Musculoskeletal, Neurology

Time-restricted ketogenic diet in amyotrophic lateral sclerosis: a case study

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder that profoundly affects physical function and quality of life. While limb-onset ALS is more common, the more severe bulbar-onset form affects over 25% of patients and typically leads to a faster progression, with a median survival of 24 months from the onset of symptoms.

Research indicates that both neuron metabolism and mitochondrial function are impaired in ALS. Metabolic strategies like fasting and ketogenic diets have been shown to positively influence cellular metabolism and mitochondrial health.

A recent case report documented the case of a 64-year-old man with bulbar-onset ALS who followed a time-restricted ketogenic diet (TRKD) for 18 months. His dietary plan involved consuming two meals each day, with a macronutrient distribution of 60% fat, 30% protein, and 5% carbohydrates.

Throughout the intervention, his physical function, mood, quality of life, and biomarkers were monitored and analyzed.

Key Findings:

• ALS-related function (ALSFRS-R): Improved by 7%
• Pulmonary function: Forced expiratory volume increased by 17% and forced vital capacity increased by 13%
• Mood and stress: Depression and stress levels normalized
• Quality of life: Functional Assessment of Chronic Illness Therapy—Fatigue score improved by 19%, and patient consistently mentioned enhanced energy, improved sleep, and reductions in his chronic musculoskeletal pain.
• Neurocognitive function: Stable or improved in most tests
• Swallowing function: Remained stable overall
• Blood biomarkers: Stable glucose levels and mild ketosis (average beta-hydroxybutyrate level of 0.77 mmol/L)

Despite declines in maximal inspiratory and expiratory pressures and some physical performance tests, the patient’s overall function stabilized or improved, suggesting potential benefits of TRKD in ALS management.

Currently more than 45 months since symptom onset, the patient remains functionally independent and dedicated to his TRKD. This case report provides promising evidence for further exploration of ketogenic interventions in ALS.