Ketogenic diet in MS patients as an aid to increase microbiota diversity and quantity
A recent study published in the journal Frontiers in Microbiology explores the role of gut microbiota in multiple sclerosis, specifically the changes in its quantity and the potential for influencing microbiota through a ketogenic diet.
Gut Microbiota
Gut microbiota is a complex ecosystem with seemingly great significance for health. Several decades ago, it was discovered that all vertebrates, including humans, are colonized by a wide range of bacteria, fungi, viruses, and parasites that exist in symbiotic homeostasis. The term microbiota refers to the ecological community of commensals and potential pathogens living in our bodies. The term microbiome, which refers to the genome of microbiota, is used interchangeably.
The effects of microbiota include protection against pathogens, breakdown of complex carbohydrates, production of short-chain fatty acids, further processing of metabolic products flushed into the intestine by bile, and the production of vitamins (K, B12, niacin, pyridoxine).
The enormous bacterial diversity in the gut provides a significant antigenic diversity and shapes a healthy immunity. Many studies have demonstrated the role of the gut microbiome in the pathogenesis of obesity, gastrointestinal and endocrine diseases, and its crucial role in the development of autoimmune diseases, including multiple sclerosis (MS). The gut microbiome is dynamically changing and largely depends on lifestyle factors, especially diet.
Quantity is also important
Most studies focus on finding a typical microbial pattern, thus having a qualitative nature. However, the aim of this study is particularly to assess the quantity, or concentration, of various microbial groups in MS patients and healthy controls, and to monitor changes in the colonic microbiome during a ketogenic diet. This is a diet high in fats, moderate in proteins, and limited in carbohydrates. Its principle is to maintain the body in ketosis, where it uses ketone bodies (mainly beta-hydroxybutyrate) as an alternative energy source. Unlike many other diets, a ketogenic diet is well tolerated even in the long term. The possibility of objective compliance can be an advantage, verified through blood and urine analysis using laboratory methods.
Study methodology and progression
The study included 14 healthy volunteers and 25 patients with relapsing-remitting multiple sclerosis (RRMS). Their gut microbiome was analyzed using fluorescent in situ hybridization (FISH) with 162 ribosomal RNA probes.
After the initial evaluation of microbiota, a random selection of 10 RRMS patients underwent a 6-month ketogenic diet. Compliance was monitored by measuring blood beta-hydroxybutyrate concentrations (≥ 500 μmol/l) twice a week after dinner and urine acetoacetate concentrations (≥ 500 μmol/l) once a week after dinner. Stool samples were collected at 0, 2, and 12 weeks and after 6 months. The concentration of 35 numerically significant bacterial groups was assessed.
Results
No typical pattern was found in the representation of specific bacterial groups in RRMS patients. However, the quantity and diversity of gut microbiota were significantly reduced. The diversity of numerically significant bacterial groups in RRMS patients was 36% lower compared to healthy controls (p < 0.001), and the overall concentration of all significant bacterial groups was on average 24% lower compared to healthy controls (65 vs. 85.4 × 109 bacteria/ml; p < 0.001).
The effects of the ketogenic diet were biphasic. In the short term of 2 weeks, both diversity and concentration decreased, but after 12 weeks, the concentration of bacteria started to increase, reaching levels observed in healthy controls by 23–24 weeks.
Conclusion
The data acquired strongly indicate a disruption in the fermentation function of the colon in MS patients. The concentration and biological diversity of numerically significant bacterial groups were initially significantly reduced in MS patients. The ketogenic diet normalized the gut microbiota in observed patients within 6 months.
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Source: Swidsinski A., Dörffel Y., Loening-Baucke V. et al. Reduced mass and diversity of the colonic microbiome in patients with multiple sclerosis and their improvement with ketogenic diet. Front Microbiol 2017 Jun 28; 8: 1141, doi: 10.3389/fmicb.2017.01141.
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