A small randomized study indicates that a ketogenic diet may help reduce symptom severity and fatigue in people living with myasthenia gravis (MG).
The research study, published in the Journal of Autoimmunity, followed 41 adults with generalized MG for 12 weeks. Participants were randomly assigned to either follow a ketogenic diet, which is very high in fat and very low in carbohydrates, or to continue eating as usual.
Those on the ketogenic diet showed numerical improvements across several measures of disease activity compared to the control group. The most notable change was in fatigue, with scores on a standard fatigue scale dropping meaningfully while remaining unchanged in those eating as usual.
The Quantitative Myasthenia Gravis score (QMG), a standardized test measuring muscle strength and function, also improved in the diet group while controls showed a slight worsening.
Although a positive trend was also observed in the Myasthenia Gravis Activities of Daily Living score (MG-ADL), which tracks how symptoms affect everyday tasks, these changes were more modest and less certain in direction.
The researchers also observed modest changes in immune markers, including a trend toward lower levels of serum calprotectin, a marker of inflammation, and a shift in regulatory T-cell populations, which help keep the immune system from attacking the body’s own tissues.
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The diet was generally well tolerated. Of the 20 participants assigned to the ketogenic group, five did not complete the full 12 weeks. Only one stopped due to a side effect, specifically persistent nausea, while the remaining four withdrew for reasons unrelated to the diet itself. Among those who finished the intervention, most said they would be willing to continue the diet after the study ended.
“These findings are particularly noteworthy given that, despite the availability of modern targeted therapy approaches such as C5-inhibitors and FcRn-antagonists, only approximately 34–40% of treated MG patients achieve minimal symptom expression in controlled clinical trials,” the researchers noted, highlighting the need for complementary strategies that can address remaining disease burden.
The authors also pointed to serum calprotectin, an emerging marker of inflammatory activity that has been previously studied in MG, as a promising candidate for monitoring disease activity in future dietary intervention trials.
However, the findings should be interpreted with caution. The study was small, open-label and recruited from a single center, and the ketogenic group had slightly more severe disease at baseline. The authors noted that larger, blinded multicenter trials are needed to confirm these results.
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