches in Multiple Sclerosis

TypeinterventionalSponsorCharite University, Berlin, GermanyRan2017 to 2021Enrolled111ConditionsMultiple SclerosisArmsketogenic diet, Intermittent therapeutical fasting, Active comparator
3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Trial
  2. Review
  3. Review
  4. Preventive strategies in neuroimmunology.Neurological research and practice · 2026
    Review
  5. Review
  6. The Role of Lipid Alteration in Multiple Sclerosis.International journal of molecular sciences · 2026
    Review
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors.

Lina S Bahr *Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany. lina.bahr@charite.de.
Judith Bellmann-Strobl *Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
Daniela A KoppoldInstitute of Social Medicine, Epidemiology, and Health Economics, corporate member of Freie Universität Berlin and Humboldt-Universität, Charité - Universitätsmedizin, Berlin, Germany.
Rebekka RustExperimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
Tanja Schmitz-HübschExperimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
Maja OlszewskaCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
Jean StadlbauerCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
Markus BockDepartment of Hand Surgery, Upper Extremity and Foot Surgery, Center for Orthopedic Rheumatology and Trauma Surgery, Hospital Waldfriede, Argentinische Allee 40, 14163, Berlin, Germany.
Michael ScheelCharité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
Claudia ChienExperimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
Jan MultmeierBioStats GmbH, Nauen, Germany.
Alexander KrannichExperimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117, Berlin, Germany.
Andreas Michalsen *Institute of Social Medicine, Epidemiology, and Health Economics, corporate member of Freie Universität Berlin and Humboldt-Universität, Charité - Universitätsmedizin, Berlin, Germany.
Friedemann Paul *Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.
Anja Mähler *Experimental and Clinical Research Center (ECRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Lindenberger Weg 80, 13125, Berlin, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundMultiple sclerosis (MS) is the most common inflammatory disease of the central nervous system in young adulthood leading to disability and early retirement. Ketone-based diets improve the disease course in MS animal models and health outcomes in different pilot studies of neurodegenerative diseases.

methodsWe enrolled 105 individuals with relapsing-remitting MS (RRMS) in an 18-month, randomized, controlled study, and randomized them into (1) standard healthy diet (SD) as recommended by the German Nutrition Society, (2) fasting diet (FD) with 7-day fasts every 6 months with intermittent fasting at 6 of 7 days a week or (3) ketogenic diet (KD) with 20–40 g carbohydrates per day. Primary outcome was the number of new MRI lesions after 18 months in the KD and FD compared to SD and compared to baseline. Secondary outcomes included further MRI outcomes, disease biomarkers as well as metabolic, and clinical MS outcomes.

resultsEighty-one participants completed the study. The primary endpoint number of new T2 lesions after 18 months did not change in any of the groups (SD 0 (0-(-1)), FD 0 (2 − 0), KD 0 (2 − 0)). Secondary endpoints were analyzed exploratorily: Compared to baseline, in the FD group, Neurofilament light chain (NfL) -concentrations were lower at 9 months (-1.94 pg/mL, p = 0.042) and depressive symptoms improved slightly at 18 months (p = 0.079). In the KD group, cognition improved at 18 months (symbol digit modalities test + 3.7, p = 0.020). Cardiometabolic risk markers (body mass index, abdominal fat, blood lipids, adipokines, blood pressure) improved in all three groups at 9 months differently and were partially associated with clinical outcomes in the FD and KD group.

conclusionThe results suggest beneficial effects of dietary interventions, underscoring their potential as a complementary strategy in the treatment of RRMS. To further clarify the impact of such interventions on the disease course and patient-centered outcomes — such as cognitive function and depressive symptoms —future studies with larger, more homogeneous study populations are warranted.

trial registrationClinicalTrials.gov, NCT03508414. Retrospectively registered on 25 April 2018.

Indexed as

Anti-inflammatory dietCaloric restrictionCardiometabolic riskCognitionDietary interventionFastingKetogenic dietMRIMultiple sclerosisNfL

Identifiers

PMID40836308
PMCPMC12366206

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.