Keto for Multiple Sclerosis in November 2025: What the Newest Evidence Means—and a Safe, Practical Plan You Can Use

What’s new and relevant (as of November 12, 2025)

What’s scientifically proven vs. preliminary—and why it matters

Proven in 2025 RCTs

Compared with standard healthy eating, a ketogenic diet did not reduce new lesions over 18 months but supported improvements in cardiometabolic health and patient‑reported outcomes (fatigue/quality of life). For many with MS—who face higher cardiometabolic risk—this is clinically meaningful, even if MRI disease activity doesn’t change. (BMC Nutrition RCT, 2025; https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-025-01156-5). ^[9]

Promising, but not definitive

ACTRIMS‑presented multi‑omics suggest keto can tilt immune cells toward a less inflammatory phenotype (↓myeloid pro‑inflammatory signaling; ↑regulatory T‑cells). This supports biological plausibility for symptom benefits but remains surrogate biology, not a hard clinical endpoint. (https://multiplesclerosisnewstoday.com/news-posts/2025/03/03/actrims-2025-ketogenic-diet-alters-immune-cell-function/; https://www.medscape.com/viewarticle/new-support-ketogenic-diet-multiple-sclerosis-2025a10005k4). ^[10]

Mechanistic rationale (ketones and inflammation)

β‑hydroxybutyrate can inhibit the NLRP3 inflammasome—reducing IL‑1β/IL‑18 signaling—offering a plausible anti‑inflammatory mechanism relevant to MS. This is shown in cells and animal models; translation to clinical MS endpoints remains to be proven. (Nature Medicine 2015 https://pubmed.ncbi.nlm.nih.gov/25686106/; Journal of Neuroinflammation 2020 https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-020-01948-5). ^[11]

Who should consider a ketogenic approach for MS?

• Those with fatigue, metabolic comorbidities (prediabetes, insulin resistance, dyslipidemia), or weight‑management needs who value symptom and metabolic improvements—even if lesions don’t fall.
• Those willing to follow a whole‑food, high‑fiber, olive‑oil–forward keto pattern (not a processed‑meat or ultra‑processed food approach), aligning with ECTRIMS 2025 signals to limit UPFs. (https://ectrims.eu/press/ultra-processed-foods-linked-to-heightened-disease-activity-in-early-multiple-sclerosis-new-study-finds/). ^[12]

A brain‑ and immune‑friendly ketogenic template for MS

A 3‑day MS‑smart keto menu (high‑fiber, olive‑oil–forward)

Common mistakes (and fixes) for people with MS on keto

• Too little fiber: aim for 15–25 g/day via non‑starchy vegetables, nuts, seeds, and small portions of low‑sugar berries—supports gut health and regularity.
• Ultra‑processed “keto” convenience foods: may undermine inflammation goals and are linked to worse MS activity; favor whole‑food choices. (ECTRIMS 2025; press summary). ^[16]
• Over‑restricting calories: keto often blunts appetite, but extreme deficits can sap energy and lean mass; anchor meals around adequate protein and strength training.
• Ignoring labs: some individuals see rises in LDL/ApoB on keto; monitor and adjust fat quality (shift toward EVOO, nuts, fish) and total saturated fat if ApoB rises.

Safety and coordination with your neurology team

• Do not alter or stop disease‑modifying therapies (DMTs); nutrition is an adjunct.
• Discuss vitamin D targets and monitoring; practices vary, but many clinicians individualize dosing to reach sufficient levels. (AAN/Neurology resources). (https://pubmed.ncbi.nlm.nih.gov/29686116/). ^[17]
• Be cautious with “all‑fat” extremes: rodent data associate very long‑term, very‑high‑fat keto with liver fat and impaired glucose handling; emphasize olive‑oil–forward patterns and periodic re‑evaluation. (University of Utah/Science Advances, Oct 2025). (https://healthcare.utah.edu/newsroom/news/2025/10/new-study-mice-reveals-long-term-metabolic-risks-of-ketogenic-diet). ^[18]

“We really can modify immune cell phenotypes with a dietary intervention.” — Michael D. Kornberg, MD, PhD, presenting multi‑omics from a ketogenic MS trial at ACTRIMS 2025. (https://www.medscape.com/viewarticle/new-support-ketogenic-diet-multiple-sclerosis-2025a10005k4). ^[19]

Practical 2‑week onboarding plan

1. Pre‑work (days −7 to 0): baseline labs (lipids including ApoB if available, liver enzymes, fasting glucose/insulin), vitamin D level, weight, fatigue score (e.g., MFIS), and discuss with your neurologist.
2. Week 1: Drop to ~40 g net carbs; emphasize EVOO, fish, eggs, poultry, non‑starchy veg, nuts; add electrolytes; walk daily; begin light resistance training.
3. Week 2: Tighten to ~20–30 g net carbs if tolerated; protein 1.2–1.6 g/kg reference weight; schedule fiber on purpose; continue strength 2–3x/week; monitor energy and fatigue.
4. Reassess at 4–8 weeks: weight, fatigue, lipids, vitamin D as indicated; adjust saturated fat downward and MUFAs/omega‑3s upward if ApoB increases.

References (selected)

• Bahr LS et al. Fasting, ketogenic, and anti‑inflammatory diets in multiple sclerosis: randomized controlled trial with 18‑month follow‑up. BMC Nutrition. 2025 Aug 20. https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-025-01156-5. ^[20]
• Multiple Sclerosis News Today (ACTRIMS 2025 multi‑omics report). https://multiplesclerosisnewstoday.com/news-posts/2025/03/03/actrims-2025-ketogenic-diet-alters-immune-cell-function/. ^[21]
• Medscape coverage of ACTRIMS 2025. https://www.medscape.com/viewarticle/new-support-ketogenic-diet-multiple-sclerosis-2025a10005k4. ^[22]
• ECTRIMS 2025 press: Ultra‑processed foods and early MS activity. https://ectrims.eu/press/ultra-processed-foods-linked-to-heightened-disease-activity-in-early-multiple-sclerosis-new-study-finds/. ^[23]
• Youm Y‑H et al. β‑hydroxybutyrate blocks NLRP3 inflammasome–mediated inflammatory disease. Nature Medicine. 2015;21:263–269. https://pubmed.ncbi.nlm.nih.gov/25686106/. ^[24]
• J Neuroinflammation 2020: BHB inhibits NLRP3 and reduces AD pathology (mechanistic support). https://jneuroinflammation.biomedcentral.com/articles/10.1186/s12974-020-01948-5. ^[25]
• University of Utah Health news on Science Advances mouse study (long‑term high‑fat keto risks). https://healthcare.utah.edu/newsroom/news/2025/10/new-study-mice-reveals-long-term-metabolic-risks-of-ketogenic-diet. ^[26]
• UCI guidance discouraging ketone supplements in sport. https://www.cyclingnews.com/news/uci-recommends-against-use-of-legal-ketone-supplements-among-professional-cyclists/. ^[27]
• AAN/Neurology resources on DMTs; vitamin D practices vary. https://pubmed.ncbi.nlm.nih.gov/29686116/. ^[28]

Actionable summary

• Use keto as an adjunct to—never a replacement for—MS disease‑modifying therapies.
• Prioritize whole‑food, olive‑oil–forward keto with ample non‑starchy vegetables, nuts, seeds, and omega‑3–rich fish; minimize ultra‑processed foods. ^[29]
• Target 20–40 g net carbs, 1.2–1.6 g/kg protein, and fats from EVOO, olives, avocado, nuts, and fish; schedule fiber and electrolytes to curb constipation and cramps.
• Track outcomes that matter (fatigue, quality of life, weight, labs) and decide with your care team whether the benefits justify continuing.
• Skip ketone supplements; they add cost and GI side effects without clear MS benefit. ^[30]

Evidence note: We prioritized sources from 2025 and highlighted what’s new. No peer‑reviewed MS keto papers were posted on November 11–12, 2025; therefore, this guide synthesizes the most recent 2025 RCT and expert‑reported findings alongside prior mechanistic work and relevant clinical guidance.