Objective:

​​​To assess the feasibility of combining Mediterranean and ketogenic dietary principles in persons with Parkinson’s disease (PwP).

Background: Dietary interventions have been proposed as adjunct self-management strategies for persons with Parkinson’s disease (PwP). While Mediterranean-style diets may alleviate PD-associated gut dysbiosis, ketogenic diets may help circumvent disease-linked deficits in brain glucose metabolism. Studies have yet to assess the potential benefits of combining Mediterranean and ketogenic dietary principles in PwP.

Method: In this ongoing crossover study (NCT05469997), participants with PD follow two 8-week dietary interventions, separated by an 8-week washout: 1) a high-fat, low-carbohydrate Mediterranean diet (MEDI-KD) and 2) a standard Mediterranean diet supplemented with medium chain triglycerides (MEDI-MCT). Participants are recruited on a rolling basis from a tertiary center in Vancouver, Canada. Interim feasibility analysis was performed based on study retention rates, weekly blood ketone monitoring and qualitative analysis of post-intervention participant interviews.

Results: 48 of a target 50 participants attended first study visits, of which 45 (94%) started the first diet to which they were randomized. Five (10%) participants withdrew, and one was lost to follow-up (2%), before completing the first intervention phase, while another three (6%) withdrew before completing the second phase. Reasons for withdrawal from the MEDI-KD phase included social limitations (1/4), gastroparesis leading to increased OFF time (1/4), socioeconomic (1/4) and time (1/4) constraints. Reasons for withdrawal from the MEDI-MCT phase included tremor exacerbation (1/4), diarrhea (1/4), time constraints (1/4) and a disabling injury (1/4). The mean blood ketone level in the MEDI-KD and MEDI-MCT phases were 0.42 (SD: 0.28; n = 22) mM and 0.27 (SD: 0.18; n = 19) mM, respectively. During interviews, positive reflections centered on professional nutritional guidance, increased dietary mindfulness and Mediterranean-style cuisine. Negative sentiments were focused on the restrictive nature and social impracticability of the ketogenic diet, as well as the gastrointestinal side effects of MCT oil.

Conclusion: While Mediterranean-style diets appear to be well-received among PwP, interim trial results suggest several barriers to their combination with ketogenic-style interventions.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/interim-analysis-of-the-feasibility-of-mediterranean-ketogenic-dietary-interventions-in-parkinsons-disease/