The Ketogenic Diet in the Treatment of Post-concussion Syndrome—A Feasibility Study

Abstract

Concussion is the most common form of mild traumatic brain injury (mTBI). Although most patients' symptoms resolve within a month, patients with post-concussion syndrome (PCS) may continue to experience symptoms for years and have limited treatment options. This pilot study assessed the feasibility and symptom-related effects of a ketogenic diet (KD) in patients with PCS symptoms. The Ketogenic Diet in Post-Concussion Syndrome (KD-PCS) was a single-arm trial of a 2-month KD high in non-starchy vegetables and supplemented with medium-chain triglyceride (MCT) oil. Macronutrient targets were ≥70% fat, ≤10% carbohydrate, and the remainder as protein as energy. We assessed feasibility by daily self-reported measure of urine acetoacetate and collection of 3-day food records and serum beta-hydroxybutyrate at multiple timepoints. We assessed symptoms by administering the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and Modified Balance Error Scoring System (M-BESS) at baseline and month 2 and the Post-Concussion Symptom Scale (PCSS) at baseline, month 1, and month 2. Fourteen participants enrolled in the KD-PCS. Twelve participants completed the study and 11 implemented the KD (73% fat, 9% carbohydrate, and 18% protein) and achieved ketosis. One participant complained of MCT-related diarrhea that resolved and another reported nausea and fatigue that resulted in withdrawal from the study. Among compliant participants, the visual memory domain of the ImPACT improved by 12 points (p = 0.02) and PCSS scores improved by 9 points, although not statistically significant. This pilot trial suggests that the KD is a feasible experimental treatment for PCS and justifies further study of its efficacy.

Potential for Ketotherapies as Amyloid-Regulating Treatment in Individuals at Risk for Alzheimer’s Disease

“…The recent emergence of the well-formulated KD (WFKD), which we have shown can be nutritionally dense ( Taylor et al, 2019a ; Rippee et al, 2020 ), seeks to address a common criticism that KDs lack diet quality and variety. These arguments likely stem from formative KD work in epilepsy ( Martin-McGill et al, 2018 ), where strict classical 4:1 KD ratios, a ratio of 4 g of fat consumed for every 1 g of carbohydrate and protein combined (i.e., 90% energy from fat and ≤ 2% energy from carbohydrate), leave little room for nutrient-dense foods in order to meet macronutrient goals for epileptic seizure management.…”

A mixed methods investigation into athletic trainer and dietitian's nutrition practices for sport-related concussion patients

“…50 Secondly, in another pilot study examining the ketogenic diet for post-concussion syndrome patients, authors found an improvement in visual memory, but no other concussion assessment, after two months of dietary intervention (≥70% fat, ≤10% carbohydrates, and the remaining protein). 52 For both macronutrients and micronutrients, respondents often noted that these nutrients should be provided through whole foods and not just supplements. Given the current literature findings, it is clear much more work should be done in this area to determine if macronutrient or micronutrient focus, either through foods or supplements, impacts concussion prevention or recovery.…”

Optimization of Nutrition after Brain Injury: Mechanistic and Therapeutic Considerations

“…Prospective clinical trials have been proposed for both acute spinal cord injury and TBI [ 131 , 132 ]. In a pilot feasibility study by Rippee et al, KD was feasible after mild TBI and alleviated post-concussive symptoms [ 133 ]. Currently, there are no rigorous studies of the clinical utility of KD after ischemic or hemorrhagic stroke and anoxic brain injury; however, given the proposed benefits, KD could find similar applications.…”