Case reports on utilizing a ketogenic diet to improve neuro-recovery and metabolism following spinal cord injury (SCI)
Aslam H, Renfro C, Bosarge P, Kulkani A, Cetin H, Cetin B, Kirksey K, McLain A, Yarar-Fisher C
University of Alabama at Birmingham, Birmingham, Alabama, USA
The ketogenic diet (KD) has been shown to improve outcomes in numerous neurodegenerative disorders via preventing oxidative damage; attenuating neuroinflammation and glutamate excitotoxicity; and inhibiting apoptosis in the brain and spinal cord. A KD followed by patients with sub-acute spinal cord injury (SCI) may improve post-injury hyperglycemia and neurological outcomes compared to patients who are on a standard hospital diet (SD). In addition, the KD may result in changes to the gut microbiome not seen in patients with sub-acute SCI on a SD.
We present a case series of three patients who are part of an ongoing pilot study that examines the effects of a KD versus a SD on motor and sensory function, glycemic control and gut microbial composition.
Patients were consented and American Spinal Injury Association (ASIA) Impairment Scale (AIS) exams were performed within 72 hours of hospital admission after an acute traumatic SCI. Two patients were randomized to the KD intervention group and one patient was randomized to the SD group. The duration of both diet interventions were 8 weeks.
American Spinal Injury Association (ASIA) Impairment Scale (AIS) exams were performed to assess motor and sensory function. Fasting glucose and insulin were measured to determine glycemia status. Fecal samples were collected to identify changes in gut microbial composition before, 4 and 8 weeks after interventions.
For tube feeding, the KD composition by caloric intake was approximately 72% fat, 25% protein and 3% carbohydrate. For solid feeding, the KD composition by caloric intake was 62.4% fat, 27.3% protein, and 8.3% carbohydrates. For the SD group, no intervention was initiated and the patient followed standard hospital diet protocol.
The patients in the KD group demonstrated a 12.95% increase in light touch sensation, 16.1% increase in pin prick sensation and 9% increase in motor scores. There was an 11% decrease in fasting glucose and 51% increase in fasting insulin levels in the KD group as compared to a 5% increase in fasting glucose and 61% decrease in fasting insulin levels in the SD patient (pre vs. 8 weeks). In addition, there was an 80% increase in Firmicutes to Bacteroidetes ratio (F/B ratio) and 25% increase in Lachnospiraceae families in the gut microbiota in the KD group. F/B ratio did not change and the percent of Lachnospiraceae families decreased in the SD group.
Our preliminary results suggest that the KD may decrease fasting glucose and improve sensory function in patients with sub-acute SCI. In addition, changing the diet from a SD to a KD may alter the gut microbial composition, for which the implications will need to be further studied.
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