b'into a six-month prospective, intention-to-treatKeep in mind that this was a relatively KD intervention. Adherence was monitoredsmall study over a short period of time. Some with daily urine ketone testing. At baseline,nutritionists have concerns about doing a fatigue, depression, and quality of life scoresketogenic diet for long periods of time because were obtained in addition to, fasting adipokinesof the heavy red meat consumption and lack and MS-related clinical outcome metrics.of fruits and vegetables. The ketogenic diet Only sixty-four of the subjects were includedshould also be avoided during pregnancy or in the full data analysis. Fat mass percentagein those with chronic kidney disease. There decreased while on the KD and fatigue effect,are also concerns about rebound weight gain fatigue severity, and depression scores werewhen a person goes off of a restrictive diet all lowered. A signicant increase in quality ofsuch as the ketogenic diet.life was noted while on the KD, and neurologicalFinally, when thinking about diet and MS, disability did not worsen. Laboratory tests andwe should remember to think of your MS as patient-reported information during the triala part of your total health picture. People with were recorded. All subjects were advised toMS tend to die from the same things most take a multivitamin and vitamin D supplementfolks do: heart disease, cancer, and stroke. I while on the KD. There was a signicant declinethink the most practical thing to do is eat a in leptin while on the KD and a change inhealthy diet (such as a Mediterranean diet or BMI. Nutrition consults and close monitoringsimilar), get into a regular exercise plan, and were provided during the study to make suremaintain a healthy body weight as much as key nutrients were not being depleted. Therepossible. was a lack of a control group for comparisonBotulinum toxins may help manage and this study notes more research is neededbladder problems to see if KDs could be a complementary therapeuticapproachwithMStreatment.Two randomized, double-blind phase 3 This research was published in the Journalworldwidestudieswhichincludedthe of Neurology, Neurosurgery, and Psychiatry.Carolinas Medical Center in Charlotte, N.C.Dr. Thrower:A frequently asked question fromenrolled patients from around the world with those living with MS is regarding diet. Whileneurogenic detrusor overactivity incontinence lots of opinions and books exist regarding theThese patients were having regularly performed topic, true studies are scarcer. This study caughtclean intermittent catheterization and were my eye for that reason. When looking at ainadequatelymanagedwithoraltherapy. Thirty percent of the patients have MS and the diet change for the person with MS, we needremaining patients have a spinal cord injury. to think about the safety and goals of the diet.Pooled results from the rst placebo-controlled I would also add that the convenience of thetreatment cycle are reported. Patients received diet is vital. Can a person stick to it? Theinjections of abobotulinumtoxinA 600 U or ketogenic diet has been around a while. Many800 U or placebo into the detrusor muscle. peoplelookatitforweightloss.ThisMSAt week six, NDOI episodes per week were study showed that people did stick with it, didsignicantly reduced in each aboBoNT-A group tolerate it, and did see some objective benets. versus placebo and the volume per void had 57 msfocusmagazine.org'