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

Area of Science:

• Neurodegenerative diseases
• Metabolic pathways
• Mitochondrial function

Background:

• Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disorder with limited treatment options.
• Bulbar-onset ALS has a particularly poor prognosis, with a median survival of 24 months.
• Neuron metabolism and mitochondrial dysfunction are implicated in ALS pathogenesis.

Observation:

• A 64-year-old male with bulbar-onset ALS implemented a time-restricted ketogenic diet (TRKD) for 18 months.
• The patient had a 21-month history of progressive disease, including pseudobulbar affect.
• This is the first documented case of ALS managed with a TRKD protocol.

Findings:

• The patient demonstrated improvements in ALS-related function (7%), respiratory function (forced expiratory volume 17%, forced vital capacity 13%), mood, and quality of life (19%).
• Fatigue significantly improved (23%), and swallowing and neurocognitive status remained stable.
• Physical function and respiratory muscle strength showed declines, but weight loss was attenuated and no adverse effects were reported.

Implications:

• The TRKD protocol may offer a potential metabolic strategy to mitigate symptoms and improve outcomes in bulbar-onset ALS.
• Further research is warranted to explore the efficacy and mechanisms of ketogenic diets in ALS management.
• This case highlights the potential of dietary interventions in neurodegenerative disease.